Must-read: reports of acetyl fentanyl-related deaths among drug abusers may herald deadly epidemic
September 4, 2013, 7:41 pm
Acetyl Fentanyl Overdose Fatalities — Rhode Island, March-May 2013. Lozier M et al. MMWR 2013 Aug 30;62:703-704.
On June 27 of this year, the Pennsylvania Department of Drug and Alcohol Programs issued a warning noting 50 overdose deaths this year in that state along from the potent synthetic opioid fentanyl and a derivative, the previously unseen drug of abuse acetyl fentanyl, a compound that resembles heroin but is as much as five times more potent.
The current issue of Morbidity and Mortality Weekly Report documents 14 acetyl fentanyl overdose fatalities in the state of Rhode Island over the course of about two and a half months earlier this year. These deaths may be harbingers of a much more widespread problem, with the potent acetyl fentanyl contaminating or surreptitiously being substituted for fentanyl itself. The Pennsylvania warning mentions that during the last epidemic of fentanyl overdoses in 2006, 269 victims died just in Philadelphia. In Cook County Illinois during that outbreak there were 342 fentanyl-related deaths.
The MMWR report mentions that in these cases, larger than usual doses of naloxone may be needed to reverse respiratory depression. In the Cook County experience, naloxone doses of 6 -12 mg were required to reverse the respiratory effects of fentanyl.
As for laboratory analysis, acetyl fentanyl will result in a positive ELISA screen for fentanyl. However, the GC/MS confirmatory test will not detect fentanyl. In that case, the CDC recommends that further testing for fentanyl analogues be considered.
To read my Emergency Medicine News column about the 2006 outbreak of deaths from fentanyl-contaminated heroin in Philadelphia, and that city’s problems with establishing an appropriate prehospital protocol for treating victims with naloxone, click here.
[Corrections: The original post misspelled the name of the lead author of this MMWR article. It is Lozier. Also, at several points, the post incorrectly referred to “alpha fentanyl” instead of “acetyl fentanyl.”