Acetylfentanyl HCL (acetyl fentanyl) is an opioid analgesic drug that is an analog of fentanyl. Studies have estimated Acetylfentanyl HCL to be fifteen times more potent than morphine. It has never been licensed for medical use and instead only been sold as a designer drug. Acetylfentanyl HCL was discovered at the same time as fentanyl itself and had only rarely been encountered on the illicit market in the late 1980s. . As a μ-opioid receptor agonist, Acetylfentanyl HCL may serve as a direct substitute for heroin or other opioids. Side effects of fentanyl analogs are similar to those of fentanyl itself, which include itching, nausea and potentially serious respiratory depression, which can be life-threatening. Fentanyl analogs have killed hundreds of people throughout Europe and the former Soviet republics since the most recent resurgence in use began in Estonia in the early 2000s, and novel derivatives continue to appear.
Acetyl fentanyl is a relative of a powerful prescription painkiller called fentanyl and is five times more potent than heroin as a painkiller, according to the Centers for Disease Control and Prevention. The illegally produced compound may be secretly mixed with heroin to make it a more potent product, or may be sold in pills disguised as oxycodone.
“What’s frightening about this emerging street drug is that users themselves may not be aware that they are ingesting it,” drug researcher John Stogner, of the department of criminal justice and criminology at the University of North Carolina at Charlotte, said in a statement.
Clusters of deaths related to acetyl-fentanyl overdoses have occurred in several states, including Rhode Island and Pennsylvania.
Such overdose outbreaks will likely continue to happen, Stogner wrote in a report about the trend published Sunday (Aug. 17) in the journal Annals of Emergency Medicine.
“The number of potentially problematic compounds is countless,” but with experience in criminology, “it is possible to forecast which drugs are likely to become an issue, Stogner said. “Acetyl fentanyl, a slight variant of fentanyl, is one such drug.” [Krokodil, Molly and More: 5 Wretched New Street Drugs]
Drug users who overdose on the spiked heroin or pure acetyl fentanyl marketed as heroin appear as if they have overdosed on heroin — they look lethargic and disoriented, and have shallow breathing, a slow heart rate and low blood pressure, he said. But if an overdose victim doesn’t respond to the standard treatment for opioid overdose, which is a medicine called naloxone, doctors should consider that acetyl fentanyl might be the culprit.
A larger dose of naloxone may save the patient, Stogner said.
Doctors should also test for acetyl fentanyl and report the cases they see, because such overdoses tend to occur in clusters after a number of people consume mixed batches of acetyl fentanyl and heroin, Stogner said.
Legally, acetyl fentanyl is in a gray area. It is considered illicit for human consumption, but it is not regulated if it’s labeled as “not for human consumption.” This presents legal loopholes that drug distributors use to make a profit by mixing a highly regulated drug, such as heroin, with a less-regulated one, such as acetyl fentanyl, Stogner said.