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These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.
There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.
These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.
Acetylfentanyl is considered extremely addictive with a high potential for abuse and is capable of causing psychological dependence. Compulsive redosing is commonly reported, particularly due to the short duration of effects.
Chronic use leads to extreme physical dependence. Cravings and withdrawal symptoms occur upon sudden cessation. Animal studies have demonstrated that acetylfentanyl can completely suppress morphine withdrawal symptoms, confirming significant cross-dependence liability with other opioids.
Acetylfentanyl has caused hundreds of documented fatalities worldwide, including at least 52 confirmed deaths in the United States between 2013-2015, 32 in Europe, and 12 in Russia. Postmortem blood concentrations in fatal cases have ranged from 0.089 to 0.945 μg/mL. The drug exhibits a worse safety ratio than morphine, meaning the dangerous overdose level is closer to the psychoactive level. Due to extreme potency, the substance can potentially be absorbed through skin contact in amounts sufficient to cause fatal overdose. Larger than normal doses of naloxone may be required to reverse overdose.
| Species | Route | Value |
|---|---|---|
| mouse | oral | 9.3 mg/kg |
Animal toxicity studies observed significant bleeding in the small intestines of mice administered acetylfentanyl; the relevance of this finding to human use at typical doses remains unclear.
Respiratory depression occurs at doses proportionally closer to the psychoactive range than with many other opioids; this effect can rapidly progress to fatal anoxia, with pulmonary edema documented in overdose fatalities.
Acetylfentanyl was first described in patents from Research Laboratorium Dr. C. Janssen (Janssen Pharmaceutica), a Belgian pharmaceutical company. Its analgesic activity was characterized in a 1968 patent by Paul Janssen, the company's founder. The compound was discovered contemporaneously with…
UN Single Convention on Narcotic Drugs 1961 (Schedule I and Schedule IV, added 2016)
Listed in Annex 1 of the Narcotic Substances Regulation under the Suchtmittelgesetz (Narcotics Act).
Controlled since October 1, 2015. Illegal to sell, buy, import, export, and manufacture.
Added to national drug control legislation on June 8, 2015.
Controlled under Anlage II of the Betäubungsmittelgesetz (Narcotics Act) since June 20, 2017. Manufacturing, possession, import, export, purchase, sale, procurement, and dispensing without a license is prohibited.
Listed as a controlled substance under Japanese drug control legislation.
Placed under control pursuant to Republic of Lithuania Minister of Health Order No V-1062 (September 21, 2015), amending the narcotic and psychotropic substances lists.
Controlled under the definition of 'substitute drug' per the Act of October 8, 2010 amending the Act on counteracting drug addiction. Article 44b prohibits manufacturing or introducing substitute drugs to trade.
Regulated as a controlled substance since August 2015.
Prohibited since February 2016 under Turkish drug control legislation.
Temporarily placed in Schedule I on July 17, 2015 via Federal Register notice and subsequently permanently scheduled. Classified as having high abuse potential with no accepted medical use. Federal prosecutions for distribution have resulted in multi-year prison sentences.
Controlled as an analog of fentanyl under the Controlled Drugs and Substances Act. Manufacturing, possession, and distribution are prohibited.
Controlled since 2013 via Regulatory Administrative Act 162/13 within updates to law L29/77. Falls under a generic clause addressing all fentanyl chemical groups.
Controlled as a narcotic substance under Annex 4 of drug control legislation since September 28, 2015.
Controlled under Schedule I of the Misuse of Drugs Regulation 1988 (S.I. 328 of 1988).
Included in the first list of Cabinet Regulation N 847, which governs narcotic substances, psychotropic substances, and precursors controlled in Latvia.
Regulated under the Medicines Act (Legemiddelloven).
Classified as a Schedule I controlled substance. Possession, production, and distribution are prohibited.
Specifically named as a controlled substance under Verzeichnis D of Swiss narcotics legislation.
Made a Class A controlled substance in 1986 as an analogue of fentanyl under the Misuse of Drugs Act 1971 (Modification) Order 1986. Class A substances carry the most severe penalties under UK law.
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