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We report deaths between 2016 and 2017 at the Medical Examiner's Office in Detroit, <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content> where acetyl fentanyl was found in the decedent's blood and compare them to previously published deaths between 2015 and 2016. The recent cases (cohort B) had a mean acetyl fentanyl concentration of 0.9 ng\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> (range: 0.1\u20135.3 ng\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>) and an associated higher concentration of fentanyl along with multiple other drugs present. The older cases (cohort A) had higher concentrations of acetyl fentanyl (mean: 8.9 ng\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>; range: 0.28\u201337 ng\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>) with lower, yet still toxic, concentrations of fentanyl. We conclude that the cause of death in these recent cases was likely multiple drug toxicity with fentanyl and that the consistently observed lower peripheral blood concentrations of acetyl fentanyl are most likely an artifact in the manufacture of the consumed illicit fentanyl.<\/jats:p>","DOI":"10.1111\/1556-4029.13840","type":"journal-article","created":{"date-parts":[[2018,6,25]],"date-time":"2018-06-25T22:49:25Z","timestamp":1529966965000},"page":"149-153","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Acetyl Fentanyl: Trends and Concentrations in Metro Detroit"],"prefix":"10.1111","volume":"64","author":[{"given":"Sarah","family":"Avedschmidt","sequence":"first","affiliation":[{"name":"Michigan Medicine Department of Pathology\/Wayne County Medical Examiner's Office 1300 E Warren Ave Detroit MI 48207"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Michigan Medicine Department of Pathology\/Wayne County Medical Examiner's Office 1300 E Warren Ave Detroit MI 48207"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Isenschmid","sequence":"additional","affiliation":[{"name":"National Medical Services 3701 Welsh Road Willow Grove PA 19090"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kilak","family":"Kesha","sequence":"additional","affiliation":[{"name":"Department of Forensic Pathology Auckland City Hospital PO Box 110031 Auckland New Zealand 1148"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Moons","sequence":"additional","affiliation":[{"name":"Michigan Medicine Department of Pathology\/Wayne County Medical Examiner's Office 1300 E Warren Ave Detroit MI 48207"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avneesh","family":"Gupta","sequence":"additional","affiliation":[{"name":"Michigan Medicine Department of Pathology\/Wayne County Medical Examiner's Office 1300 E Warren Ave Detroit MI 48207"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,25]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Acetylfentanyl (N\u2010(1\u2010phenethylpiperidin\u20104\u2010yl)\u2010N\u2010phenylacetamide). 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