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.

[8][9][10] Acetylfentanyl has been analytically confirmed in 32 fatalities in four European member states between 2013 and August 2015, Germany (2), Poland (1), Sweden (27), and the United Kingdom (2).

[3][11] The Centers for Disease Control and Prevention (CDC) issued a health alert to report that between March 2013 and May 2013, 14 overdose deaths related to injected acetylfentanyl had occurred among intravenous drug users (ages between 19 and 57 years) in Rhode Island.

[14] One fatal poisoning caused by intravenous injection of a "bath salt" product containing acetylfentanyl mixed with 4'-Methoxy-α-pyrrolidinopentiophenone (a substituted cathinone) has been reported in 2016.

[5] Acetylfentanyl may be quantitated in blood, plasma, or urine by liquid chromatography-mass spectrometry to confirm a diagnosis of poisoning in hospitalized patients or to provide evidence in a medicolegal death investigation.