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Noting a significantly higher number of drug overdose deaths in Rhode Island during March 2013 compared with the monthly average the previous year (21 vs. 9), public health officials launched an investigation. Twelve decedents (10 identified in March and another 2 identified during the investigation) tested positive for acetyl fentanyl, a new synthetic opioid that is 5 times more potent than heroin. Of the 12 decedents, 10 had positive toxicology screens for other drugs of abuse. In all cases, screening toxicology testing (ELISA) was positive for fentanyl, but confirmatory testing with gas chromatography/mass spectrometry was negative. Another two acetyl fentanyl overdose fatalities were identified in the state after the investigation, brin…