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U-47700, also known as “Pink”, “Pinky“, or “U4” on the streets, is a potent, synthetic opioid medication developed as a dangerous designer drug. Even small doses can be very toxic or even deadly. Over the past 5 years, reports have surfaced of multiple deaths due to street use of U-47700 or “Pink”. Importation into the U.S. is primarily from clandestine chemical labs in China.

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Fatalities due to Pink (U-47700) in the United States join the growing incidence of drug overdose deaths due to prescription opioids and synthetic designer drugs like “spice” and “bath salts.” The public using these street or Internet products can never know exactly what is in them, how much, or the degree of toxicity with use. The Drug Enforcement Agency (DEA) reported at least 46 deaths linked to use of U-47700 that occurred in 2015 and 2016. Fatalities have been reported in Arizona, New York, New Hampshire, Ohio, Texas, and Wisconsin, North Carolina, with multiple reports from state and local forensics laboratories. According to DEA, no other reports of use in the U.S. were found prior to 2015.

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Those who abuse U-47700 may be at risk of addiction and substance abuse disorder, overdose and death, similar to abuse of other narcotic substances such as heroin, prescription pain opioids, and designer opioids. This drug may be found in combination, knowingly or unknowingly, with other drugs of abuse bought on the streets such as heroin or fentanyl. It has also been confiscated as a separate product.

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In July 2016, a toxicology case report was published in the Annals of Emergency Medicine that detailed events in which fentanyl and U-47700 were being sold misleadingly as the prescription opioid pain medication Norco (acetaminophen and hydrocodone) on the streets of Northern and Central California. In one patient who presented to the emergency room, naloxone (Narcan) was administered which reversed respiratory depression and pinpoint pupils. After additional chemical analysis, it was found the “Norco” contained hydrocodone, fentanyl, and U-47700.

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