Acetyl fentanyl (N-[1-phenethylpiperidin-4-yl]-N-phenylacetamide) is one of countless novel psychoactive substances that have emerged within the American and international drug scene within the last decade. Although some agents such as Salvia divinorum and Mitragyna speciosa are natural botanicals newly “discovered” by entrepreneurs who package and market fortified versions of the plant product as a “legal high,” the potentially most problematic novel psychoactive substances are newly introduced synthetic compounds such as acetyl fentanyl.