JEFFERSON COUNTY, N.Y. -- It's not a new drug, but it is new to the North Country.
Acetyl fentanyl isn't the fentanyl you may know as a necessary pain medication. It's a manufactured synthetic that is some five times more powerful than heroin.
"Yeah, we're very concerned about it," said Jefferson County Public Health Planner Steve Jennings. "These are the types of things you hope never present in your community, but it's here."
You never hope because it's that deadly. It killed one person in December and now four more in early 2017. It's typically cut or laced into heroin, and sometimes people don't even know they're taking it.
"Whatever you buy in a baggie on the street, you will not have any idea what the dosage is. You have no idea how strong it is," said PIVOT Project Director Anita Seefried-Brown.
It has people and agencies like PIVOT, there to help those with substance abuse addictions, terrified.
"It is a drug with which one plays Russian Roulette. It may kill you the first use, and it may not. But it could kill you the second time," Seefried-Brown said.
For an area already so low on resources -- the nearest detox beds are more than an hour away at Canton-Potsdam -- the waiting list is growing. At two to three weeks, she says, it could be too late.
"What is the implicit message when we tell people, 'Well, the waiting list is two and a half to three weeks'? What is the message? The message can really only be continue to use, just try not to kill yourself," Seefried-Brown said.
If a person who wants help could quit, Seefried-Brown says, they would, adding the time for lawmakers and communities to fight back was "yesterday."
Seefried-Brown also says physicians around the country bear some of the burden. She's pushing for more education and training on warning signs and prescription dosages.