Changing America

Fentanyl in pills drives spike in drug overdoses

“Fentanyl is almost like it’s becoming a totally different animal right now. We’ve heard for years that fentanyl can be in heroin, and that’s powder form, but when it’s in pill form, it totally changes the situation.”
This photo shows an arrangement of Oxycodone pills in New York on Aug. 29, 2018. (Associated Press photo/Mark Lennihan, File)

Story at a glance

  • Counterfeit pills containing fentanyl are illegally manufactured to look like legitimate prescription opioids commonly prescribed to alleviate pain or anxiety.

  • The number of pills on the illegal drug market has spiked in recent years.

  • Researchers warn the trend can lead to people unknowingly ingesting the powerful drug, resulting in accidental overdoses.

Fentanyl and other potent synthetic opioids are fueling an unprecedented spike in fatal drug overdoses nationwide, and now researchers warn the number of counterfeit prescription pills containing fentanyl is rapidly rising, creating a dangerous situation where people may unknowingly ingest the drug and put themselves at increased risk of overdose. 

Drug traffickers often mix illicit fentanyl — which can be 50 times more powerful than heroin or morphine — with other powder drugs such as cocaine, heroin and methamphetamine because it’s cheap to manufacture and a small amount can be incredibly potent. 

Counterfeit pills are also illegally manufactured to look like legitimate prescription opioids commonly prescribed to alleviate pain or anxiety, such as Oxycodone and Percocet, and are sold by street dealers or over the internet. It’s important to note there is no concern of counterfeit pills cropping up in legitimate prescription supplies.

Because fentanyl is often mixed with other drugs or made to look exactly like prescription drugs in size, shape and color, many consume the powerful synthetic opioid without intending to, which can lead to accidental overdoses. 

Now a new study funded by the National Institute on Drug Abuse (NIDA) published Thursday in the journal Drug and Alcohol Dependence set out to understand trends in the prevalence of illicit fentanyl in both powder and pill forms. 

Researchers analyzed national data on law enforcement seizures of the drug between January 2018 and December 2021 and found steep increases in both the number of fentanyl powder and pill seizures. 


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The study found the proportion of counterfeit pills to total seizures more than doubled over that time, with pills now representing more than 29 percent of illicit fentanyl seizures by the end of 2021. 

“Fentanyl is almost like it’s becoming a totally different animal right now. We’ve heard for years that fentanyl can be in heroin, and that’s powder form, but when it’s in pill form, it totally changes the situation,” Joseph Palamar, associate professor at the NYU Grossman School of Medicine and co-author of the study, told Changing America. 

“What really worries me is you get some average person who just wants Xanax that the doctor will not prescribe. They go to some dealer on the street to get what looks like Xanax and they’re dead in the morning. That’s what really scares me, is that this is spreading the fentanyl problem far beyond the situation a year or two ago.” 

The trend is alarming as fentanyl has pushed overdose deaths in the U.S. well past the 100,000 mark — an all-time high. In fact, the Centers for Disease Control and Prevention recently announced fentanyl is now the leading cause of death among adults 18 to 45 in the United States. 

According to the Drug Enforcement Agency (DEA), there’s been a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a lethal dose.   

Palamar notes poisoning can easily occur as those who unknowingly ingest fentanyl may have lower tolerances. 

Nora Volkow, director of the NIDA, says the rise of counterfeit pills expands the market beyond people who are already using hard drugs like heroin, to those who are experimenting or looking to take illegally obtained prescription medication to sleep at night or because they are anxious. 

“By going into illicitly manufactured prescription medication, you go to a potentially much younger population, including teenagers who may misuse a prescription medication and mix it with alcohol for experimentation, not necessarily because they are addicted,” Volkow told Changing America. 

“And so that could put them at extremely high risk for overdosing.” 

Researchers behind the study recommend bolstering high-quality drug surveillance data and access to fentanyl test strips, as well as widespread education about the risk associated with pills on the illegal market. 

“The big thing we really need is education. That’s something I’ve been pushing for a lot. Everybody’s asking me, ‘do we have to make more arrests?’ I’m sure we do, but education primarily among people who use drugs or people who are at risk for using drugs.” 

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