A “nationwide surge” in the availability of bogus prescription pills containing fentanyl is “killing unsuspecting Americans at an unprecedented rate,” the Drug Enforcement Administration (DEA) warned Monday in an urgent bulletin.
“More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined,” states the Public Safety Alert, the agency’s first in six years. “DEA laboratory testing reveals a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a lethal dose.”
The number of fentanyl-laced counterfeit pills seized by the DEA has soared nearly 430 percent since 2019, the agency says—claiming that two out of every five of those pills contained a potentially lethal dose, according to the DEA lab. The barrier to entry for dealers is low. Pill-pressing machines can be purchased online for a few hundred dollars. A die to stamp each tablet with the Xanax logo runs $155.
Counterfeit pills are made to look like the real thing, and are often almost impossible for an average person to tell apart. Some of the most commonly faked drugs include opioids such as Oxycontin, Percocet, Vicodin, and Xanax, as well as stimulants used to treat ADHD like Adderall, counterfeit versions of which can contain pure meth. More than 93,000 people died in the United States of a drug overdose last year, according to the Centers for Disease Control and Prevention. And fentanyl, says the DEA alert, is “the primary driver of this alarming increase in overdose deaths.” Earlier this month, actor Michael K. Williams died after using heroin and cocaine he didn’t know had been laced with fentanyl, the New York City medical examiner’s office announced last week.
A review of court filings from across the nation offers a glimpse at just how pervasive the problem of fentanyl-spiked pills has become. (And no, you can’t overdose on fentanyl just by touching it.)
In Ohio, a local man allegedly pressed phony Xanax pills using fentanyl on a machine in his home. The product, which reportedly looked identical to the real thing, was responsible for numerous overdose deaths in the area, according to prosecutors.
In Tennessee, the DEA identified a drug trafficker selling tablets that looked “nearly identical to Percocet pills” but were in fact “a mixture of alprazolam, acetaminophen, and fentanyl.” At least one user died after taking what they thought were 10 mg Percocets, and at least seven others were hospitalized.
In South Florida, a husband found his wife dead of an overdose after she took what looked like legitimate oxycodone—Percocet—but was actually a counterfeit containing a fentanyl analog.
“This alert does not apply to legitimate pharmaceutical medications prescribed by medical professionals and dispensed by licensed pharmacists,” states Monday’s DEA bulletin. “The legitimate prescription supply chain is not impacted. Anyone filling a prescription at a licensed pharmacy can be confident that the medications they receive are safe when taken as directed by a medical professional.”
Drug traffickers know their market backwards and forwards, according to the DEA’s 2020 National Drug Threat Assessment. Mexican traffickers “have consistently chosen to counterfeit a brand of licit 30 mg oxycodone pills that have been regularly diverted for years to the street market for opioids,” the report states, explaining that dealers “are taking advantage of an established market for these pills to increase the profit margins with fentanyl.”
But being able to fill prescriptions at a pharmacy—or, more accurately, not being able to fill them—is inextricably linked to the issue at hand, according to Tracey Helton, a recovering opioid user who now works as a harm reduction counselor in Chicago.
With supply intentionally constricted by authorities trying to make a dent in the addiction problem without an associated decrease in consumer demand, the market for fakes was ready and waiting to be exploited.
“Cartels have figured out that you can buy fentanyl very, very cheap, and make pills using a press and sell them as Percocets,” Helton told The Daily Beast. “People fighting cancer can’t get pain prescriptions. They swung so far back in the other direction, a narrow opening for making money has turned into a cavern.”
Fentanyl-laced drugs are a relatively recent development, and their distribution has ramped up to unprecedented levels thanks in part to the dark web, said Adam Scott Wandt, an assistant professor of public policy at New York City’s John Jay College of Criminal Justice.
Wandt, who received a grant from the Department of Justice to study the effects of the dark web on underground drug markets, said U.S. law enforcement is essentially treading water in dealing with the fentanyl crisis.
“There’s no doubt in my mind that the DEA and Customs and Border Protection and other law enforcement agencies are perfecting their game in trying to seize fentanyl when it gets shipped into the U.S.,” Wandt told The Daily Beast. “It’s not like law enforcement is sitting on their hands, but as the government gets better [at their job], so do drug dealers.”
To Wandt, making any headway on the issue requires a two-pronged response. That is, as the largely failed “war on drugs” has shown, the U.S. is not going to arrest its way out of the country’s insatiable demand for mind-altering substances.
To be sure, authorities need to get a better handle on tracking the precursor chemicals that are used to manufacture illicit fentanyl, said Wandt. Police also need to crack down on dark web markets, and try to disrupt the retail supply chain, he explained.
“But that’s not going to do it alone,” said Wandt, who noted the importance of viewing the fentanyl problem as a public health issue and making things like beds in rehab centers available for those who need them.
“We did it to ourselves,” said Wandt. “We accidentally started a second wave opioid crisis in this country that was worse than the first wave that we had. And there’s no doubt in my mind that there are a huge number of people that did not mean to become opioid-addicted, that went to their doctors looking for legitimate help, and then spiraled out of control from there. Purdue Pharma and other companies were telling doctors that [Oxycontin] wasn’t too addictive, that it was safe to use. And it’s caused us catastrophic results.”
Helton equates the rise of counterfeit pills containing fentanyl with the days of Prohibition, when people couldn’t get liquor and made bathtub gin from ingredients that routinely poisoned them.
With fentanyl entering the recreational drug supply in such numbers, all drug users today need to think like heroin users, said Helton. Normally, someone using, say, Xanax, wouldn’t think about having a supply of Narcan on hand when they take a pill. Or having someone around to administer the shot if they begin to OD. Not anymore.
“I started doing overdose prevention in 1999, and we were telling people to use with a friend,” Helton said. “Now we’re back to the same thing. It’s not like when people find out their cocaine has fentanyl in it, they're going to stop using. But how do you use it more safely? What if one of [my teenager’s] friends takes a fake Xanax bar? Because it's happening. We’re not trying to scare anyone. We’re trying to get them to be prepared in a way that they have never been prepared before.”