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In the past couple of weeks, there have been several major developments regarding the opioid overdose epidemic. In Ohio, the Attorney General began filing litigation against 5 major pharmaceutical companies for fraudulent and unethical marketing tactics of prescription opioids. Then, the New York Times reported that drug overdose deaths had risen nearly 20% from 2015 to 2016. Most recently, the Food and Drug Administration ordered the drug manufacturer Endo Pharmaceuticals to remove an opioid painkiller, Opana ER, from the market. All of these developments have one thing in common: overdoses related to fentanyl analogs. Most people assume fentanyl is used to cut heroin, but as of recent, more and more counterfeit pills are being developed using the same deadly additives.

What’s Happening?

Due to the increase in prescriptions for opioid painkillers over the past decade, illicit opioid drug use has risen significantly. Due to the influx of prescription addiction rates, many states began to regulate opioids. Many of those who had their prescriptions regulated or downgraded switched to either heroin or pills bought on the street. This has resulted in the largest increase in overdose deaths in recorded history.

Many of these people who have had their prescriptions restricted prefer to continue using prescription opioids bought on the street. This is because they believe that the ingredients are well documented compared to heroin. Unfortunately, as of recent, it has become very popular for dealers to mimic these pills in an attempt to gain more customers. It has become commonplace for prescription pill users to be tricked into buying substances that actually resemble street heroin, resulting in overdose.

Fentanyl analogs are synthetic opioid drugs that can be up to 10,000 times stronger than morphine. Dealers use these additives because they are cheap and increase the potency of their product. Fentanyl analogs are often manufactured in foreign countries, like Mexico and China, where they are then sold on the internet or smuggled into the United States. One of the most alarming additives is known as carfentanil. Carfentanil is typically used to tranquilize elephants.

How Are Counterfeit Pills Being Made?

Counterfeit pills can easily be manufactured by even the most amateur drug dealer. A device, called a pill press, can be bought on the internet. Similar to a stamp, dealers produce inserts for pill press machines which engrave the same numbers and letters as the legitimate medication. This process is not new. Many expensive steroids, antibiotics, and cancer medications are mimicked on the black market using the same technique.

This technique lead many heroin dealers to try this method out for themselves. People began producing counterfeit pills such as OxyContin, Opana, Vicodin, Percocet, and Dilaudid among many other opioids. Dealers create a concoction of fentanyl, fillers, and food coloring to best resemble the drug they are trying to fake. Many of these counterfeit pills cannot even be recognized by untrained eyes.

The Drug Enforcement Agency states on their website that “Traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier, transform it into hundreds of thousands of pills, and sell the counterfeit pills for millions of dollars in profit. If a particular batch has 1.5 milligrams of fentanyl per pill, approximately 666,666 counterfeit pills can be manufactured from 1 kilogram of pure fentanyl.”

The DEA also noted that, in 2016, they seized 500 counterfeit pills in Loraine, Ohio. These pills resembled oxycodone, also known by the brand name OxyContin. The pills were blue and were imprinted with “A 215,” consistent with 30-milligram oxycodone pills. These counterfeit pills did not contain oxycodone or any other controlled substance, but rather a mysterious synthetic opioid believed to be related to fentanyl analogs. The specific chemical, labeled U-47700, is known to have caused 17 overdoses and several deaths in the United States.

Though U-47700 has only caused a few deaths, this should not represent the problem with counterfeit pills in the United States. This is simply one example. U-47700 is only one of hundreds, or possibly thousands, of research chemicals used to mimic prescription opioid painkillers. Foreign labs continue to develop new chemicals which can produce the same effects of nearly any drug.

Staying Safe

To reduce risk, do not buy pills from people you do not know. Ideally, it would be wise to not use pills that were not received from a pharmacy. Understandably, this is not always possible. The best way to prevent using fake prescription drugs, other than abstinence, is to purchase the drugs from someone who you know has a valid prescription. “Cold-copping” (purchasing drugs in an open street market) is very dangerous these days. If you absolutely must buy pills or heroin from a stranger, always take “test hits” to ensure the drug is not too potent. Remember, some of these drugs are thousands of times more potent than heroin and other prescription opioids; a small fraction of the pill may produce more powerful effects than you are used to.