Deadly Counterfeit Pills Continue to Escalate Deaths

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If you need prescription medications of any type, there is only one safe way to obtain them: get a prescription from a licensed medical doctor and pick up your pills from a legitimate pharmacy. Any other method such as buying them on the internet, getting them from a friend or obtaining them across the border in a foreign country could be fatal.

This is the new era of counterfeit prescription drugs. The threat posed by counterfeit pills is more severe than it has ever been. In September 2021, the Drug Enforcement Administration reported that it had seized more than 9.5 million pills so far in the year. That’s more fake pills seized than the prior two years combined. Also important to note is the fact that two out of every five fake pills seized that contained any fentanyl had a potentially lethal dose of the drug.

What’s In These Pills?

Far too often, they contain fentanyl, a type of powerful synthetic opioid. Fentanyl is actually a family of dozens of closely related drugs. The image below provides a graphic look at the relative danger of heroin, fentanyl and carfentanil. At one time, fentanyl and carfentanil were only manufactured and distributed in very controlled circumstances by pharmaceutical companies. Now, illicit forms of these and many others from the fentanyl family are present in every U.S. state.

Comparative strengths of Opioid Painkillers

Several forms of fentanyl have medical uses. Many other drugs from this family were just created in an effort to circumvent the law. As some types of fentanyl were outlawed in the U.S. or overseas, chemists simply developed new forms of the drug that could still legally be manufactured and trafficked.

The members of this fentanyl family are all fully synthetic drugs, requiring no plant products in their manufacture. This makes them cheaper and less susceptible to fluctuations in climate or rainfall than drugs like heroin or marijuana.

While fentanyl is the most common illicit drug found in these pills, some others, such as counterfeit Adderall, contain only methamphetamine which is an illicit stimulant similar to Adderall. As it is manufactured on the illicit market, it can be also produced much more cheaply than a pharmaceutical product. But the illicit form of Adderall could be fatally potent. As well, some counterfeit Adderall has been found to contain fentanyl.

Some youth who think that taking the prescription stimulant Adderall will help them succeed in their study may turn to the illicit market to obtain these pills, thus putting themselves at terrible risk.

This image shows real pills compared to counterfeit pills. The first image shows real OxyContin above counterfeit OxyContin pills that contained fentanyl. The second image shows real Adderall pills above fake pills that contained methamphetamine. The last image shows two Xanax bars. The white one is the real one while the yellow bar contained fentanyl.

Counterfeit pills
Image courtesy of the DEA.

The quantity of these counterfeit pills seized by the DEA has rocketed up 430% since 2019. This means that drug traffickers see the huge potential of this market and are exploiting it. There is no reason to think that this activity will stop any time soon.

Types of Pills Seized on the Illicit Market

Counterfeit pills containing fentanyl found on the illicit market include:

  • OxyContin
  • Oxycodone
  • Vicodin
  • Percocet
  • Norco
  • Xanax
  • Anti-anxiety medications
  • Metformin (medication for diabetics)
  • Aleve (over-the-counter pain reliever)
  • Aspirin
  • Adderall

The illicit drug ecstasy, also known as Molly and often distributed in pill form, has also been found to contain fentanyl.

Why Are Counterfeit Pills Appearing in Quantity Now?

There are higher availabilities of precursor chemicals and finished drugs than ever before. Foreign chemical manufacturers, primarily in China with more in India, have discovered this profitable product and the Chinese government has been very slow to enforce bans on the illicit forms of these drugs.

China not only manufactures fentanyl, it has also been providing the required precursor chemicals for fentanyl manufacture to drug cartels in Mexico. The chemicals arrive by the container load and the cartels then convert them into finished drugs. The finished drugs are then pressed into counterfeit pills and moved into the United States on established trafficking channels.

American drug dealers also obtain pill presses and drugs from overseas vendors. They process these drugs into pills that look like ones you get from a pharmacy. Small pill presses are available for the drug dealer who’s only dealing to his local area. There is even a YouTube video on the best way to get a result with these small presses. This is a land of opportunity for a person who doesn’t care if he harms or even kills others with their products.

For example, in June 2021 in Salem, Massachusetts, four people were arrested for manufacturing and trafficking counterfeit pills containing fentanyl. They had acquired multiple pill presses, one of which was capable of making 15,000 pills an hour. Their products were sold as Percocet, an opioid painkiller.

In May 2021, a married couple in Bessemer, Alabama was sentenced for possessing multiple pill presses along with drugs and other components needed to make counterfeit pills. They were using acetaminophen, fentanyl, heroin, and papaverine (a muscle relaxant) to make their products. They then sold these counterfeit prescription drugs in their local area or traded them for drugs they wanted.

A report from notes that the number of pill press seizures increased 19-fold between 2011 and 2017. That gives you an idea of how this industry has grown and the increase in danger to Americans.

Where Are These Drugs Being Found?

Counterfeit pills have now been found in all 50 states, 42 of which have reported overdose deaths from these pills. As illustrated in the maps below, in 2016 when pills began showing up in greater volume, they were only found in 25 states, all but eight of which also reported overdose deaths related to these pills. This expansion gives you an idea of the growth of this threat.

You can see the progression of distribution of these counterfeit pills in this series of maps.

counterfeit pill maps
Image courtesy of

The Incredible Power of Fentanyl

Fentanyl is so powerful that a quantity of the drug equal to a couple of grains of salt can be lethal. Compare that potency to the strength of heroin, as shown here. It’s easy enough to overdose on heroin. It is far more difficult to prevent an overdose of fentanyl.

Fentanyl Carfentanil Heroin Lethal Dose
Image courtesy of the DEA.

Imagine the difficulty a local drug dealer or a cartel member in another country would have ensuring that a tiny quantity of fentanyl is evenly mixed through a batch of heroin, cocaine or methamphetamine. Or maybe the drug dealer is going to mix fentanyl with a pound or two of filler material. When this pound of powder is pressed into pills, will some of them be more potent than others? Buying what seems to be prescription drugs from the illicit market is truly a modern-day form of Russian Roulette.

Any person claiming to have OxyContin, Xanax or any other prescription drug could have gotten his supplies from a person with a prescription or they could have come from a Mexican drug cartel. Each person consuming these drugs is truly taking their life in their hands. Of important note is the fact that young people are at especially high risk as they are more likely to look for pills than a drug they need to inject.

In fact, no one is safe from these counterfeits. In 2019, Los Angeles Angels pitcher Tyler Skaggs died as a result of taking a counterfeit pill he thought contained oxycodone. Instead, it had been laced with fentanyl. Skaggs asked one of the Angels staff to bring pills to his hotel room in Texas where he was staying before a four-game series against the Texas Rangers. The pills he was brought were counterfeit and that led to his death.

The dangers emanating from the trafficking of these counterfeit pills show no signs of weakening or ending soon. Helping a loved one achieve freedom from addiction may be the only way to keep them safe.


Reviewed by Claire Pinelli: ICAADC, CCS, LADC, RAS, MCAP, LCDC


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.