Drug Dealers’ Fake Pills Are More Deadly Than Ever

Emergency Care sign
Photo by Matthew Troke/Shutterstock.com

There is a tidal wave of counterfeit pills resembling authentic medications washing across America. Despite the best efforts of dedicated law enforcement personnel, the quantities and deadliness of these pills are steadily increasing.

On September 27, 2021, the Drug Enforcement Administration released a bulletin to the American public, warning that 9.5 million of these pills had been seized so far that year. Many authorities warn that only 10% of illicit drug supplies are seized by law enforcement, meaning that as many as 90 million pills may have been trafficked into our cities.

The report also stated that four out of ten of these pills contained a potentially fatal dose of fentanyl, a powerful illicit opioid.

In December 2022, the DEA released another report, stating that more than five times as many counterfeit pills had been seized in 2022. All told, 50.6 million pills and 10,000 pounds of powdered fentanyl were taken off the illicit market throughout the year.

Making matters even more dire, by this time, six out of ten of these pills contained enough fentanyl to kill.

Lethal dose of Fentanyl on a pencil tip
Image courtesy of DEA.gov

What Is a Fatal Dose of Fentanyl?

For a person who is not accustomed to consuming opioids, two milligrams of fentanyl is enough to kill a person. That amount of fentanyl looks like just a tiny smudge of powder on the point of a pencil.

If someone has been abusing opioids for a long time, they may be able to tolerate a much higher dose of this deadly drug.

According to the 2022 bulletin, those 50.6 million pills and 10,000 pounds of fentanyl represented more than 379 million potentially fatal overdoses.

Consider, however, that drug traffickers running these powders through pill presses to make these pills are not professional chemists. They are not skilled in creating high-quality pharmaceutical products. One pill can easily contain far more fentanyl than other pills due to its unprofessional manufacturing processes.

And so, some people die when they buy these pills on the illicit market, and some do not.

The Example of New York State

In 2022, New York State also experienced record levels of fentanyl seizures. Across the state, 1.9 million fake pills were seized. That was an increase of 152% over 2021. In New York City alone, a million pills were seized.

The DEA also seized 2,000 pounds of powdered fentanyl, enough to kill 72 million people.

The effect of these drugs being trafficked through the Empire State was more catastrophic, with more than 2,300 fatal overdoses occurring in New York City alone.

Fentanyl Across the Nation


These counterfeit pills have made their way into all 50 states, and there have been fatal overdoses in 42.

Nationally, two out of three fatal overdoses can be attributed to fentanyl or one of the chemically-similar drugs referred to as fentanyl analogs.

There are dozens of these analogs, with some types originally having had legitimate medical uses. Dozens more formulas never had a legitimate use but have only been found on the illicit market. All the fentanyl found in these counterfeit pills comes directly from illicit manufacturing.

In 2013, overseas labs began manufacturing these formulas in quantity and shipping their illicit products to the U.S. and Canada. The drugs first came in small packages shipped to people who ordered from secretive websites. Ordinary package delivery services such as UPS, DHL and postal systems were employed.

Later, these labs began shipping containers full of the precursor chemicals needed for fentanyl manufacturing to international drug trafficking organizations (DTOs) that took over production. These DTOs then used their existing transport channels to distribute finished fentanyl in powder and pill form to every U.S. state.

Closer to home, fentanyl processing labs have been found in British Columbia, Seattle and Syracuse, New York. Even today, pill press machines can be easily purchased from online suppliers. Anyone who can get their hands on powdered fentanyl, filler and coloring material can set up a pill manufacturing operation.

New Threat Levels

Deadly pill

Due to these latest developments, fentanyl manufacturing and distribution have hit entirely new and astronomical levels. The threat to anyone getting a drug on the illicit market is intense. Any pill found on the illicit market could contain a lethal dose of fentanyl.

According to the DEA, the following types of counterfeit pills containing fentanyl have been trafficked by drug dealers:

  • M30 pills, a generic form of oxycodone
  • Xanax bars
  • Adderall tablets
  • Diabetes drug metformin
  • Over-the-counter analgesic Aleve

Some counterfeit pills seized have bright, candy coloring that may appeal to young people. These colored pills, also containing fentanyl, have been found in 26 states. This type of drug has been nicknamed “rainbow fentanyl.”

Fentanyl has been found not only in counterfeit prescription drugs but also in cocaine and methamphetamine supplies.

Oddly, Europe has so far dodged most of this bullet. Of the European nations, Estonia, Germany, Sweden, the United Kingdom and Finland have had problems with fentanyl, but to a vastly smaller degree than the U.S.

Maintaining Safety

Perhaps more now than ever in history, it is an extremely dangerous time to either be addicted or to experiment with illicit or prescription drugs. Any pill or tiny bag of drugs can contain fentanyl. In the U.S., the CDC estimates that there were more than 73,000 fentanyl-related deaths in the twelve-month period ending August 2022.

We don’t have to lose these brothers, sisters, parents, children or neighbors. It is more important than ever before to educate Americans (especially young Americans) on the dangers of drug abuse and to help those who are addicted to arrive at effective drug rehabilitation centers at the first moment possible.


  • Drug Enforcement Administration. “Sharp Increase in Fake Prescription Pills Containing Fentanyl and Meth.” DEA, 2021. DEA.
  • Drug Enforcement Administration. “Drug Enforcement Administration Announces the Seizure of Over 379 million Deadly Doses of Fentanyl in 2022.” DEA, 2022. DEA.
  • ABC News. “New York state seized record amount of fentanyl in 2022.” ABC News, 2022. ABC News.
  • Safe Medicine. “All 50 States Have Reported Deadly Counterfeit Pills Made with Fentanyl.” Safe Medicine, 2019. Safe Medicine.
  • Centers for Disease Control and Prevention. “Provisional Drug Overdose Death Counts.” CDC, 2023. CDC.
  • StatNews. “‘Truly terrifying’: Chinese suppliers flood US and Canada with deadly fentanyl.” StatNews, 2016. StatNews.
  • Safe Medicines. “Fake Pills Are Ravaging Communities Across The U.S.” Safe Medicines, 2021. Safe Medicines.
  • Drug Enforcement Administration. “DEA Warns of Brightly-Colored Fentanyl Used to Target Young Americans.” DEA, 2022. DEA.
  • European Monitoring Centre for Drugs and Drug Addiction. EMCDDA, 2021. EMCDDA.


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.