In the 21st century, overdose deaths are five times higher–with over 100,000 overdose deaths in
the 12 months ending May 2021. Fentanyl, the synthetic opioid most commonly found in
counterfeit pills, is the primary driver of this alarming increase in overdose deaths.
60% of pills seized by the DEA and tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose.
There were 14 times as many deaths related to illicit fentanyl among teens ages 14-17 in 2020, compared to 2015. And the numbers continue to grow.
59% of teens and young adults (ages 13-24) haven’t heard of fentanyl in counterfeit pills.
Comparison between 12 months-ending January 31, 2020 and the 12 months-ending January 31, 2021
Overdose deaths involving opioids rose 38.1 percent.
Overdose deaths involving synthetic opioids (primarily illicitly manufactured fentanyl) rose 55.6 percent and appear to be the primary driver of the increase in total drug overdose deaths.
What is Fentanyl?
Well, let’s start with the question, what is an opioid?
Opioids are a class of drugs naturally found in the opium poppy plant. Opioids are made from the plant directly, whereas synthetic opioids, like fentanyl, are made by scientists in labs using the same chemical structure but synthetic ingredients that DO NOT come from a plant. Because these ingredients are man-made, they are also unlimited and therefore much less expensive than the opium plant.
Fentanyl is a potent synthetic opioid.
- POTENT: Up to 50x stronger than heroin and 100x stronger than morphine. A few grains of sand worth can be lethal.
- SYNTHETIC: Not plant based. Made in a lab.
- OPIOID: Pain reliever like oxycodone, morphine and heroin.
What is the Difference Between Pharmaceutical-Grade Fentanyl and Illicit Fentanyl?
Pharmaceutical-grade fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It is a Schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®. When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on a person’s skin, or as lozenges that are sucked like cough drops.
Illicit fentanyl, most often associated with recent overdoses, is made in labs or garages. This synthetic fentanyl is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.
Some drug dealers are mixing illicit fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. This is because it takes very little to produce a high with fentanyl, making it a cheaper option. Because there is no official oversight or quality control, these
counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug. Drug users have no way of knowing what they are getting in illegally purchased drugs, and as little as two milligrams of fentanyl (two grains of sand) can kill a person.
Illegally Made Fentanyl
Made in a sterile factory
Made in unsanitary conditions
Dose is precise and consistent
Dose is random and variable
Carefully administered by doctors
Hidden is the drug supply
Legitimate medical uses
Increase drug dealer profits
Death is uncommon when taken as prescribed by a doctor
Involved in the majority of U.S. drug deaths in recent years
What is a Fentapill?
A fentapill is a counterfeit prescription pill purposely made to resemble legitimate medicines, but instead is made of illicit fentanyl or an illicit fentanyl analog.
Counterfeit pills are illegally manufactured by criminal drug networks and are made to look like real prescription opioid medications such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®). Fake prescription pills are widely accessible and often sold on social media and e-commerce platforms–making them available to anyone with a smartphone, including minors.
Any prescription pill you don’t get directly from a pharmacy, or any powder form drugs purchased from a friend/drug dealer, may contain a lethal dose of fentanyl. Real prescription drugs are not available on Instagram or Snapchat.
The drug overdose crisis in the United States is a serious public safety threat with rates currently reaching the highest level in history. Drug traffickers are using fake pills (“fentapills”) to exploit the opioid crisis and prescription drug misuse in the United States, bringing overdose deaths and violence to American communities.
What Makes Illicit Fentanyl So Dangerous?
In addition to being extremely potent, fentanyl has a very small therapeutic index. This means that the amount of fentanyl it takes to have an effect is almost the same as the amount it takes to kill a person. That is why fentanyl is so carefully dosed and closely monitored in medical settings.
Illicit fentanyl also has a small therapeutic index, but it is manufactured without the necessary quality controls, so the potency of any given batch is an unknown variable. Combine this with improper blending when it is cut into powders and then pressed into pills, and you have a literal recipe for disaster: street drugs made with a potent, sensitive raw material that is unevenly distributed within the end product.
What Is a Lethal Dose of Fentanyl?
In toxicology, the lethal dose for a substance is referred to as the LD50, or median lethal dose, which is the amount that is needed to kill 50% of a sample group. Toxicologists point out that it is impossible to determine a precise LD50 for opioids because tolerance builds in lab subjects as the dose is increased. In other words, the lethal dose for any opioid is a moving target, technically speaking.
The DEA says that 2 milligrams (mg) of dry powder fentanyl is a “potentially lethal dose.” This general statement makes the point that a small amount can be deadly. In fact, the actual amount of fentanyl that will cause death varies depending on the person’s weight, whether they have used opioids before, their metabolism, their general health, and more. The amount of fentanyl that will kill a 110-lb person who has never ingested opioids will be different than the amount that will kill a 220-pound opioid dependent user. Therefore, a “lethal dose” may not cause death to everyone who consumes it. Conversely, a person could die from an amount of fentanyl that is less than the “lethal dose” of 2mg.
DEA lab analyses reveal that three out of every five fake pills with fentanyl contain a potentially lethal dose.
What Is a “Pressed Pill”?
A pressed pill, as the name implies, is a tablet made using a pill press machine. Pill presses can be found online and are cheap and easy to purchase. Drug traffickers use molds (or dies) with common brand marks to press pills that look exactly like pharmaceutical prescription pills (we call these fentapills). They start by mixing filler powders and dyes with illicit fentanyl powder. This dry mixture is then run through the pill press – compacted into tablets and stamped with commercial markings in a single step.
Black-market pill pressing operations lack sufficient quality controls, so the dosage varies from pill to pill and from batch to batch. As a result, the potency of any given street pill is impossible to know. This, combined with the fact that they look like safe commercial medications, is what makes fentapills so dangerous.
Are People Really Dying from Taking Just One Pill?
Yes. In fact, there are documented cases of people dying after ingesting just one half of a fentapill.
I Have Heard That There is a Way to Test a Pill for Fentanyl Before Taking It. Is That True?
As fentanyl deaths continue to rise, there is momentum behind promoting Fentanyl Test Strips (FTS) as part of a harm reduction strategy. The most widely distributed FTS is the Rapid Response Fentanyl Test Strip manufactured by BTNX. These FTS are designed to detect several common fentanyl analogs in urine; they were not designed to test pills.
The Harm Reduction community has adopted “off label” uses for the BTNX FTS and actively promotes their use (with significant disclaimers) for testing heroin, cocaine, meth and MDMA. There is strong evidence that FTS detect fentanyl in liquid samples with a high degree of accuracy. However, there are limitations specific to testing fentapills that reduce their usefulness.
Because of these limitations, FTS do not guarantee safe use of illicit pills.
- Because of the chocolate chip effect*, you cannot test a portion of a pill and be sure that the rest of the tablet or batch is free of fentanyl. You must dissolve everything that is to be consumed prior to testing.
- Because of uneven mixing, a common problem in illicit pills, you cannot test one pill from a batch and assume that the other pills in the same batch do not contain fentanyl.
- FTS detect the presence of several fentanyl analogs, but do not measure the amount or the potency.
- FTS do not detect all fentanyl analogs.
- Improper dilution can result in a false negative result.
- We do not know if FTS can or will detect the other synthetic opioids that drug traffickers are already using to make fake pills, like nitazenes.
*Because the fentanyl is never evenly distributed throughout the base powder mixture, part of the pill might have no fentanyl while the other part has a lot. Once the pill is pressed, the components are locked in place. This is called the chocolate chip effect.
My Dealer Says Her Pill Tested Negative for Fentanyl, So They Are Safe. Is That True?
No. There is no such thing as a street pill that has been tested, since that would require dissolving, testing, drying and repressing the pills. Sadly, there are dealers making this false claim in order to reassure their customers. Do not believe them.
If you buy pills online or on the street, you cannot know what they contain, no matter what anyone tells you. There currently is no test that will guarantee that a pressed pill does not have fentanyl in it, or even that it has a ‘safe’ amount of fentanyl in it. The only way to ensure that you are getting a safe pill is to get it directly from a pharmacist in a bottle with your name on it.
Fentanyl test strips (FTSs) are regularly promoted by the harm reduction community as a way to reduce the number of overdoses. Fentanyl test strips do not test for all fentanyl analogs, were not created to test pills (they were created to test urine), and their accuracy with pills has not been established; therefore, the use of FTS does not guarantee the safety of pills. We discourage the consumption of ANY illicit pill. Any time a person consumes an illicit pill in the age of fentanyl, they risk dying.
That being said, those fighting substance use disorders who are willing to take the potentially fatal risks that come with consuming illicit pills can reduce their chances of overdosing by using FTS.
In Which Street Drugs Is Fentanyl Being Found?
Fentanyl is being integrated into almost all forms of street drugs. In some cases dealers purposely add fentanyl to their drugs to reduce costs, enhance the effect of an existing drug, hook their customers, or all three. Remember, it’s a business and it’s all about making as much money as possible. In some cases, the presence of fentanyl is the result of contamination from traffickers handling multiple drugs in unclean environments or mixing several different powders with the same equipment.
Widespread Fentanyl Contamination
Fentanyl has been widely detected in all of the street drugs listed below:
Including but not limited to:
- MDMA (Ecstasy, Molly)
Drugs to Watch
- Vape Pens
- Adderall made of methamphetamine
Will Naloxone (Narcan) Work in Case of Overdose?
Naloxone (Narcan) will work in case of overdose, but extra doses may be needed.
Because fentanyl is far more powerful than other opioids, the standard 1-2 doses of naloxone may not be enough. Calling 911 is the first step in responding to any overdose, but in the case of a fentanyl-related overdose the help of emergency responders, who will have more naloxone, is critical.
Calling 911 is the first step in responding to any overdose
Why Are So Many People Dying from Illicit Fentanyl?
There are a few main contributors to the large increase in deaths from illicit fentanyl:
The amount of fentanyl being sold by drug dealers has increased dramatically since it was introduced into the illicit drug supply in the early 2010s. We estimate there are millions of fentapills currently in circulation in the U.S., more than ever before. Social media has also made these cheap fake pills much more accessible to anyone who wants them.
A major factor in fentanyl deaths is the fraudulent way that it is marketed and sold. Whether fentanyl is consumed in pill form or in other street drugs, dealers don’t always disclose that their product contains fentanyl, even if they know it does. Dealers often make their products with fentanyl and pass it off as a more familiar and less potent substance.
Fentanyl is extremely potent and lethal in very small amounts. Illicit fentapills are not made with high quality controls, so many of the street drugs and fake pills being offered by dealers are deadly and the consumer bears the risk.
These combined issues have caused the number of deaths from fentanyl to skyrocket in recent years.
Talk to your kids.
Tell your friends.
Spread the word.
No random pills or street drugs are safe.
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