The Truth About Counterfeit Pills

It has to be safe if it looks like a prescription pill, right? If I get it from my friend, it must be safe, right? Unfortunately no! There is a high probability that the medication or 'pill' you received from a friend or purchased off someone on Snapchat or Instagram is a counterfeit pill containing Fentanyl and other dangerous substances.


It is no secret that Connecticut and the Nation are amidst the worst overdose epidemic we have ever seen. The eminence loss of life we have endured over the last eight years is equally staggering as it is heartbreaking, and the primary cause of this tremendous loss of life is FENTANYL and other synthetic opioids.


While there are different delivery systems for Fentanyl and other drugs such as wax folds, twist corners, and others, nothing concerns public health and public safety experts more than counterfeit pills. Counterfeit pills are also known as counterfeit prescription pills, fentapills, pressed pills, or whatever you may know them by; they are nothing more than a delivery system for Fentanyl.


What are Counterfeit Pills?

Counterfeit pills are illicitly manufactured and made to look like the actual pharmaceutical prescription medication, such as opioids: oxycodone (Percocet), benzodiazepines: alprazolam (Xanax), and stimulants: amphetamines (Adderall). When seized and tested, these illicit pills are found to contain many different active substances, including illicitly manufactured Fentanyl and other synthetic opioids, methamphetamine, illicitly manufactured Benzodiazepines (etizolam), and synthetic cathinones (alpha-PVP).


What is a "Fentapill"?


Why are Counterfeit Pills Dangerous?

Counterfeit pills are one of the biggest threats in the illicit drug market today. According to the DEA {Drug Enforcement Agency}, they have seized more than 20,000,000 counterfeit pills across the U.S. in 2021.1 The DEA also confirms that laboratory testing on the seized counterfeit pills reveals that at least 4 out of 10 pills contain a lethal dose of Fentanyl. Some other reasons why counterfeit pills are so dangerous are:

  • Disguises illicit drugs as legitimate medication

  • Less stigma with pill use than traditional drug use

  • Provides a false sense of safety

  • Individuals think they know exactly what they're buying/taking

  • Dosing is not exact

  • Increasing potency of synthetics (Fentanyl)

While these are all important in understanding why counterfeit pills are dangerous, the most dangerous aspect is that individuals who use pills don't understand that taking one pill may kill you. People are under the impression that if you buy a prescription pill off the streets, it has been diverted to the illicit market from the pharmaceutical supply chain, which could not be more wrong. The amount of "real" prescription pills being seized by law enforcement makes up less than 10% of pill seizures meaning that almost all pills seized by law enforcement are counterfeit.


Dosing of Counterfeit Pills

Pharmaceutical companies spend millions of dollars providing the proper and exact dosing when manufacturing their prescription medications. In addition, your doctor can monitor your body's reaction and adjust the dosing if necessary to ensure the medication is working correctly with as few side effects as possible.


Drug trafficking organizations (DTO) do not possess the necessary equipment, skills, and patience to create proper dosages. The following illustrates what occurs when DTOs produce pills:

  • Tablet matrix – this substance usually contains benign adulterants that increase the yield and volume and assist in binding and coloring the illicit pills.

  • Active Substances – this substance is the illicit drug, including illicitly manufactured Fentanyl and other synthetic opioids, methamphetamine, illicitly manufactured Benzodiazepines (etizolam), and synthetic cathinones (alpha-PVP).

  • Product for tableting – this is the result of combining the tablet matrix and active substances.


The image above shows when the tablet matrix and active substances are mixed together, outside of pharmaceutical-grade conditions, you do not get an even disbursement throughout the final product for tableting. As a result, when DTOs pour the product for tableting into the pill press, there is an uneven distribution of the active substance among the pills. This is illustrated under tableting which shows the dispersion of the active substance across five pills; some pills may contain no active substance while some pills contain mostly active substance.


What does this mean for the person who takes a counterfeit pill? It's like playing Russian Roulette; you never know which pill you are taking. You may take pill one with no active substance or pill five, which is mostly the active substance, which could be the difference between life and death.


Safety Recommendations

It is crucial when using substances to do to following:

  • Practice harm reduction to decrease the chances of having a fatal overdose.

  • Use Fentanyl Test Strips (FTS) to test every dosage of any substance you are using, or combine all the doses when FTS are limited.

  • Have Naloxone on hand! Do not use alone; you can not administer Naloxone yourself if you are overdosing.

  • Use slowly – use a half or quarter of the amount you would typically use at one time.


Helpful Resources

Written by:

Bobby Lawlor, CT Drug Intelligence Officer, Overdose Response Strategy

Anna Gasinski, CT Public Health Analyst, Overdose Response Strategy