By Pat Anson, Editor
With much of the U.S. focused on the so-called epidemic of prescription opioid abuse, another deadly problem is quietly taking root around the country: illicit fentanyl being sold as counterfeit pain medication.
“It’s unreal. They’re inundated with fentanyl in the Midwest and in the northeast,” says DEA spokesman Rusty Payne. “A lot of these fentanyl pills are being marketed as knockoff oxy (oxycodone).”
We first began reporting on the fake fentanyl pain pills in April, when 14 deaths in California and 9 in Florida were blamed on counterfeit medication. Since then, the problem has spread to virtually every state.
In Massachusetts, Boston police are warning about counterfeit fentanyl pills that are nearly indistinguishable from prescription oxycodone.
“This dangerous drug is being sold to buyers who presume the pills, which are accurately formed and marked with the designation A/215, are Oxycodone 30 mg tablets. Anyone who ingests these Fentanyl pills may put themselves in serious danger of overdosing which can result in death,” police said.
In Layton, Utah, at least one recent overdose death is blamed on counterfeit roxicodone with the same markings.
“If you locate prescription pills with roxicodone markings "A" and "215" and you aren't sure where they originated from - use caution in handling them as you can absorb fentanyl through your skin,” the Layton police department warned in recent a Facebook post. “Counterfeit prescription pills are being made by street drug dealers and sold on the street, as they are cheaper and easier to obtain.”
In West Virginia, officials are investigating three non-fatal overdoses possibly caused by fentanyl disguised as Xanax, an anti-anxiety medication.
“You can tell it’s not really Xanax — if you look at the two they look the same, but not quite,” Dr. Elizabeth Scharman, director of the West Virginia Poison Center, told the Charleston Gazette-Mail. “The brand-name 2-milligram Xanax tablets are not that popular, so many people haven’t seen them before, and to them they look the same.”
And in Alabama, a routine traffic stop this week led to the arrest of a man with a vial of marijuana and a bag full of 78 white tablets. The pills looked similar to Xanax, but when tested were found to contain fentanyl.
Buyers Playing Russian Roulette
Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine and can be lethal in very small doses. It is available legally by prescription in patches and lozenges to treat more severe types of acute and chronic pain, but illicitly manufactured fentanyl is fast becoming a scourge across the U.S. and Canada.
“It’s just Russian roulette,” says the DEA’s Payne. “Pharmaceutical grade fentanyl that you have in hospitals and such, that’s really not what we’re talking about here. We’re talking about black market, underground labs in China that are manufacturing this stuff.”
Unsuspecting buyers, including some pain patients who were unable to get opioid medication legally, have no idea the drug they’re getting from a dealer or friend could be lethal. The dealers may be killing their own customers, but they’re driven by profit.
“We found that the profit margin in fentanyl is so much larger than heroin. And so have the Mexican cartels and the drug organizations,” said Payne. “A kilo of fentanyl versus a kilo of heroin on the street, when you cut it up and adulterate it enough to get it ready for street level distribution, they’re making a million to two million dollars from a kilo of fentanyl versus $80,000 for a kilo of heroin. So finances and profit are really playing a part in this. And you’ve got people here who are so addicted to opioids that there’s a market for it unfortunately.
In the past year, the DEA has issued two public safety alerts about fentanyl, but the Centers for Disease Control and Prevention (CDC) has remained relatively quiet about the problem – focusing instead on guidelines to reduce the prescribing of legal opioid medications. So have many politicians, who have railed against opioid prescribing while supporting more federal funding for addiction treatment.
But the fentanyl problem is becoming too big to ignore.
States like Massachusetts, Rhode Island, Ohio and Delaware have reported an “alarming surge” in fentanyl related deaths in recent months. In some states, the number of deaths from fentanyl now exceeds those from prescription opioids.
“We think fentanyl and fentanyl overdoses have been underreported over the years in a lot of places. But we think people are now starting to pay more attention to it,” says Payne.
What no one seems willing to admit is that – while fentanyl dealers may be killing their customers – restricting access to legal opioids may only be creating new ones. In Canada’s western province of British Columbia, where fentanyl is involved in over half the drug overdoses, regulators have adopted opioid prescribing guidelines that are even more stringent than the CDC’s.
“The guidelines will make it much harder for pain sufferers, but will do absolutely nothing to discourage abuse and addiction. That population just goes on to something else as we all know from history,” said Barry Ulmer, Executive Director of the Chronic Pain Association of Canada.
The guidelines are forcing pain sufferers like Hugh Lamkin to buy fentanyl off the street because doctors won't give him an opioid prescription for arthritis and chronic back pain.
"I don't want to be buying street drugs," Lampkin told CBC News. “I think that I have a legitimate medical condition where I should be getting medication from my doctor."
Heroin Use Reaches 20-year High in U.S.
Limits on opioid prescribing may also be fueling a surge in heroin use in the United States, according to the chief researcher for a United Nations report on worldwide drug use.
"There is really a huge epidemic (of) heroin in the U.S.," Angela Me told Reuters.
According to the U.N. World Drug Report 2016, the number of heroin users in the U.S. reached one million in 2014, the highest in 20 years. Heroin use has increased sharply over the last two years in both North America and Europe.
The increase has coincided with a drop in heroin prices, but Me believes it could also be connected to the development of abuse deterrent formulas for OxyContin and other opioid pain medications, which have made the pills harder to crush and snort.
"This has caused a partial shift from the misuse of these prescription opioids to heroin," Me said.