Clinical Insight – Counterfeit Pills

Drug overdose deaths remain a significant public health concern in the United States, with fentanyl contributing to many fatalities. While some individuals intentionally use illicit substances, others may unknowingly ingest dangerous drugs found in counterfeit pills marketed as legitimate prescription medications. This issue of Clinical Insight reviews the growing prevalence of counterfeit pills and the risks they pose.

What are counterfeit pills?

• • Counterfeit pills are fake medications that contain ingredients other than the intended medication. They may contain no active medication, the wrong ingredient, or incorrect amounts of the intended medication.
  • These pills are made to look like legitimate prescription medications, such as oxycodone (e.g., OxyContin®, Percocet®), hydrocodone (e.g., Vicodin®), alprazolam (e.g., Xanax®), or amphetamine (e.g., Adderall®).
  • Some counterfeit pills are produced in a variety of shapes and bright colors that may appeal to children and adolescents.
  • Many counterfeit pills contain illicit substances such as fentanyl and methamphetamine.
  • Counterfeit pills are especially dangerous because individuals may believe they are taking authentic prescription medications when, in fact, they may contain potentially lethal amounts of illicit drugs.

Where do counterfeit pills come from and how are they obtained?

• • The majority of counterfeit pills are manufactured outside of the U.S., although an increasing number are produced domestically.
  • These pills are often made in substandard conditions without quality control measures to ensure consistent dosing. As a result, they may contain unexpected substances, incorrect drug concentrations, or misleading labeling.
  • Many counterfeit pills are purchased online through internet marketplaces and social media platforms, making them easily accessible to anyone with a smartphone, including adolescents and young adults. Reports have indicated that some high school and college students purchase stimulant drugs through illicit internet marketplaces to enhance academic performance. However, these products may contain methamphetamine or other unexpected substances.

How extensive is the problem?

• • Counterfeit pills have been seized in all 50 states.
  • Drug Enforcement Agency (DEA) laboratory testing has shown that many counterfeit pills contain fentanyl, and some contain amounts considered potentially lethal. According to the DEA, 2 out of every 5 counterfeit pills containing fentanyl were found to contain a potentially lethal dose, an amount small enough to fit on the tip of a pencil.
  • The DEA has warned that pills purchased outside of licensed pharmacies may be illegal, dangerous, and potentially lethal. Medications obtained through licensed pharmacies are subject to quality control standards and are not associated with the risks posed by counterfeit pills.

Why is this relevant to urine drug monitoring?

• • Given the accessibility and prevalence of counterfeit pills, as well as their resemblance to legitimate prescription medications, individuals may be unaware that they are ingesting substances such as fentanyl or methamphetamine.
  • Unexpected urine drug test results, particularly the detection of unreported substances, may be related to the ingestion of counterfeit pills containing undisclosed ingredients.