What are they?

• Many fake pills are made to look like prescription opioids – such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®) – but contain fentanyl or methamphetamine.

• Criminal drug networks are mass-producing fake pills and falsely marketing them as legitimate prescription pills to deceive the American public.

• Fake pills are widely available, and DEA and its law enforcement partners are seizing deadly fake pills at record rates.

• Fake pills are more lethal than ever before. DEA lab testing reveals that 2 out of every 5 pills with fentanyl contain a potentially lethal dose.

• The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist.

Counterfeit Drugs:

OxyCodone, OxyContin®, Tylox®, Percodan®, Valium®, Xanax®, Restoril®, Ativan®, Klonopin®, Adderall®, Concerta®, Dexedrine®, Focalin®, Metadate®, Methylin®, Ritalin®

Street Title

OxyCodone: 30s; 40s; 512s; Beans; Blues; Buttons; Cotton; Greens; Hillbilly Heroin; Kickers; Killers; Muchachas; Mujeres; OC; Oxy; Oxy 80s; Roxy; Roxy Shorts; Whites, Xanax®: Bars; Benzos; Bicycle Handle Bars; Bicycle Parts; Bricks; Footballs; Handlebars; Hulk; Ladders; Planks; School Bus; Sticks; Xanies; Yellow Boys; Zanbars; Zannies; Z-Bars, Adderall®: A-Train; Abby; Addy; Amps; Christmas Trees; Co-Pilots; Lid Poppers; Smart Pills; Smarties; Study Buddies; Study Skittles; Truck Drivers; Zing

How are they abused?

Fentanyl is a synthetic opioid that is 100 times stronger than morphine and 50 times stronger than heroin. It is often injected or pressed into counterfeit pills. Methamphetamine usually comes in pill or powder form and is smoked, snorted, or injected.

What is their effect on the body?

Fentanyl misuse may result in an intense, short-term high; temporary feelings of euphoria; slowed respiration and reduced blood pressure, nausea, fainting; seizures or death. Methamphetamine misuse may result in agitation; increased heart rate and blood pressure; increased respiration and body temperature; anxiety and paranoia. High doses can cause convulsions, cardiovascular collapse, stroke or death.

Fentanyl is a synthetic opioid typically used to treat patients with chronic severe pain or severe pain following surgery.  Fentanyl is a Schedule II controlled substance that is similar to morphine but about 100 times more potent.  Under the supervision of a licensed medical professional, fentanyl has a legitimate medical use.  Patients prescribed fentanyl should be monitored for potential misuse or abuse.

Illicit fentanyl, primarily manufactured in foreign clandestine labs and smuggled into the United States through Mexico, is being distributed across the country and sold on the illegal drug market.  Fentanyl is being mixed in with other illicit drugs to increase the potency of the drug, sold as powders and nasal sprays, and increasingly pressed into pills made to look like legitimate prescription opioids.  Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.

There is significant risk that illegal drugs have been intentionally contaminated with fentanyl.  Because of its potency and low cost, drug dealers have been mixing fentanyl with other drugs including heroin, methamphetamine, and cocaine, increasing the likelihood of a fatal interaction.

Producing illicit fentanyl is not an exact science.  Two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance and past usage.  DEA analysis has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet.

• 42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered a potentially lethal dose.
• Drug trafficking organizations typically distribute fentanyl by the kilogram.  One kilogram of fentanyl has the potential to kill 500,000 people.

It is possible for someone to take a pill without knowing it contains fentanyl. It is also possible to take a pill knowing it contains fentanyl, but with no way of knowing if it contains a lethal dose.

According to the CDC, synthetic opioids (like fentanyl) are the primary driver of overdose deaths in the United States. Comparison between 12 months-ending January 31, 2020 and the 12 months-ending January 31, 2021 during this period:

• 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. 

Unless a drug is prescribed by a licensed medical professional and dispensed by a legitimate pharmacy, you can't know if it’s fake or legitimate. And without laboratory testing, there’s no way to know the amount of fentanyl in an individual pill or how much may have been added to another drug. This is especially dangerous because of fentanyl's potency.

How does fentanyl affect the body?

Fentanyl, similar to other commonly used opioid analgesics (e.g., morphine), produces effects such as:

• euphoria
• pain relief
• relaxation
• sedation
• confusion
• drowsiness
• dizziness
• nausea
• vomiting
• urinary retention
• pupillary constriction

What are the overdose effects?

Overdose may result in:

• stupor
• changes in pupillary size
• cold and clammy skin
• cyanosis - blue discoloration of the skin
• respiratory failure leading to death
• coma

If you’re like most people, you probably turn to the internet for answers to a lot of questions.  

While search engines are very useful, there is a lot of incorrect info about drugs online. 

If you’re looking for accurate information about counterfeit pills, we’ve pulled together some of the internet’s most searched questions about them and answered below. 

What are fake or counterfeit drugs?  

Counterfeit pills are fake medications that have different ingredients than the actual medication. They could have a little bit of the real ingredients, or none at all. Users won’t be able to tell if a pill is real or fake by just looking at it. And, unfortunately, many counterfeit pills contain deadly amounts of fentanyl or methamphetamine.

How can you tell if drugs are fake? 

A lot of counterfeit pills are made to appear legitimate. So, there really isn’t a clear way to tell if a pill is fake just by looking at it.  

What does ‘laced’ mean? 

When you hear someone say a something is “laced,” they mean that a substance was added to it that was not originally there. Examples: Many counterfeit pills are laced with fentanyl. Some snacks are laced with THC (marijuana) oil. 

What can fake drugs do? 

Since counterfeit drugs are unregulated and made illegally, they can actually be deadly. Just a tiny bit of fentanyl can lead to an overdose, and counterfeit pills often have varying amounts. 

What does Oxycontin look like?  

Check out the images of legitimate Oxycodone and the counterfeit Oxycodone. The authentic oxycodone M30 tablets are on the top, the counterfeit oxycodone M30 tablets containing fentanyl are on the bottom. Hard to tell the difference, right? Is it worth the risk?

Authentic Oxycodone

Synthetic opioid drug prescribed for pain as OxyContin®, Tylox®, and Percodan®. These drugs are derived from one species of the poppy plant, and have a high potential for abuse.

Counterfeit

Street Names: 30s; 40s; 512s; Beans; Blues; Buttons; Cotton; Greens; Hillbilly Heroin; Kickers; Killers; Muchachas; Mujeres; OC; Oxy; Oxy 80s; Roxy; Roxy Shorts; Whites

The images of legitimate and counterfeit pills are examples and do not represent the many variations of counterfeit pills. Never trust your own eyes to determine if a pill is legitimate. The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist.

Authentic Alprazolam

Depressants that produce sedation, induce sleep, relieve anxiety and prevent seizures. Available in prescription pills, syrup and injectable preparation. Prescribed as Valium®, Xanax®, Restoril®, Ativan®, Klonopin®

Counterfeit

Street Names: Bars; Benzos; Bicycle Handle Bars; Bicycle Parts; Bricks; Footballs; Handlebars; Hulk; Ladders; Planks; School Bus; Sticks; Xanies; Yellow Boys; Zanbars; Zannies; Z-Bars

The images of legitimate and counterfeit pills are examples and do not represent the many variations of counterfeit pills. Never trust your own eyes to determine if a pill is legitimate. The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist.

Authentic Amphetamine

Prescription stimulants used to treat Attention-Deficit / Hyperactivity Disorder (ADHD). Used as a study aid, to stay awake, and to suppress appetites. Prescribed as Adderall®, Concerta®, Dexedrine®, Focalin®, Metadate®, Methylin®, Ritalin®.

Counterfeit

Street Names: A-Train; Abby; Addy; Amps; Christmas Trees; Co-Pilots; Lid Poppers; Smart Pills; Smarties; Study Buddies; Study Skittles; Truck Drivers; Zing

The images of legitimate and counterfeit pills are examples and do not represent the many variations of counterfeit pills. Never trust your own eyes to determine if a pill is legitimate. The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist.

Have you ever been tempted to buy your medicines from an online pharmacy or another website?

You can protect yourself and your family by being cautious when buying medicine online. Some pharmacy websites operate legally and offer convenience, privacy, cost savings and safeguards for purchasing medicines.

Not all websites are the same. The U.S. Food and Drug Administration warns that there are many unsafe online pharmacies that claim to sell prescription drugs at deeply discounted prices, often without requiring a prescription. These internet-based pharmacies often sell unapproved, counterfeit or otherwise unsafe medicines outside the safeguards followed by licensed pharmacies.

Many unsafe online pharmacies use fake “storefronts” to mimic licensed pharmacies or to make you think their medicines come from countries with high safety standards. But the medicines they sell could have been made anywhere, with little care or concern for safety and effectiveness. Also, these drugs could be fake, expired or otherwise unsafe for you and your family.

How can you tell if an online pharmacy is operating legally? The FDA’s BeSafeRx page has resources and tools to help you make safer and more informed decisions when buying prescription medicines online.

Warning Signs of an Unsafe Online Pharmacy

Beware of online pharmacies that:

• Do not require a doctor’s prescription.
• Are not licensed in the U.S. and by your state board of pharmacy.
• Do not have a licensed pharmacist on staff to answer your questions.
• Send medicine that looks different than what you receive at your usual pharmacy, or arrives in packaging that is broken, damaged, in a foreign language, has no expiration date, or is expired.
• Offer deep discounts or prices that seem too good to be true.
• Charge you for products you never ordered or received.
• Do not provide clear written protections of your personal and financial information.
• Sell your information to other websites.

These pharmacies often sell medicines that can be dangerous because they may:

• Have too much or too little of the active ingredient you need to treat your disease or condition.
• Not contain the right active ingredient.
• Contain the wrong ingredients or other harmful substances.

The active ingredient of an approved drug product is what makes the medicine effective for the illness or condition it is intended to treat. If a medicine has unknown active ingredients, it could fail to have the intended effect, could have an unexpected interaction with other medicines you are taking, could cause dangerous side effects, or could cause other serious health problems, such as serious allergic reactions.

Also, these drugs may not have been stored properly, such as in a warehouse without necessary temperature controls, which may cause the medicine to be ineffective in treating your condition.

Know the Signs of a Safe Online Pharmacy

There are ways you can identify a safe online pharmacy. These pharmacies:

• Always require a doctor’s prescription.
• Provide a physical address and telephone number in the U.S.
• Have a licensed pharmacist on staff to answer your questions.
• Are licensed with a state board of pharmacy.

Another way to help ensure you are using a safe and legal online pharmacy is to check the pharmacy’s license in the state’s board of pharmacy license database by using the location tool on the FDA’s BeSafeRx website. If your online pharmacy is not listed, don’t use that pharmacy.

Counterfeit or fake medicine can be made with the wrong dose or no dose of medicine, or with toxic or harmful ingredients. Counterfeit medicines are unsafe. They are usually packaged to look like the real thing. Other health products, such as medical devices, mosquito nets, vaccines, or bug sprays can also be fakes

Avoid buying medicine in other countries

Bring all your medicines, in their original containers, with you when you travel.

It’s hard to spot counterfeit drugs, the only real way to know if a drug is counterfeit is through chemical analysis done in a laboratory. Sometimes, counterfeit drugs differ in size, shape, or color, or are sold in poor-quality packaging, but they often appear identical to the real thing.

Counterfeit medicine and health products are sold worldwide but are more commonly found in low and middle-income countries where it is may be hard to enforce drug quality standards. Studies show about 9%-41% of medicines sold in low- and middle- income countries are counterfeit. In contrast, in high-income countries, such as the United States, less than 1% of medicines sold are counterfeit.

If you must buy medicines while traveling

If an emergency occurs and you must buy medicines while traveling, take the following steps to reduce your chances of buying counterfeit drugs:

• Only buy medicines from licensed pharmacies and ask for a receipt. Do not buy medicines from open markets.
• Ask the pharmacist whether the drug has the same ingredients as your current medicine. If possible, bring your medicine with you to the pharmacy.
• Make sure that the medicine is in its original packaging.
• Look closely at the packaging. Poor-quality printing or packaging can be a sign of a counterfeit product.

As our nation remains in the midst of an opioid crisis, another disturbing trend has emerged: the selling and the use of fake medication. 

These pills, which are often sold online, look like legitimate prescription meds such as oxycodone or Adderall. In fact, people buy them believing that they are similar to the pills you would get from the doctor. 

But many of these fake pills actually contain different ingredients and are laced with dangerous – and sometimes deadly – amounts of the synthetic opioid fentanyl or methamphetamine.  

Quick Facts:

• According to DEA lab testing: 6 out of every 10 pills with fentanyl contain a potentially lethal dose.
• DEA seized more than 50.6 million fake pills in 2022 and more than 10,000 pounds of fentanyl.
• Fake prescription pills are easily accessible and often sold on social media and e-commerce platforms.

Chances are that you’ve heard one of many tragic overdose stories connected to the use of fake pills. 

Earlier this year, the 16-year old son of famous television therapist Dr. Laura Berman died after overdosing on fentanyl. Berman believes her son bought the drug, which he thought was Xanax, from a dealer on Snapchat.

In 2020, 23-year-old Wyatt Williamson died after consuming a pill he thought was Xanax, but was actually laced with fentanyl.

Where Did They Come From? 

Most of these pills are produced in other countries; mainly China, Mexico, and India. However, an increasing number of pills laced with fentanyl are being produced in the U.S.  

They are usually produced in substandard conditions, labeled incorrectly, and may include dangerous, unapproved substances. There are no quality control mechanisms in the illicit labs producing fake pills to ensure dosing is not lethal.  

As stated earlier, online sales via internet marketplaces and social media are the major sources for obtaining fake pills. A significant number of high school and college students purchase Adderall and Xanax from dark web drug markets and/or through social media referrals.