Counterfeit Pills: DEA Fact Sheet

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Counterfeit Pills

WHAT ARE COUNTERFEIT PILLS?

Counterfeit pills are fake medications that have different ingredients than the actual medication. They may contain no
active ingredient, the wrong active ingredient, or have the right ingredient but in an incorrect quantity. Counterfeit pills
may contain lethal amounts of fentanyl or methamphetamine and are extremely dangerous because they often appear
identical to legitimate prescription pills, and the user is likely unaware of how lethal they can be.

WHAT IS THEIR ORIGIN?

The majority of counterfeit drug production occurs in other countries, mainly China, Mexico, and India. Furthermore, an
increasing number of pills laced with fentanyl are being produced in the U.S. Mexican and domestic drug trafficking
organizations operating in the U.S. produce counterfeit pills with pre-made chemicals and drugs from China and/or
Mexico. 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 counterfeit pills to ensure
dosing is not lethal. Online sales via internet marketplaces and social media are the major sources for obtaining
counterfeit pills.

A significant number of high school and college students purchase Adderall and Xanax from dark web drug markets
and/or through social media referrals1, which market deadly versions of these drugs tainted with fentanyl and/or
methamphetamine. Some students begin using prescription stimulants, often referred to as “study drugs,” in the belief
it will benefit their academic performance, but the nonmedical use of prescription stimulants has not been proven to
improve academic performance2.

Left: Authentic oxycodone M30 tablets (top) vs. counterfeit oxycodone M30 tablets containing fentanyl (bottom). Center:
Authentic Adderall tablets (top) vs. counterfeit Adderall tablets containing methamphetamine (bottom). Right: Authentic
Xanax tablets (white) vs. counterfeit Xanax tablets containing fentanyl (yellow).

What are common street names?

Counterfeit oxycodone M30 pills: Mexican Blues, Blues, M-Boxes


1. Moyle L, Childs A, Coomber R, Barratt MJ. #Drugsforsale: An exploration of the use of social media and encrypted messaging apps to supply and access drugs. Int J
Drug Policy. 2019 Jan;63:101-110. doi: 10.1016/j.drugpo.2018.08.005. Epub 2018 Dec 7. PMID: 30530252.

2. University of Rhode Island. "ADHD drugs do not improve cognition in healthy college students." ScienceDaily. ScienceDaily, 19 July 2018.
What do they look like?

Counterfeit pills are nearly identical to actual prescription medications. The majority of counterfeit pills resemble
oxycodone 30mg pills (M30s), but can also mimic hydrocodone, alprazolam (Xanax), Adderall, and other medications.
There are indications that drug trafficking organizations are specifically targeting kids and teens by creating counterfeit
pills in a variety of shapes and bright colors to appeal to that age group. Counterfeit M30 pills can vary in color from
white to blue. The best way to avoid counterfeit medication is to take only medications prescribed by a licensed medical
professional and dispensed by a registered pharmacist.

How are they used?

Counterfeit pills are especially dangerous because people think they are purchasing legitimate prescription medications.
However, these fake pills often contain lethal amounts of illicit drugs. Distributors in the United States are selling
counterfeit pills on social media, appealing to a younger audience that use these apps. Minors and young adults
experimenting, as well as regular substance users, believe they are buying authentic oxycodone, Adderall, Xanax, or
other medicines, but are unwittingly purchasing counterfeit pills that contain lethal amounts of drugs, usually fentanyl
and methamphetamine. Fentanyl is approximately 100 times more potent than morphine, and 50 times more potent
than heroin as a painkiller. Twenty-six percent of tablets tested in a DEA laboratory contained a lethal dose of fentanyl.

What is their effect on the body?

Counterfeit pills that contain fentanyl can be deadly. A lethal dose of fentanyl is about two milligrams, equivalent in size
to a few grains of salt. Fentanyl, similar to other commonly used opioid analgesics (e.g., morphine), produces effects
such as relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention,
pupillary constriction, and respiratory depression. Synthetic opioids, such as illicit fentanyl, remain the primary driver of the
increase in overdose deaths, accounting for 80 percent of all deaths involving an opioid3.

Counterfeit pills containing methamphetamine are highly addictive and act on the central nervous system. Taking even
small amounts of methamphetamine can result in wakefulness, increased physical activity, decreased appetite, rapid
breathing and heart rate, irregular heartbeat, increased blood pressure, and hyperthermia (overheating).

What are the overdose effects?

Fentanyl overdose may result in stupor, changes in pupillary size, cold and clammy skin,
cyanosis, coma, and respiratory failure leading to death. The presence of the triad of
symptoms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive
of opioid poisoning.

Methamphetamine overdose may result in death from stroke, heart attack, or multiple
A lethal dose of fentanyl.
organ problems caused by overheating.

Which drugs cause similar effects?

Drugs that cause similar effects to fentanyl include other opioids such as morphine, hydrocodone, oxycodone,
hydromorphone, methadone, and heroin. Drugs that cause similar effects to methamphetamine include cocaine and potent
stimulant pharmaceuticals, such as amphetamines and methylphenidate.

What is their legal status in the United States?

Fentanyl-like substances are currently emergency scheduled through October 22, 2021, as Schedule I narcotics.
Methamphetamine is a Schedule II stimulant. Drug scheduling information can be found at https://www.dea.gov/drug-
information/drug-scheduling.

For more information, visit www.getsmartaboutdrugs.com (for parents) and www.justthinktwice.com (for teens).
3. Centers for Disease Control and Prevention

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