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• Posted May 7, 2024

Almost All Counterfeit Oxycontin Pills Contain Fentanyl

Lab tests of counterfeit oxycodone (Oxycontin) pills seized by police in Rhode Island in 2022 found 99.3% also contained dangerous fentanyl. 

It was typically mixed with another potentially deadly drug, xylazine.

Both drugs make overdose more likely and more fatal, experts note. 

As too many American families have tragically come to know, "counterfeit prescription pills have been associated with adverse outcomes, including fatal overdose," said a team of researchers led by Dr. Rachel Wightman. She's associate professor of epidemiology and emergency medicine at Brown University in Providence, RI.

Wightman's team published its findings May 6 in the Journal of the American Medical Association. 

For years, the makers of illicit fake prescription opioids, amphetamines and tranquilizers have adulterated their pills with fentanyl and, more recently, the animal tranquilizer xylazine.  

Fentanyl is 100 times more powerful than morphine and 50% more powerful than heroin, and is increasingly to blame for overdose and death among people who are addicted to opioids or who take counterfeit meds recreationally.

Deaths linked to illicit pills containing xylazine,a horse tranquilizer, are also soaring. According to a study released last summer, the number of xylazine-involved OD deaths nationwide rose from 102 in 2018 to 3,468 in 2021.

In their report, Wightman's group obtained state forensic drug chemistry lab test results for 1,176 counterfeit pills seized by law enforcement in Rhode Island between early 2017 and the end of 2022.  

"The number of pills obtained during seizure incidents range from a single pill to thousands," the researchers noted. "Any pill that yielded a result other than the expected active ingredients as marked was considered counterfeit."

The bulk of the counterfeit pills fell into three classes: Oxycodone (686 pills); alprazolam (brand name Xanax, 312 pills); and amphetamines (174 pills).

According to lab analyses, almost all the fake oxycodone pills seized during 2022 contained fentanyl -- that's a steep rise from about 10% of pills found to contain the drug between 2017 and 2020, the researchers noted.

Fentanyl was detected in 2.6% of the fake Xanax pills. None of the counterfeit amphetamine pills contained fentanyl, the tests showed.

Xyalzine was almost always found in counterfeit oxycodone pills that were also contaminated with fentanyl, the researchers said. 

"Of 137 pills containing xylazine, 135 (98.5%) were counterfeit oxycodone," the researchers wrote, and "xylazine was detected with fentanyl in 136 of 137 pills."

Dr. Kimberly Sue, an addiction medicine doctor at Yale Medicine in New Haven, Conn., said there likely are some people who are specifically seeking out xylazine for illicit use on its own.

"But I would say for the majority of people, they don't know they're using it and they don't intend to be using it,"she added.

Pat Aussem, vice president of consumer clinical content development at the Partnership to End Addiction, noted that xylazine is a depressant that slows brain activity and causes extreme drowsiness.

"It can result in slowed breathing and heart rate in people who use it, as well as dangerously low blood pressure,"she said. "The risk of overdose is amplified when combined with other substances like fentanyl."

Xylazine further increases a person's risk of fatal overdose because it does not respond to the OD rescue drug naloxone, experts said.

More information

Learn the warning signs of fentanyl overdose and how you might save a life at UC Davis Health.

SOURCES: Kimberly Sue, MD, addiction medicine doctor, Yale Medicine, New Haven, Conn.; Pat Aussem, LPC, MAC, vice president, consumer clinical content development, Partnership to End Addiction, New York City; Journal of the American Medical Association, May 6, 2024