A new study shows a dramatic spike in the number of counterfeit fentanyl pills being seized by law enforcement, an indication of the growing illicit drug supply driving the country's historic opioid crisis.
Last year, more than 115 million pills containing illicit fentanyl were seized by law enforcement, compared to over 71 million in 2022, according to the study published Monday in the International Journal of Drug Policy. The study found that the number of pills seized last year was 2,300 times greater than the roughly 50,000 seized in 2017.
The counterfeit pills are made to look like legit prescription opioid medications — like oxycodone or benzodiazepines — but are often far deadlier.
Public health officials have been warning about the presence of fentanyl, a potent synthetic opioid, in the illicit drug supply for more than a decade. The new report highlights the rising threat of cheap and highly potent counterfeit pills, especially in the western U.S.
"Availability of illicit fentanyl is continuing to skyrocket in the U.S., and the influx of fentanyl-containing pills is particularly alarming," said Joseph Palamar, an associate professor in the Department of Population Health at the NYU Grossman School of Medicine, who was the lead author on the study. "Public health efforts are needed to help prevent these pills from falling into the hands of young people, and to help prevent overdose among people taking pills that unsuspectingly contain fentanyl."
The study was led by researchers who participate in the National Drug Early Warning System, a federal program that monitors drug seizures in 33 so-called High-Intensity Drug Trafficking Areas across the country. The data comes from a mix of federal, state and local law enforcement organizations. It does not include seizures made by U.S. Customs and Border Protection.
4-in-10 drug overdose deaths involve fentanyl
Among the factors fueling the spread: The counterfeit pills are cheap to make and buy, and social media and the dark web have made them easier to buy online. Fentanyl also delivers a very powerful but very brief high, so people consume more of it than they would other opioids.
It's also faster-acting and many times more potent than heroin and morphine, making it highly addictive and much easier to overdose. In fake prescription pill form, it can be mistaken for a safer drug. In reality, there's no telling how much fentanyl is in them.
"It's like Russian roulette," said Dr. Samuel Beckerman, an emergency medicine physician in Los Angeles. "One pill might be enough to make you stop breathing. Another pill might just be enough to get you high."
In 2021, illicit fentanyl was the sole drug involved in 41% of drug overdose deaths with evidence of counterfeit pill use, according to the Centers for Disease Control and Prevention.
The fake pills account for an increasing chunk of overall fentanyl seizures, the study found. Fentanyl seizures more than quadrupled between 2017 and 2023. Almost half of last year's fentanyl seizures were in fake pill form, compared to just 10% of fentanyl seizures at the start of that period.
Most fentanyl pill seizures were in western U.S. states
The study highlights how the opioid epidemic, which has been historically worse in eastern states, has taken deeper root in the West.
While the most fentanyl seizures in 2023 — powder and pill form — took place in Florida, the second- and third-most seizures came in Arizona and California, respectively.
When looking at the number of seizures of illicit fentanyl pills specifically, researchers again found the highest numbers occurring in western states. There, the pills accounted for nearly 78% of all fentanyl seizures in the region last year.
The total number of pill seizures were greatest in California, followed by Arizona and Colorado.
"Most of the fentanyl that we're seeing, on the West Coast at least, is coming from Mexico. A lot of the precursors are getting shipped there from China and then it's getting manufactured in Mexico," said Caleb Banta-Green, a research professor at the University of Washington's School of Medicine who studies drug use epidemiology and was not part of the study.
Banta-Green, who also directs UW's Community-Engaged Drug Education, Epidemiology & Research Center, says an increase in the fentanyl supply out West, as the study suggests, would reflect what he's seen happen in Washington state.
Within the past two years alone, fentanyl overtook heroin as the most used opioid in the state, according to a community survey conducted by the center.
The spread of fentanyl-laced fake prescription pills has also meant that many people who don't normally use opiates — and never intended to — end up getting hooked on them.
In Los Angeles, Dr. Beckerman, who works at Huntington Hospital and LA General Medical Center, said it's become common to see patients who overdosed on what they thought was Adderall or MDMA from a friend and didn't know they ingested fentanyl.
"But the friend got it from somebody else who got it from somebody else and it didn't come from a pharmacy," he said. "That pill probably has like a 60 to 70% chance of containing a potentially lethal dose of fentanyl."
Accidental fentanyl overdose deaths in the region jumped from 109 in 2016 to 1,910 in 2022, according to the LA County Department of Health.
"The language that I like to use is that these are not just accidental overdoses, these are fentanyl and opiate poisonings," Beckerman said. "These are people who have never done opiates in their life. They're not taking them because they want to take fentanyl."
To combat the opioid crisis, experts say Americans need greater access to medications that are considered the gold standard for treating opioid use disorder, such as methadone, buprenorphine and naltrexone. Stigma about addiction often limits the use of these life-saving drugs.
"Until we make effective treatment and harm reduction easier to get than fentanyl, people keep using fentanyl," Banta-Green said. "And we are doing it, but we need to take it to a massive scale in the United States."
