LOS ANGELES — Los Angeles County public health officials on Tuesday issued an alert warning Angelenos that some pharmacies in Mexico have been selling counterfeit medications containing fentanyl and other narcotics.
“The landscape of overdose deaths no longer primarily affects those who are using substances regularly,” the alert said. “Due to fentanyl, we are seeing people overdose and die the first time they try an illicit substance or counterfeit pill.”
Citing Los Angeles Times reporting, the alert named several cities where counterfeit pills — including primarily fake Adderall and oxycodone — have been found in stores, and warned people against using substances alone in the event of a possible overdose.
“The safest course of action is to avoid using pills from any sources besides those that come from an FDA-licensed pharmacy or are prescribed by your healthcare provider,” health officials wrote in a news release.
The alert comes on the heels of a four-month investigation by The Times, which found that pharmacies from Tijuana to Tulum have been selling fake pills over the counter, passing off powerful methamphetamine as Adderall and deadly fentanyl as Percocet and other opioid painkillers.
Pharmacies south of the border have long been known for selling a wide range of medications over the counter — including many that would require a prescription in the U.S. But experts had generally believed those pills were what store owners said they were.
Instead, it was street drug supplies that were typically seen as the most likely to be tainted with fentanyl or methamphetamine. Now, it seems the problem has expanded.
The Times first reported on it in February, after purchasing and testing pills from independent pharmacies in three cities: Tijuana, San José del Cabo and Cabo San Lucas. Using at-home test strips, reporters found fentanyl or methamphetamine in individual pills sold one at a time in each tourist destination — but the testing was limited to northwestern Mexico at the time.
Around the same time, a UCLA research team recorded similar findings, using an infrared spectrometer to show that 20 out of 45 pills purchased in the same region were actually counterfeits containing fentanyl, methamphetamine or heroin.
But the early research and reporting left many unanswered questions, including whether anyone had been harmed and whether officials knew about the problem.
Over the next few weeks, reporters identified at least half a dozen people who overdosed or died after taking pills they’d purchased in pharmacies in Mexico. As early as 2018, grieving families began to alert government officials. It was not until March — after The Times first reported on the problem — that the U.S. State Department issued an alert explicitly warning the public about the danger.
“The U.S. Department of State is aware of recent media reports regarding counterfeit pharmaceuticals available at pharmacies in Mexico, including those tainted with fentanyl and methamphetamine,” the federal alert said. “Counterfeit pills are readily advertised on social media and can be purchased at small, non-chain pharmacies in Mexico along the border and in tourist areas.”
Yet, it was still not clear how widespread the problem was and whether it extended beyond the Baja Peninsula. Then, this week, The Times published a broader investigation that included testing results from eight cities, stretching from the country’s southeastern tip in the Yucatán Peninsula to its westernmost point near California and from the southwestern coast to the Texas border.
Overall, 28 out of the 55 pills reporters tested — a little more than 50% — were counterfeit. More than a third of the opioid painkillers tested were fake, and the vast majority of those were positive for fentanyl. After having some of the samples tested in a lab, reporters also found that one of the opioids was actually a weaker medication and another contained no drugs at all.
Meanwhile, 12 of 15 samples sold as Adderall tested positive for other substances, including methamphetamine and, in one case, MDMA, the designer drug commonly known as ecstasy. Reporters also found that, in some cities, entire sealed bottles of medications proved to be counterfeit.
Though most of the pills that tested positive for illicit substances came from independent pharmacies, in Puerto Vallarta, counterfeits were even available at one regional pharmacy chain.
Drug market experts say that Mexican drug cartels — which produce most of the fentanyl reaching the streets stateside — are likely the source of the counterfeit pills. In many cases, the pharmacies that sold them seemed to be targeting tourists, even offering laminated lists of “travel medicines” and providing prices in U.S. dollars.
To avoid counterfeit medication, county health officials on Tuesday also recommended testing substances for the presence of fentanyl using at-home test strips, which can be purchased online.
To help avoid fatal overdoses, officials recommended keeping on hand naloxone, an overdose-reversing medication that is available in pharmacies without a prescription and through community distribution points.
