In 2021, more than 107,600 people died of drug poisoning or overdose in the United States. Of those deaths, over 71,000 (66%) resulted from synthetic opioids, such as fentanyl.¹ By comparison, during the same period, nearly 49,000 were killed by firearms.² This is not surprising; the opioid crisis has plagued the nation for more than 20 years, claiming over 760,000 lives.³

Additionally, fentanyl has been chemically modified to create analogs, such as acetyl fentanyl, furanyl fentanyl, and carfentanil. Used as an elephant tranquilizer, carfentanil is approximately 10,000 times more potent than morphine and 100 times more powerful than fentanyl.⁹

As part of its One Pill Can Kill campaign, the DEA and its law enforcement partners seized more than 10.2 million fentanyl pills and approximately 980 pounds of fentanyl powder between May and September 2022. As little as 2 milligrams of fentanyl can be deadly, so this is equivalent to more than 36 million lethal doses of fentanyl.¹⁰

Joseph Pergolizzi et al., “Illicitly Manufactured Fentanyl Entering the United States,” Cureus 13, no. 8 (August 2021), https://doi.org/10.7759%2Fcureus.17496.

U.S. Department of Justice, Drug Enforcement Administration, “One Pill Can Kill,” accessed October 24, 2022, https://www.dea.gov/onepill.

Cartels use fentanyl because it is cheap to produce, and they can increase the product’s volume by mixing it with other substances, including lactose, mannitol, and sugars — this process is known as “cutting.” Fentanyl is also added to other drugs, such as heroin, cocaine, and methamphetamine to increase product weight and profitability.¹³

In the last six years, the availability and lethality of fake prescription pills in the United States has increased dramatically.¹⁴ In 2021, the DEA seized approximately 20.4 million counterfeit pills and 15,000 pounds of fentanyl.¹⁵ Testing of the pills determined 6 out of every 10 contained a potentially lethal dose of fentanyl.

The Sinaloa and Jalisco New Generation (CJNG) Cartels are responsible for most of these pills. Based out of Mexico, they are mass-producing fentanyl and pressing it into fake pills that have flooded into the United States for distribution.¹⁶

Case Examples

Across the United States, law enforcement works tirelessly to stop the deadly spread of counterfeit pills. One Boston man attempted to distribute approximately 5,000 fake prescription pills containing fentanyl but was arrested before delivering them.¹⁷ In another case, police in Ohio seized counterfeit oxycodone pills that contained carfentanil.¹⁸ On a larger scale, U.S. Immigration and Customs Enforcement recently indicted 26 individuals in San Diego and seized nearly half a million fake fentanyl-laced pills.¹⁹ Although numerous arrests are made every year, fatalities from fentanyl-laced pills far outweigh this figure.

Social media applications and the dark web make it possible to obtain fake pills easily, providing drug traffickers with a powerful tool to distribute their products.²⁰ Most at risk are young people who think that they are purchasing legitimate prescription pain and/or anxiety pills through social media or friends, giving them a false sense of security.²¹ Reports indicate that in a two-year span, deaths from fentanyl more than tripled, and about 90% of the pills bought from a social media dealer contained fentanyl.²²

Law Enforcement Concern

Clearly, counterfeit pills are finding their way into nearly every community, and it is not just users who are at risk. Generally, officers are the first on scene to overdose calls, and encountering the pills can be hazardous for them and their K-9 partners.

A simple and effective solution to ensure officer safety — a practice that many police departments across the nation have adopted — is for officers to carry naloxone, also known by several brand names. The medicine rapidly reverses an opioid overdose and is frequently administered by officers as a nasal spray. Although naloxone can quickly restore normal breathing to someone whose respiration has slowed or stopped because of an opioid overdose, a single dose may not be effective.²³ Because fentanyl is stronger than and appears to differ from other opioids due to its rapid onset, multiple, sequential doses of naloxone at higher concentrations may be required in some fentanyl overdoses.²⁴

Conclusion

COVID-19 claimed over 1 million lives and is finally releasing its grip on the nation.²⁵ However, the opioid crisis continues, killing one person every five minutes.²⁶ Criminal organizations like the Sinaloa and Jalisco New Generation Cartels are not making it any easier — test results show an increasing number of drugs sold by these groups are counterfeit and laced with lethal amounts of fentanyl. Social media is powerful, and unsuspecting individuals have easy access to fake pills. Therefore, recognizing them and ensuring the safety of first responders who encounter them is critical.