The Deadly Problem of Counterfeit Drugs

counterfeit Oxycontin

Counterfeit Oxycontin. The outer casing color (green) is extremely close, however, the inside should be white. Source: Studio L

While there are many illustrations of the utter failure that is drug prohibition, counterfeit drugs produced and circulated "underground" are proving to be one very deadly example.

Although many seasoned users would like to think they'd have no problem identifying counterfeit drugs if they happened to encounter them, the latest news and images indicate it isn't so simple. The methods and techniques used in the production of counterfeit drugs have become fairly sophisticated, making it increasingly difficult to spot the differences through a simple visual inspection.

This article was first published by Studio L Online. Read the original here.

Sadly, recent news on the topic has all too often come hand in hand with the overdose and death of the unknowing, and often far too young, users. Here in Canada, counterfeit Oxycontin has spread across the provinces, leaving a trail of bodies and OD victims behind.

In the summer of 2013, the Canadian Centre on Substance Abuse (CCSA) and the Canadian Community Epidemiology Network on Drug Use (CCENDU) issued an alert regarding reports of illicit fentanyl (not prescription grade) in both pill and powder forms appearing for sale on the streets in various areas of the US and Canada. The alert stated: "Illicit fentanyl was first brought to the attention of CCENDU members in May 2013 when the presence of fentanyl analogues was reported in Montreal, Quebec. Illicit fentanyl has since appeared in a number of other Canadian communities and the availability of this drug might continue to spread."

The following February (2014), the CCSA and CCENDU issued an updated warning to alert the public about the increasing availability of fake or counterfeit Oxycodone pills containing illicit fentanyl. According to the alert, the pills resemble 10mg and 80mg Oxycontin pills. "Some are green and stamped with 'CDN' on one side and the number 80 on the other (see Figure 1). [...] While the green tablets appear to be more widely available, pills have also surfaced that are white with the number 10 stamped in place of the 80."

Using Health Canada's Drug Analysis Service (DAS) for verification, it was determined that tablets seized by law enforcement agencies contained fentanyl 89 percent of the time, and were occasionally found to consist of Alprazolam or ketamine.

"After verification with Health Canada’s Drug Analysis Service (DAS), laboratory tests of seized counterfeit oxycodone tablets (different brands, sizes and colours) were most often found to contain fentanyl (89% of the time). Much less frequently tablets were found to contain Alprazolam or Ketamine as the active ingredient. Note that DAS only analyzes a subset of the substances seized by law enforcement agencies, which would also be a subset of the substances found on the illicit market." - February 2014 CCSA Alert

This presents some serious dangers.

Just as I was writing this, the CCSA & CCENDU issued yet another alert on February 6, 2015. This latest alert warns that there "continues to be reports of fatal and non-fatal overdoses that are suspected or confirmed to involve non-pharmaceutical (illicit) fentanyl." The report also states that most of the overdoses that occurred took place in users under the age of 40 who unknowingly ingested the illicit fentanyl.

Visually, some versions of the pills are quite similar from the outside.

Others, not so much ....

Counterfeit 80mg Oxycontin. While the lettering stamped into the pill is correct, the outer coating is not the proper shade of green. It also seems to contain darker speckles of green in areas.

The top pills are real 80mg Oxycontin. Below, for comparison, is another counterfeit 80mg Oxycontin. The shade of green is clearly wrong.

Those of you who inspected the above examples thoroughly will probably have noticed that two different versions of the 80mg Oxycontin appear in the photos. Good eye! The first close-up of the pills shown, bearing the imprints "80" and "CDN," are counterfeit versions of the Canadian 80mg Oxycontin manufactured by Purdue Pharma.

Several years ago in Canada (early 2012), Oxycontin was pulled from the market and replaced with a tamper-proof version known as OxyNeo. The new tamper-proof OxyNeos contain polyethylene oxide (also found in Concerta extended-release tablets) "as part of the controlled-release mechanism and serves as an abuse deterrent." This makes the pill difficult to chew, crush, or snort, and turns it into a gel-like substance when mixed with water, making injecting extremely difficult and dangerous. They are also manufactured by Purdue Pharma, imprinted with the letters "ON" on one side, and the pill dose on the other (10, 15, 20, 30, 40, 60, 80).

Previously, Oxycontin was imprinted with the letters "CDN" on one side, and the pills dose on the other (10, 20, 40, 80, 120, 160) -- one of the counterfeit versions shown above. The other counterfeit pills shown above, bearing the imprints "80" and "OC", are knock-offs of the US 80mg Oxycontin, manufactured by Purdue Pharma. For more information, the wonderful Opiateaddictionresource.com has an incredibly thorough list of prescription Oxycodone pills, and a list of other prescription opiates, imprints, and manufacturers.

Many users tend to trust pills because they assume they are of pharmaceutical quality, but as we have seen with the counterfeit Oxys, this is far from the case. But it's not just pharmaceuticals that users have to worry about.

Over the past several years, heroin cut with fentanyl or powdered fentanyl being sold as heroin has become a dangerous problem in many areas all across Canada, as well as in the US. Even when a seasoned user unknowingly injects fentanyl (up to 100 times more powerful than Morphine), or a fentanyl-heroin mix, there is a serious risk of overdose and death.

Local Police and RCMP have also taken to releasing warnings regarding this deadly problem. RCMP in Surrey, Prince George, and Vernon, British Columbia, have all issued their own alerts, and the RCMP in cities across Canada have done the same. From Grande Prairie, Alberta, across to Moncton, New Brunswick, the alerts are pouring in. Recently in Hamilton, Ontario, the risks of fentanyl-tainted heroin prompted the Hamilton Police to take the huge step of actually offer up amnesty from criminal charges to anyone who turns over the fentanyl drugs to the Police.

fentanyl isn't the only illicit drug making headlines, though. "Molly" or "Ecstasy," a popular club drug, has also been thrust into the news recently. While the drug is commonly thought to be "MDMA" (3,4-methylenedioxymethamphetamine) among users, that is very rarely the only ingredient being thrown into the mix. In the UK, a substance known as "PMMA" (ParaMethoxyMethylAmphetamine) has been circulating widely in the form of a pill that bears the imprint of the Superman logo, and has been implicated in the deaths of four people in recent months.

What makes this drug so deadly is the fact that PMMA is far more potent than MDMA, comes on significantly slower, and is toxic at much smaller doses. This can lead a user to assume they haven't taken enough and ingest more, when in reality the PMMA simply hasn't kicked in yet -- possibly leading to overdose. Several different alerts have been issued to inform users and the general public about the dangers of ingesting the Superman pills, as well as the general dangers of PMMA and its close relative PMA.

Let's be realistic here, though. As good as the intentions are behind these warnings regarding dangerous batches of pills, such as the counterfeit Oxycontin or the Superman pills, it is not going to stop these truly unfortunate overdoses and deaths from occurring. Even when warnings are sent out about possible or confirmed bad batches, they certainly don't reach all users, nor do all users heed the warnings. It would be naive to think that whomever is behind the Superman pills only has access to that one particular design of pill press inlay stamp. By changing out the style of stamp that is inlaid/pressed into the pills (such as the superman logo/design), users would again be none the wiser of the dangers of the new batch -- at least initially.

While some of the pills are clearly counterfeits, others are relatively accurate in their designs when only inspected visually. Unfortunately, a visual inspection is the only type of test available to most users. There are various drug/pill testing kits available to users for purchase, such as the DanceSafe Pill Test Kit, although there are limitations and some mixed reviews regarding their ability to tell the difference between pure MDMA and that contaminated with other illicit drugs.

No matter how many users see the warnings regarding the dangerous Superman pills and actively avoid them, this problem will continue to occur if we continue along the current policy path.

Regardless of the associated risks, people are going to continue to use drugs. That isn't news. So how do we actually make an impact, and reduce the amount of accidental overdose and death due to bad batches and counterfeit drugs?

LEGALIZE AND REGULATE!!

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Studio L is a freelance writer living in Southwestern Ontario. She is a recovering IV drug user, methadone patient, and harm reduction advocate, and covers these issues in her blog.