One Pill Can Kill: DEA's Fentanyl-Laced Counterfeit Drugs Alert

Written by Gerard Bullen | Edited By Editorial Team

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On September 27, 2021, the U.S. Drug Enforcement Agency (DEA) issued its first national Public Safety Alert in 6 years as lethal counterfeit prescription pills are now literally flooding the U.S.

Many of these fake tablets – made to resemble legitimate OxyContin, Xanax, and Adderall prescription medications and clearly aimed at the young and vulnerable – now contain a lethal dose of the synthetic opioid fentanyl.


Tragically, these fake fentanyl-laced tablets are behind record numbers of Arizona teenagers from Tucson dying from a fentanyl overdose.

In fact, fentanyl overdose is now the leading cause of accidental death for teenagers in the Arizona city of Tucson, having overtaken the rate of mortality for 12-19-year-olds from motor vehicle accidents.


This is our reality. Fentanyl overdoses have replaced car accidents as the leading cause of death for people 19 and younger in Pima County. Pima County deputy sheriffs are responding to a call involving fentanyl every 40 hours.” – Arizona Governor Doug Ducey: October 6, 2021


Fentanyl Pills

Source: DEA “One Pill Can Kill” Media Toolkit


DEA Alert: Sharp Increase in Fake Prescription Pills


Released on September 27, 2021, the DEA Public Safety Alert – “Sharp Increase in Fake Prescription Pills Containing Fentanyl and Methamphetamine” – is a stark warning to all U.S. communities that these deadly counterfeit tablets amount to a dangerous public health crisis affecting all demographics across the entire nation.


Counterfeit OxyContin Tablets, known as “M30”s or “Mexican Oxy”


Here’s a detailed summary of the pertinent information contained in the public safety alert:

DEA Warns that International and Domestic Criminal Drug Networks are Flooding the United States with Lethal Counterfeit Pills

“The Drug Enforcement Administration warns the American public of the alarming increase in the lethality and availability of fake prescription pills containing fentanyl and methamphetamine. 

International and domestic criminal drug networks are mass-producing fake pills, falsely marketing them as legitimate prescription pills, and killing unsuspecting Americans.”

“DEA and its law enforcement partners are seizing deadly fake pills at record rates. More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined.”


IMPORTANT: In fact, a staggering two-thirds of all the total number of these counterfeit pills seized this year throughout the entire U.S. were seized right here in Arizona.


Polo Ruiz, an assistant special agent at the DEA’s Tucson office, says southern Arizona is now a major gateway for illicit drugs to enter the U.S. He confirmed that the majority of illicit tablets recently seized by the DEA was in the state of Arizona. 

According to Special Agent Ruiz, “They’re using this transportation point as a means to send everything to the Midwest and west coast.”


“Officials report a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a deadly dose.

The number of DEA-seized counterfeit pills with fentanyl has jumped nearly 430% since 2019.

DEA laboratory testing further reveals that today, two out of every five pills with fentanyl contain a potentially lethal dose.

Additionally, methamphetamine is increasingly being pressed into counterfeit pills.”


Lethal Doses of Heroin, Carfentanil & Fentanyl


Lethal Doses of Fentanyl and Carfentanyl

Image (right): 2mg Dose of Fentanyl, considered potentially lethal by the DEA

Source: DEA “One Pill Can Kill” Media Toolkit


“Fake prescription pills are widely accessible and often sold on social media and e-commerce platforms – making them available to anyone with a smartphone, including teens and young adults.

These counterfeit pills have been seized by the DEA in every U.S. state, and in unprecedented quantities. 

Drug traffickers are using fake pills to exploit the opioid crisis and prescription drug misuse in the United States, bringing overdose deaths and violence to American communities.”

Drug trafficking is also inextricably linked with violence.

This year alone, DEA seized more than 2,700 firearms in connection with drug trafficking investigations – a 30% increase since 2019.”


Fake Tablets Only $2 to $5 Each


The counterfeit pills are easily purchased online to anyone with a smartphone – obviously including teens and young adults – through social media platforms like Snapchat, and e-commerce platforms, too.


According to DEA spokeswoman Jodie Underwood of the agency’s Phoenix Division in Arizona, “It used to be that 26% of the fentanyl (being trafficked) contained a possibly lethal dose. Now it’s 42%.” 


The biggest driving factor behind the criminally commercial success of these illicit opioid-based products is cost. They are readily available, easy to traffick, and very cheap – only $2 to $5 per tablet.


DEA spokeswoman Underwood also stated, “Transactions use emojis and code-words and are done in private chat rooms, and even if we were to see them, we wouldn’t recognize them. An emoji with popcorn might be code.” 

Fentanyl-Laced Fake Pills: Manufacture & Mass Production

One of the Mexican drug cartels’ most trafficked and most profitable drugs are now counterfeit medications, and it is mainly these fake pills that are behind the recent rise in fentanyl deaths of Pima County; AZ teenagers, for example.


The cartels produce the tablets from restricted precursor chemicals which are imported in bulk from China.


From these chemicals, the cartels manufacture the pills in large illegal labs, and, because they are cheap to make and small in size, they are then easily trafficked in bulk across the border.


However, the cartels are not the only criminal organizations behind the pills, as criminal homegrown drug organizations are also producing them right here in the U.S. 


DEA Administrator Anne Milgram said the agency is working hard to shut down the traffickers’ distribution networks, but it’s a seemingly endless task: “The pervasiveness of these illicit drugs, and the fatal overdoses that too often result, is a problem that cuts across America from small towns to big cities and everything in between.”


DEA-Seized Illegal Pill Press: Used to Manufacture Counterfeit Tablets


Pill press

Source: DEA “One Pill Can Kill” Media Toolkit


“DEA remains steadfast in its mission to protect our communities, enforce U.S. drug laws, and bring to justice the foreign and domestic criminals sourcing, producing, and distributing these deadly fake pills.

DEA has launched the public awareness campaign, One Pill Can Kill, to educate the public on dangers of counterfeit pills and how to keep Americans safe.”


“One Pill Can Kill” – DEA Launches Public Awareness Campaign


In conjunction with the ​​Lethal Counterfeit Pills public safety alert issued on September 27, 2021, the DEA has launched a public awareness campaign – “One Pill Can Kill.”


Part of the campaign’s aim is to educate the U.S. public – specifically, children, teenagers, and their parents – and the campaign’s media toolkit contains a group of detailed photographs showing the vital differences between authentic prescription tablets and the counterfeit pills circulating everywhere across the nation.


However, the DEA additionally warns that the high-quality images come with a critical proviso: “Do not represent the many variations of counterfeit pills. Never trust your own eyes to determine if a pill is legitimate.”


One Pill Can Kill


The Partnership of Safe Medicines – an organization that studies counterfeit drugs – said that every U.S. state has seen a death caused by a pill containing fentanyl.


Its Executive Director, Shabbir Imber Safdar, stated: “Never have we seen a death in every single state from a problem like this before. It’s unprecedented. The danger with counterfeit pills is people that have no history of addiction take one pill and die.”


I had to talk to my family about the dangers of fake pills. The DEA awareness campaign One Pill Can Kill is very clear. Don’t ever take a pill that you didn’t get from a pharmacy or hospital,” Safdar said. 

The Counterfeit Pills Being Targeted at U.S. Youth


The most commonly available of these counterfeit pills made to look like prescription opioids are:


  • Oxycodone: Oxycontin®, Percocet®, and Hydrocodone: Vicodin®
  • Alprazolam: Xanax®
  • Amphetamines: Adderall®


Clearly, the illicit Mexican cartels and U.S. drug organizations have seen the abuse of real prescription drugs in recent years, and now are producing cheap fake alternatives themselves to target the U.S. public, and, in particular, the youth, including teenagers.


Let’s look in detail at the fentanyl-laced counterfeit pills now to be easily found and purchased online across the U.S.


1. Oxycodone: OxyContin®


Legitimate Oxycodone is a prescription pain medication, and it is found in several products, including OxyContin.


OxyContin (also known as “oxy”) was developed in 1995 by Purdue Pharma to provide long-lasting pain relief, so people with severe pain would not have to take pills as often. 


However, in reality, it had been seriously and criminally mismarketed – the supposed “12-hour period of action” was nowhere near that length of time, and its potential for addiction was also criminally downplayed.


Many patients also experienced excruciating symptoms of withdrawal, including an intense craving for the drug.


OxyContin was still widely prescribed, and, unsurprisingly, quickly became associated with abuse and addiction. Users quickly found that when the tablet was crushed, the drug released into the body more quickly, which increased its effects. 


OxyContin became America’s bestselling painkiller, and Purdue reaped over $31 billion in revenue. However, OxyContin played a significant part in the U.S. Opioid Epidemic, and this continues with the fake tablets made to look exactly like them.


Street names for the drug include Hillbilly Heroin, Kicker, Oxy, Mexican Oxy, M30s, and Roxy.


U.S. Opioid Epidemic: Update


According to the American Medical Association (AMA), the U.S. opioid crisis continues to worsen. Their recent Issue Brief (now updated to November 12, 2021) states:


  • “Every state has reported a spike or increase in overdose deaths or other problems during the COVID pandemic;
  • One prevailing theme is the fact that the epidemic now is driven by illicit fentanyl, fentanyl analogs, methamphetamine, and cocaine, often in combination or in adulterated forms; 
  • Overdose related to prescription opioids and heroin remain high and also are increasingly contaminated with illicit fentanyl.”


Visual Comparison of Authentic Medication with Counterfeit Tablets:

Oxycodone (30mg) & Xanax


Oxy & Xanax Square


Images (left to right): Authentic Oxycodone, 30mg tablet (top left); Counterfeit Oxycodone, 30mg tablet (top right); Authentic Xanax tablet (bottom left); Counterfeit Xanax tablet (bottom right)

Source: DEA “One Pill Can Kill” Media Toolkit


2. Alprazolam: Xanax®


Xanax, is the leading brand name for the drug alprazolam – used for treating anxiety and panic disorders


However, it has become one of the most commonly abused prescription medications in the U.S., as recreational users take high doses of the drug-seeking a “Xanax High,” a rapidly induced, yet long-lasting euphoric state.


Between 2005 and 2013, Xanax was the most widely prescribed psychiatric medication in the U.S., and enabled many people suffering from anxiety disorders to control their symptoms and enjoy their lives once again.


However, the medication, from the class of drugs known as benzodiazepines, which also includes Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam), is designed only for short-term use, like opioid pain killing medications.


This is due to its highly addictive nature, and its recreational use, often prompted by other abusers describing the high from Xanax, has led to high rates of abuse and addiction.


Street names for Xanax include:


  • Bars

  • Bicycle Handlebars

  • Footballs

  • French Fries

  • Hulk

  • Ladders

  • School Bus

  • Xanies

  • Zan

  • Zannies

  • Zanbars

  • Z-Bars


Looking at these slang names, it is easy to see how teens and young adults could simply use emojis to describe what they want in, say, Snapchat.


According to the CDC report: “Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines – 38 States and the District of Columbia, 2019–2020”:


  • From 2019 to 2020, benzodiazepine overdose visits per 100,000 to emergency departments increased by 23.7%; both with – 34.4% – and without – 21.0% – opioid co-involvement
  • From April-June, 2019 to April-June, 2020:
    • Prescription benzodiazepine-involved overdose deaths increased by 21.8%
    • Illicit benzodiazepine-involved overdose deaths increased by 519.6%
  • During January-June, 2020, 92.7% of benzodiazepine-involved deaths also involved opioids, and 66.7% involved illicitly manufactured fentanyl


3. Amphetamines: Adderall®


Adderall and other prescription stimulants are legal, approved medicines that increase levels of alertness, attention, and energy.


However, they are classified as Schedule II drugs under the Controlled Substances Act because they have a high potential for abuse and addiction.


These medications are generally used for the treatment of:


  • Attention-deficit hyperactivity disorder (ADHD)
  • Narcolepsy (uncontrollable episodes of deep sleep) and, only occasionally,
  • Treatment-resistant depression


The most commonly known prescription stimulants being used in the U.S. include:


  • dextroamphetamine / amphetamine [combination product] (Adderall®)
  • dextroamphetamine (Dexedrine®)
  • methylphenidate (Ritalin®, Concerta®)


Fake Adderall Tablets Clearly Targeting the Young


If more proof were needed that it is teenagers and young adults who are the drug dealers’ primary target, other counterfeit pills manufactured in bulk and sent across the U.S. border include fake Adderall.


Visual Comparison of Authentic Adderall with Counterfeit Adderall


Fake Addy


Images (left to right):  Authentic Adderall, 20mg tablet (top left / mid left / bottom left); Counterfeit Adderall, 30mg tablet (top right / mid right / bottom right)

Source: DEA “One Pill Can Kill” Media Toolkit


It is not just fentanyl that is being used in these counterfeit pills – fake Adderall tablets contain illicit methamphetamine.


How are Snapchat & Others Responding to U.S. Parents’ Allegations?


On June 4, 2021, in an event organized by the Association of People Against Lethal Drugs (APALD), parents and family members gathered in 30 cities around the U.S. to protest about social media companies’ inaction on drug sales on their platforms.

The protest in Santa Monica focused on the Snapchat headquarters. Protestors brought photos of their lost loved ones framed in the Snapchat logo and the statement “Snapchat is an accomplice to my murder.”


Social Media


One mother, Amy Neville, from California, whose 14-year-old son Alexander died from a counterfeit pill purchased through the Snapchat app, organized the headquarters protest.


She stated that along with failing to keep drug dealers off their platform, Snapchat has not been responsive to law enforcement requests for information about users suspected of drug dealing.


Snapchat is a publicly-traded company with a reported $100 billion valuation that made $2.5 billion in 2020. It has an extremely younger user base compared to other platforms, so the risk of failing to address the issue effectively is now becoming a serious problem for parents.


Snapchat told us in a recent call with other victim families that they are a small company that doesn’t have the staff to respond to all the requests they get from law enforcement,” Amy Neville said.


In a public statement, Snapchat stated: “Given the number of young people using Snapchat every day, we believe that the most impactful way we can provide support and education for young people is in-app – through a program raising awareness on the impact drugs can have on users’ mental health.”


What Parents Need to Know


The DEA runs an educational resource website for U.S. parents, teachers, and caregivers, called “Get Smart About Drugs.” The website offers the following information for concerned parents:


  • Keep the communication lines open: Make sure to always have an open line of communication with your young loved ones. Let them keep you in the know about their friends, what’s happening in their school, their interests, and more.
  • Make sure they know the consequences: Because the drugs can be so readily available online, kids may believe that they aren’t really that dangerous. But many times, dealers will lace pills with other substances (like fentanyl) that will increase the drug’s potency and make its consumption even more dangerous. 
  • Check out their “searches” (if you suspect drug use): Look through their browser or Google searches (on their computer or cell phones). Keep an eye out for any “How to buy ____ online” -type searches. Bring up anything that causes strong suspicion. Make sure you point out recent cases in the news about young people overdosing on drugs.
  • Monitor their delivered packages (if you suspect drug use): Drugs are often delivered in unmarked and discreet packages. If you find your loved one getting such mail, or packages that you don’t expect, ask them about it. You also may want to stick around when they are opening the package.  

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    SpringBoard Recovery is a drug and alcohol rehab center located in Scottsdale (just outside Phoenix), Arizona, and we offer an accredited intensive outpatient drug treatment program, helping our clients successfully recover from a range of substance addictions.


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    External Sources:


  • U.S. Drug Enforcement Agency (DEA). Public Safety Alert: Sharp Increase in Fake Prescription Pills Containing Fentanyl and Methamphetamine. September 2021. Available at DEA.gov
  • U.S. Drug Enforcement Agency (DEA). “One Pill Can Kill” Media Toolkit. September 2021. Available at DEA.gov
  • U.S. Drug Enforcement Agency (DEA). One Pill Can Kill. September 2021. Available at DEA.gov
  • The Partnership of Safe Medicines. Homepage. November 2021. Available at SafeMedicines.org.
  • U.S. National Library of Medicine. The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy. February 2009. Available at NLM.NiH.gov.
  • American Medical Association (AMA). Issue Brief: Nation’s drug-related overdose and death epidemic continue to worsen. November 2021. Available at AMA-ASSN.org.
  • U.S. National Library of Medicine. A Review of Alprazolam Use, Misuse, and Withdrawal. February 2018. Available at NLM.NiH.gov.
  • U.S. Centers for Disease Control & Prevention (CDC). Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines: 38 States and the District of Columbia, 2019–2020. August, 2021. Available at CDC.gov.
  • U.S. Drug Enforcement Agency (DEA). Get Smart About Drugs. 2021. Available at GetSmartAboutDrugs.gov.

    Author: Gerard Bullen
    DECEMBER 6, 2021

    Gerard has been writing exclusively for the U.S. substance addiction treatment industry for many years, providing a range of medically-reviewed work, including white papers, long-form, and short-form content articles, and blog posts for accredited addiction treatment centers. A member of the American Medical Writers Association, Gerard’s specific focus is substance addiction (an area that has impacted Gerard’s personal life in several ways), and he is particularly drawn to the topics of professional, evidence-based treatment, new and alternative therapies, and enabling readers to find their own sustainable, long-term recovery. Gerard lives and works in Maryland, U.S., he’s happily married, and a proud father. His interests include hiking with the family, reading fiction (from the classics to virtually all of the current NYT bestseller list), American and British film classics, and his beloved dogs, Toby and Coco, both rescued from the local pound.

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