Understanding Fentanyl and Counterfeit Pills

Learn about fentanyl, how it is being added to other drugs and where you can obtain Narcan and fentanyl test strips

Page updated on Aug 31, 2021 at 5:30 PM


What is fentanyl? 

Fentanyl is a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. 

Authorities are reporting that fentanyl is increasing being added to counterfeit pills. What does that mean--and why is that so dangerous?  

According to the  CDC and  DEA, illegally made fentanyl sold through illegal drug markets is being distributed across the country. It is being mixed in with other illicit drugs, like cocaine and heroin, to increase the potency of the drug—with or without the a person’s knowledge. It is also sold as powders and nasal sprays, and increasingly pressed into pills made to look like legitimate prescription pills and opioids like percocet and oxycodone.

It is possible for someone to take a counterfeit pill without knowing it contains fentanyl. It is also possible to take a counterfeit pill knowing it contains fentanyl, but with no way of knowing if it contains a lethal dose. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl with little or none of the promised drug. If a person using the substance is unaware, these substances can result in an overdose. 

Producing illicit fentanyl is not an exact science.  According to the  DEA, two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance and past usage.  DEA analysis has found counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of fentanyl per tablet. 

  • 26% of tablets tested for fentanyl contained a lethal dose. 
  • Drug trafficking organizations typically distribute fentanyl by the kilogram. One kilogram of fentanyl has the potential to kill 500,000 people. 


What are fentanyl patches and how can they be misused? 

Fentanyl can be prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse. Fentanyl patches are abused by removing its gel contents and then injecting or ingesting these contents. Patches have also been frozen, cut into pieces and placed under the tongue or in the cheek cavity.  

What are the statistics around fentanyl? 

According to the  CDC, synthetic opioids (like fentanyl) are the primary driver of the increases in overdose deaths in the United States, increasing 38.4 percent during the 12-month period ending May 2020. The Virginia Department of Health reported in April that  overdose deaths in the state rose 41.2% in 2020 to an estimated 2,297, with fentanyl-related overdoses accounting for 1,655 (71%) of all fatal overdoses. 

What are fentanyl test strips? 

Fentanyl test strips detect the presence of fentanyl, a synthetic opioid 100 times more potent than morphine, in an unregulated injectable drugs, powders and pills.  Research by the Washington State Department of Health reveals that individuals using fentanyl test strips take steps to reduce their risk of overdose. 

Does Narcan help if someone is overdosing on fentanyl? 

Yes. Fentanyl is an opioid and Narcan can reverse the effects of an opioid overdose for 30 to 90 minutes. However, many opioids—especially large doses of fentanyl—can remain in the body longer than that. Because of this, it is possible for a person to still experience the effects of an overdose after a dose of naloxone wears off. Also, some opioids are stronger and might require multiple doses of naloxone. Therefore, one of the most important steps to take is to call 911 so the individual can receive immediate medical attention. (Source:  DrugAbuse.gov

Where can residents obtain fentanyl test strips and Narcan? 

Narcan is available without a prescription at Virginia pharmacies to residents who want to be prepared to act should they personally encounter someone overdosing from opioids.

You can also request fentanyl test strips and Narcan to be mailed to you by emailing your name and mailing address to  opioids@alexandriava.gov. There is no cost for the strips, Narcan or mailing. 

Narcan is also available for free from the Alexandria Health Department by calling 703.746.4888 or emailing  opioids@alexandriava.gov

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