Fentanyl is now the #1 cause of death among 18- to 45- year olds in the U.S., and Placer County is no exception. In 2020, 24 Placer County residents died from fentanyl poisoning and nearly half of them were under 25 years of age. That’s a 700% increase from 2019.
A fentapill is a counterfeit prescription pill purposely made to resemble legitimate medicines, but instead is made of illicit fentanyl or an illicit fentanyl analog.
There are two types of fentanyl you need to know about.
Fake pills are illegally made in garages, basements, and other clandestine settings by unqualified drug makers who do not ensure the quality or consistency of the dose. When batches of fake pills are mixed, each pill may contain a different amount of illicit fentanyl making the dose of each pill impossible to predict.
These products are not regulated and there is no way to ensure consumer safety. Because of this, use of illicit fentanyl is very dangerous. Illegally manufactured fentanyl is involved in the majority of U.S. drug deaths in recent years.
*One of the other negative aspects of poor quality control is that at times, the “illicit fentanyl” is not actual fentanyl. Within an illicit fentanyl supply, there may be unreacted precursor chemicals, byproducts that form due to poor heating or stirring, etc. Also, the amateur chemists can change the ingredients (precursors) of the recipe to form “fentanyl analogs.” Pharmaceutical grade fentanyl is manufactured under strict, government regulated quality control standards so that precursor chemicals or byproducts that are left over from the synthesis process are removed as the final fentanyl product is purified.
In toxicology, the lethal dose for a substance is referred to as the LD50, or median lethal dose, which is the amount that is needed to kill 50% of a sample group. Toxicologists point out that it is impossible to determine a precise LD50 for opioids because tolerance builds in lab subjects as the dose is increased. In other words, the lethal dose for any opioid is a moving target, technically speaking.
The DEA says that 2 milligrams (mg) of dry powder fentanyl is a “potentially lethal dose.” This general statement makes the point that a small amount can be deadly. In fact, the actual amount of fentanyl that will cause death varies depending on the person’s weight, whether they have used opioids before, their metabolism, their general health, and more. The amount of fentanyl that will kill a 110-lb person who has never ingested opioids will be different than the amount that will kill a 220-pound opioid dependent user. Therefore, a “lethal dose” may not cause death to everyone who consumes it. Conversely, a person could die from an amount of fentanyl that is less than the “lethal dose” of 2mg.
Illicit fentanyl is an ideal raw material for drug dealers. It is cheap to get and extremely potent. Because it is potent, only a tiny amount of powder is needed to make large quantities of drugs, making it easy to hide from law enforcement and extremely profitable to sell. Money is the biggest driver of illicit drug sales. Trying to get real prescription pills from the pharmacy to the street is difficult and risky. Pressing out a fake oxy is easy and costs the maker just pennies per pill. If an oxy sells for 40 bucks on the street, almost 100% of that goes in the dealers’ pockets. Apply that math to a batch of 5,000 or 10,000 pills and you can see there is A LOT of money to be made by the dealers up and down the supply chain.
Let’s look more closely at how fentapills get into the buyer’s hands. The people making the pills usually sell them to other dealers, who sell them to other dealers, and so on, many times before the deadly pills are sold to the buyer. Whether the pills are made in Mexico or in the U.S., it is highly unlikely that the people making the fentanyl powder and fentapills, or the higher-level dealers, even know that their product has killed someone. They have made their money and moved on. Buyer beware: even a trusted friend does not know what is in the drugs they are giving you; they cannot test the dosages of their pills and have no way of backing their claim that the pills they are offering are safe.
Not all fentapills contain a lethal dose, so many people take a fake pill, assume it was real and then get comfortable taking another. This creates demand, especially since fentanyl is so addictive. This is another feature that dealers like – dependent customers are repeat customers, and that market segment is growing.
As fentanyl deaths continue to rise, there is momentum behind promoting Fentanyl Test Strips (FTS) as part of a harm reduction strategy. The most widely distributed FTS is the Rapid Response Fentanyl Test Strip manufactured by BTNX. These FTS are designed to detect several common fentanyl analogs in urine; they were not designed to test pills.
The Harm Reduction community has adopted “off label” uses for the BTNX FTS and actively promotes their use (with significant disclaimers) for testing heroin, cocaine, meth and MDMA. There is strong evidence that FTS detect fentanyl in liquid samples with a high degree of accuracy. However, there are limitations specific to testing fentapills that reduce their usefulness.
Because of these limitations, FTS do not guarantee safe use of illicit pills.
*Because the fentanyl is never evenly distributed throughout the base powder mixture, part of the pill might have no fentanyl while the other part has a lot. Once the pill is pressed, the components are locked in place. This is called the chocolate chip effect.
An analog is a compound having a structure similar to that of another compound, but differing from it in respect to a certain component. Some fentanyl analogs have been created by pharmaceutical companies for legitimate medical use. Others have been developed by illicit drug traffickers to get around drug laws.
Wikipedia currently lists 84 different fentanyl analogs, and new fentanyl analogs are still being formulated. Not all fentanyl analogs have the same potency. For instance, carfentanil is 100 times stronger than fentanyl (and 10,000 times more potent than morphine).
Source: Song for Charlie
Fentanyl poisoning has killed dozens of Placer County residents since 2019. In the “One Pill Can Kill” podcast, we take a deeper look at the epidemic of fake pills and its impacts on our community, what you can do to keep your family safe, and how Placer County health, law enforcement and education agencies are working to address it. The “One Pill Can Kill” podcast is presented by the Placer County Health and Human Services Department, Sheriff’s Office and District Attorney’s Office.