Big leap in fentanyl seizures in pill form in US, says study

Fentanyl is one of the main drivers for an epidemic in opioid-related deaths still sweeping the US, and a new study looking at seizure data in the US gives serious cause for concern.

The study looked at fentanyl seizures in the US between 2018 and 2021, breaking down the data between fentanyl in bulk powder form and fentanyl-containing tablets – which are often counterfeits of other medicines like oxycodone or alprazolam.

 The bulk volume of seized powder rose around eight-fold, from 298 kg in the first quarter of 2018 to 2,416 kg in the last three months of last year. Even more alarming was the amount of sized pills – up from 42,200 to almost 2.1 million over the same period.

In fact, the proportion of seizures in pill form more than doubled from around 14% at the start of the study period to 29% by the end, which the researchers say  is raising the risk of unintentional exposure to fentanyl.

That's a worry, as fentanyl was responsible for almost half of the 67,000 drug overdose deaths in the US in 2018. It is a schedule II prescription opioid – approved by the FDA for use in severe pain – and is 50 to 100 times more potent than morphine.

Previously, it was almost always the case that fentanyl powder would be shipped from source countries like China and Mexico, to be pressed into pill form once within US borders.

The authors of the study, led by Joseph Palamar of New York University Grossman School of Medicine, say they are particularly concerned for opioid-naïve individuals who consume counterfeit benzodiazepines such as alprazolam, who may be at particularly high risk of overdose.

"Public education about the risk of non-pharmacy-sourced pills containing fentanyl needs to be more widespread," they write, pointing to a 2019 study showing that awareness among nightclub and dance festival attendees of fentanyl was only around 53 per cent.

They also recommend increased access to naloxone to reverse the effects of fentanyl in overdose, fentanyl test strips that can be used by consumers to check pills, and real-time surveillance to detect when fentanyl pills are being distributed and allow timely warnings.

"Prevention and harm reduction efforts are needed to help prevent unintentional overdose among those at risk for fentanyl exposure through counterfeit pills," according to the researchers, who have published their work in the journal Drug and Alcohol Dependence.