Two-thirds of illicit pills in Washington DC fake; study

It is well established that a lot of the illicit pills sold on the street are outright counterfeits, but there's not been much work to determine the exact proportion – until now.

Researchers in Washington DC have carried out an analysis of 567 prescription pharmaceutical pills sent to the DC Department of Forensic Sciences (DFS) for analysis over a 56-month period, and concluded that overall 119 of them – 21 per cent – were counterfeit.

Moreover, the proportion of counterfeits rose steadily from the start of the study, and by 2021 almost 63 per cent were deemed to be fake, with most of them (57 per cent) blue pills stamped with '30M' – consistent with the conformation of a 30 mg oxycodone tablet.

In 2017, all suspected pharmaceutical pill exhibits processed by the DC DFS were determined to be genuine pills.

As expected, the most common psychoactive substance found in the counterfeits was fentanyl – which is 50 to 100 times more potent than morphine and a major cause of overdoses and deaths in the US and elsewhere – found in 75 per cent of samples.

Also encountered commonly was tramadol, a lower-potency which is used as an adulterant in fentanyl, as well as the benzodiazepine etizolam.

"Counterfeit pill manufacturers often use fentanyl because it is widely available, highly potent, and costs less than other opioids," write the authors in the journal Forensic Science International.

Among the other findings from the sampling study was that there have been increasing numbers of falsified pills stamped with 'K 56', 'RP 10 325' and 'R P 10' – all mimicking oxycodone products – as well as C 230 which is used on acetaminophen/oxycodone fixed dose combinations.

The dominance of 30M could be because ’30M′ die moulds can be easily purchased on the dark web, according to the DFS scientists.

"These counterfeit pills pose a considerable threat to public health, made worse by the illicit market's disregard of safe limits of drug concentrations and/or drug combinations," they write.

"As the opioid epidemic continues to evolve, it is necessary to enhance drug surveillance for these counterfeit pharmaceutical pills."

In one recent case, federal agents seized more than 478,000 counterfeit pharmaceutical pills laced with fentanyl, as well as about 51 kilograms of methamphetamine, 10 kilograms of cocaine, 4 kilograms of powder fentanyl, and 4 kilograms of heroin.