CDC Report: Emphasize Counterfeit Pill Risks in Overdose Prevention Messaging

The number of overdose deaths caused by counterfeit pills has more than doubled from July 2019 to September 2019 to October 2021 to December 2021. It has tripled in western US states, with the majority of those who used counterfeit pills being younger, Hispanic or Latino, and had a history of prescription drug misuse and smoking, according to an article published in the CDC’s Morbidity and Mortality Weekly Report.

“Counterfeit pills can expose new populations to highly potent drugs such as [illicitly manufactured fentanyls] IMFs and illicit benzodiazepines, and persons using pills might not be aware of their contents,” wrote Julie O’Donnell, PhD, Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, and coauthors.

From July 2019 to December 2021, 106,293 overdose deaths were recorded in 30 jurisdictions. The percentage of overdose deaths that involved counterfeit pills increased from 2.0% in July 2019 to September 2019 to 4.7% in October to December 2021. This increase was mainly driven by western jurisdictions, where the percentage rose from 4.7% to 14.7%. However, all other regions reported percentages below 4%. There were 54,768 overdose deaths between January and December 2021 in 35 jurisdictions, and among them, 2437 (4.4%) were caused by counterfeit pills. The report shows that the deceased individuals who had evidence of counterfeit pill use were mostly young, with 57.1% being under the age of 35.

Additionally, a higher percentage of Hispanic or Latino individuals (18.7%) were found to have evidence of counterfeit pill use compared to those who did not (9.4%). More than half of the overdose deaths caused by counterfeit pills (55.8%) occurred in Western states, whereas only 16.3% of deaths without counterfeit pill use were in these states. IMFs and illicit benzodiazepines were more commonly involved in deaths with evidence of counterfeit pill use. IMFs were the sole drugs involved in 41.4% of deaths with evidence of counterfeit pill use, compared with 19.5% of deaths without such evidence.

Xylazine, a veterinary sedative, was detected less frequently among IMF-involved deaths with evidence of counterfeit pill use (2.1%) than among other IMF-involved deaths (7.9%). A higher percentage of individuals with evidence of counterfeit pill use had a history of prescription drug misuse (27.0% versus 9.4%). Finally, smoking was the most common non-ingestion drug use route (39.5%) among deaths with evidence of counterfeit pill use, particularly in western jurisdictions (55.1%).

Over 50% of deaths related to counterfeit pill use involved counterfeit oxycodone, either alone (55.2%) or with counterfeit alprazolam (3.9%). The use of counterfeit oxycodone was more common among Hispanic decedents, particularly in Western jurisdictions. Deaths involving both counterfeit oxycodone and alprazolam were prevalent among younger individuals, with 40% occurring among those aged 15 to 24 years. Illicitly manufactured fentanyl (IMFs) was the only drug involved in nearly half of the deaths related to counterfeit oxycodone. Illicit benzodiazepines were involved in almost 20% of deaths where counterfeit alprazolam was present.

“Overdose deaths might be reduced with effective prevention messaging by federal, state, and local public health entities that 1) highlights the dangers of pills obtained illicitly or without a prescription, 2) emphasizes the importance of taking only pills that were prescribed, and 3) encourages drug product testing,” wrote the report authors.

Reference

O’Donnell J, Tanz LJ, Miller KD, et al. Drug Overdose Deaths with Evidence of Counterfeit Pill Use — United States, July 2019–December 2021. MMWR Morb Mortal Wkly Rep. 2023;72:949–956. DOI: http://dx.doi.org/10.15585/mmwr.mm7235a3