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Counterfeit pills are fake medications that have different ingredients than the actual medication. They may contain no active ingredient, the wrong active ingredient, or have the right ingredient but in an incorrect quantity. Counterfeit pills may contain lethal amounts of fentanyl or methamphetamine and are extremely dangerous because they often appear identical to legitimate prescription pills, and the user is likely unaware of how lethal they can be.


The majority of counterfeit drug production occurs in other countries, mainly China, Mexico, and India. Furthermore, an increasing number of pills laced with fentanyl are being produced in the U.S. Mexican and domestic drug trafficking organizations operating in the U.S. produce counterfeit pills with pre-made chemicals and drugs from China and/or Mexico. They are usually produced in substandard conditions, labeled incorrectly, and may include dangerous, unapproved substances. There are no quality control mechanisms in the illicit labs producing counterfeit pills to ensure dosing is not lethal. Online sales via internet marketplaces and social media are the major sources for obtaining counterfeit pills. A significant number of high school and college students purchase Adderall and Xanax from dark web drug markets and/or through social media referrals, which market deadly versions of these drugs tainted with fentanyl and/or methamphetamine. Some students begin using prescription stimulants, often referred to as “study drugs,” in the belief it will benefit their academic performance, but the nonmedical use of prescription stimulants has not been proven to improve academic performance.

What are common street names?

Counterfeit oxycodone M30 pills: Mexican Blues, Blues, M-Boxes

References for page 1

Moyle L, Childs A, Coomber R, Barratt MJ. #Drugsforsale: An exploration of the use of social media and encrypted messaging apps to supply and access drugs. Int J Drug Policy. 2019 Jan;63:101-110. doi: 10.1016/j.drugpo.2018.08.005. Epub 2018 Dec 7. PMID: 30530252.

 University of Rhode Island. "ADHD drugs do not improve cognition in healthy college students." ScienceDaily. ScienceDaily, 19 July 2018.

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What do they look like?

Counterfeit pills are nearly identical to actual prescription medications. The majority of counterfeit pills resemble
oxycodone 30mg pills (M30s), but can also mimic hydrocodone, alprazolam (Xanax), Adderall, and other medications. There are indications that drug trafficking organizations are specifically targeting kids and teens by creating counterfeit pills in a variety of shapes and bright colors to appeal to that age group. Counterfeit M30 pills can vary in color from white to blue. The best way to avoid counterfeit medication is to take only medications prescribed by a licensed medical professional and dispensed by a registered pharmacist.

authentic oxy  authentic oxy back Authentic oxycodone M30 tablets


counterfeit oxy Counterfeit oxycodone M30 tablets

authentic adderall front  authentic adderall back Authentic Adderall tablets


counterfeit adderall front  counterfeit adderall back Counterfeit Adderall tablets

Xanax authentic front Xanax authentic backAuthentic Xanax tablets (white)


counterfeit Xanax front counterfeit Xanax back Counterfeit Xanax tablets (yellow)

How are they used?

Counterfeit pills are especially dangerous because people think they are purchasing legitimate prescription medications. However, these fake pills often contain lethal amounts of illicit drugs. Distributors in the United States are selling counterfeit pills on social media, appealing to a younger audience that use these apps. Minors and young adults experimenting, as well as regular substance users, believe they are buying authentic oxycodone, Adderall, Xanax, or other medicines, but are unwittingly purchasing counterfeit pills that contain lethal amounts of drugs, usually fentanyl and methamphetamine. Fentanyl is approximately 100 times more potent than morphine, and 50 times more potent than heroin as a painkiller. Twenty-six percent of tablets tested in a DEA laboratory contained a lethal dose of fentanyl.

lethal dose of fentanyl  Lethal dose of Fentanyl

What is their effect on the body?

Counterfeit pills that contain fentanyl can be deadly. A lethal dose of fentanyl is about two milligrams, equivalent in size to a few grains of salt. Fentanyl, similar to other commonly used opioid analgesics (e.g., morphine), produces effects such as relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression. Synthetic opioids, such as illicit fentanyl, remain the primary driver of the increase in overdose deaths, accounting for 80 percent of all deaths involving an opioid. Counterfeit pills containing methamphetamine are highly addictive and act on the central nervous system. Taking even small amounts of methamphetamine can result in wakefulness, increased physical activity, decreased appetite, rapid breathing and heart rate, irregular heartbeat, increased blood pressure, and hyperthermia (overheating)

What are the overdose effects?

Fentanyl overdose may result in stupor, changes in pupillary size, cold and clammy skin, cyanosis, coma, and respiratory failure leading to death. The presence of the triad of symptoms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning. Methamphetamine overdose may result in death from stroke, heart attack, or multiple organ problems caused by overheating.

Which drugs cause similar effects?

Drugs that cause similar effects to fentanyl include other opioids such as morphine, hydrocodone, oxycodone,
hydromorphone, methadone, and heroin. Drugs that cause similar effects to methamphetamine include cocaine and potent stimulant pharmaceuticals, such as amphetamines and methylphenidate.

What is their legal status in the United States?

Fentanyl-like substances are currently emergency scheduled through October 22, 2021, as Schedule I narcotics.
Methamphetamine is a Schedule II stimulant. Drug scheduling information can be found at

For more information, visit (for parents) and (for teens).


References for Page 2:

 Centers for Disease Control and Prevention