In March and April, 56 people in the Sacramento area were hospitalized after taking Norco brand hydrocodone pills. Fifteen died.
But, as we discovered, these pills were not pharmaceutical hydrocodone at all. They were counterfeits containing fentanyl that were purchased on the street. Fentanyl is an opioid far more powerful than hydrocodone. Counterfeit pills containing fentanyl were also found in Prince’s home.
While fentanyl made by pharmaceutical companies is sometimes diverted to the black market, since 2013 the distribution of illicitly manufactured fentanyl has risen to unprecedented levels.
These illicitly made substances are generally formulated to look like others drugs—heroin or oxycodone tablets. This means that users may not be aware they are taking fentanyl or another synthetic opioid. For instance, our work at the Clinical Toxicology and Environmental Biomonitoring Laboratory at UCSF has identified counterfeit Norco containing fentanyl and a new synthetic opioid that is chemically unrelated to anything used in medicine. Fentanyl has also been found in counterfeit Xanax, an anti-anxiety drug.
We study the pharmacology and toxicology of new psychoactive substances (NPS). These entirely synthetic, illicitly made “designer drugs” are designed to work on the same receptors in the body as drugs like marijuana, methamphetamine, or heroin. The adulteration of counterfeit pharmaceuticals and street drugs with synthetic opioids is arguably the most worrying new trend in our field.
