The steep recent increase in overdose deaths and near-deaths nationwide involving fentanyl signals a new chapter in the epidemic of opioid use. Throughout the United States and Canada, seizures of pill presses, large quantities of active pharmaceutical ingredient in powder form, and counterfeit pills have been reported. Since fall 2013, the highly potent opioid fentanyl and its analogues have contributed to more than 5000 overdose deaths in the United States. In 2014, one-fifth of Ohio’s overdoses were associated with fentanyl; in 2015, two-thirds of New Hampshire’s fatal overdoses and half of Rhode Island’s overdoses were associated with fentanyl. The research letter by Arens et al1 in this issue of JAMA Internal Medicine reports a case series of counterfeit Xanax (alprazolam) tablets containing fentanyl and etizolam detected by poison control and emergency medical professionals in San Francisco, California. The authors should be commended for identifying and warning the public, to prevent further harm occurring as a result of the supply of this counterfeit medication.
Traci C. Green, Michael Gilbert. Counterfeit Medications and Fentanyl. JAMA Intern Med. 2016;176(10):1555–1557. doi:10.1001/jamainternmed.2016.4310