Overdose deaths have been consistently rising in Alaska for the past several years. Most of that is due to illegal fentanyl. And, it’s showing up more and more in pills that look like prescription drugs, but are counterfeit.
The counterfeit pills look just like the prescription opioid pills they’re mimicking. Or sometimes they’re designed to look like an anti-anxiety pill like Xanax. But they’re actually made with fentanyl–a synthetic or lab-created opioid.
Captain Tony Wegrzyn is the commander of the Alaska Bureau of Investigation. He said state law enforcement responded to Alaska’s recent jump in overdose deaths with a big effort to find and seize illegal fentanyl.
“The dosage units of fentanyl that we seized was within the millions of potentially fatal doses, so enough to kill Alaska twice over,” Wegrzyn said.
It’s too early to say, but he’s hoping that because of that work, Alaska will see a decline in overdose deaths for 2023. That data will likely be released in early fall next year.
He said fentanyl has been a boon to drug dealers because it’s potent and relatively easy to make. And his understanding is that most of the fentanyl and counterfeit pressed pills are being made in Mexico by cartels. Wegrzyn said part of the danger is that the labs making fentanyl and pressing pills are not pharmaceutical-grade.
“Those are farms in rural parts of Mexico in kitchens and bathrooms and houses,” said Wegrzyn. “There’s no beakers involved. It’s buckets and pieces of wood to stir them.”
So, he said, the distribution of the fentanyl within batches of pills is not consistent.
“Some batches may be very potent,” said Wegrzyn, “and some batches may not have anything; it might just be binder. And you just don’t know.”
According to the Drug Enforcement Administration, or DEA, six in 10 of these fake pills nationally have a potentially fatal dose of fentanyl. Wegrzyn says rates in Alaska are likely similar.
But the demographics of overdoses tend not to be young people. Less than six percent of opioid overdose deaths are of people under 24 and last year there were almost no deaths of kids younger than 14.
Coleman Cutchins is a lead pharmacist for the state health department. He said the risk profile of counterfeit pills is alarming. He said it’s not safe to take a pill that wasn’t prescribed for you.
“Honestly, we’re at the point where the risk of somebody handing you a tablet that looks like a medication [if] you don’t know where it came from, is a very similar risk to somebody handing you a syringe with a needle on it and saying, ‘Inject this,’” said Cutchins.
This is partly because fentanyl is such a powerful drug. A lethal dose of it can fit on the tip of a pencil.
“Even in the medical world, fentanyl is dosed in micrograms,” said Cutchins. “And micrograms is an extremely small unit of measure[ment].”
Cutchins said that counterfeit pills have been found at pharmacies in Mexico. But he said it’s highly unlikely fake pills would show up in a pharmacy in the United States or Canada, where there’s much stricter oversight on drug manufacturing.
But Americans sometimes get prescriptions from Mexico, either in person or online, because the prices are lower and the restrictions looser. The Centers for Disease Control and Prevention warns Americans not to do that.
Cutchins said fentanyl is a huge issue now. But he’s also concerned because this current wave of the opioid epidemic seems to be full of synthetic opioids, which are lab-produced. And he’s worried things will get worse.
“We’re kind of on the front end of this wave,” said Cutchins. “And we’re a little bit in the dark. And so like, what’s going to happen next, in terms of the evolution of synthetics. And they’re becoming so much more powerful, and [have] so much more potential to cause injury and to cause death. That is just very different than it’s been in the past.”
Right now, Alaska and the rest of the U.S. rely heavily on Narcan or naloxone to reverse opioid overdoses. Coleman said his biggest fear is that a lab will create a type of fentanyl that can’t be reversed by Narcan.