Counterfeit painkillers bought on black market contributing to spike in overdoses

(KMSP) - As doctors make it increasingly difficult for patients on prescription painkillers to obtain them, the nation’s opiate crisis has turned many to the black market.

Risky as the decision may be, it is they only place they can turn to find the medication they have become dependent on, regardless of its lawlessness.

Yet, purchasing illicit drugs is perhaps infinitely more dangerous than ever because law enforcement in Minnesota and across the country has begun seeing more fentanyl overdose deaths.

Over the past two months, the Drug Enforcement Administration announced hundreds of thousands of counterfeit pills, many containing fentanyl, have contributed to this issue.

“We’ve never had this issue,” Carol Falkowski, one of Minnesota’s foremost experts on drug abuse, told Fox 9.

Although the powerful drug was first introduced to doctors in the 1950s, the first time most people even read the term “fentanyl” was on the autopsy report for Prince.

The potent synthetic opioid led to the Minnesota icon’s accidental death—and robbed the world of a legend.

“We have never before had a situation where such a strong drug is being sold both as a legitimate Rx pill and mixed in with illegal street drugs,” Falkowski said.

Fentanyl now permeates the black market more than any other time since its creation – a market that thrives on people in pain more than ever, Falkowski says.

“Let’s say a person is addicted to prescription pain killers, their legitimate supply runs out, it’s not uncommon for them to seek out some pills through the black market. Well if those black market prescription pills carry fentanyl it will kill them,” Falkowski said.

What’s worse – fentanyl is almost always fatal. The drug is 50 times stronger than heroin and 100 times more potent than morphine.

“The people who are pressing the fentanyl into the pills and selling them as legitimate prescriptions on the black market are absolutely merchants of death,” Falkowski said.  

Dr. Mark Willenbring, medical director of Alltyr, an addiction treatment clinic in St. Paul, says it is “scary as hell.”

“The cartels are substituting fentanyl because the profit they make from a kilo of fentanyl is about two to three times the profit they make from a kilo of heroin,” Willenbring said.

So whether someone turns to the black market to manage addiction or chronic pain, the manufacturers inside clandestine labs are likely the only people aware of what is inside the fake pills.

“Street dealers don’t usually know what’s in them,” Willenbring told Fox 9.

The amount of fentanyl it takes to kill a person is so small even the law enforcement heads warn their own against field testing the drug.

The DEA posted a video on their website in late July wherein two detectives who were inadvertently exposed to fentanyl powder while trying to secure it off the street explain the drug’s dangerous effects.

Both men inhaled a minute amount and described feeling as though they were on death’s door.

“I thought that was it,” E. Price, a county investigator says in the video, “I thought I was dying.”

“It was so quick and such a small amount we didn’t even have time to think,” D. Kallen a county investigator in Atlantic, N.J., said.

In Minnesota, several addiction treatment doctors have seen an increase in fentanyl availability over the past three years.

“The real drivers behind counterfeit pill [are] actually the dark web and bitcoin,” Joseph Lee, medical director of Hazelden Betty Ford Youth Continuum, said.

Lee says dealers use technology to easily and anonymously stock their inventory with only a few strokes on a keyboard, ignorant to whether their supply will instantly  kill their customers or not.

“I see kids from around the country who use bitcoin and the dark web to get thousands of pills from China from Canada and other clandestine labs that look like the real things in the United States,” Lee said.

Already, the Centers for Disease Control and Prevention reports synthetic opioid deaths are up 79 percent, from 3,097 in 2015 to 5,554 in 2014.

Willenbring says the instance of fake pills has surged and is pronounced in the Upper Midwest and in the Northeast, although he says, national-level data lags in supporting that claim.

However, both the CDC and DEA confirm the increase in fentanyl overdoses and deaths coincides with a rise in fentanyl availability.

The issue certainly begs a key question: why would manufacturers or dealers even risk killing customers?
“In the illegal market there’s no honor in thieves,” Falkowski said. “Or is there just so little regard for the end result that that’s not even a consideration?”

As it stands, manufacturers and dealers rely on the increasing demand for prescription pain medication.

“Everybody knows a guy, who knows a guy,” Falkowski said of how easy it is to find illicit prescription drugs.

The presence of fentanyl hidden inside the fake pills creates additional complications in hospitals as well.

“It’s a challenge for people in emergency rooms when they’re treating people for an opiate overdose to know if it’s fentanyl because they need more naloxone to reverse it than if it’s heroin or a weaker drug,” Falkowski said.

Addiction treatments specialists say the problem calls for the medical community to step up to the plate, require rehab and an informed incentive.

“The reaction to the opioid problem has been to restrict access to pain medication but not to increase access to appropriate treatment for opioid addiction,” Willenbring said, adding that the stigma around prescription pain addiction and managing chronic pain exacerbates this issue.

As doctors continue to make it a challenge for patients already on these prescriptions to get them anymore, the results of this response may only get worse before it gets better.

Willenbring expects to see more people turning to illicit drugs, more deaths and even suicides because of this issue. Which ultimately means the dependent, and the desperate, remain at high risk as many people in pain are currently prey for profit.