Fake Prescription Pills Increase the Burden of Overdose Epidemic

The Drug Enforcement Administration (DEA) on Monday released a public safety alert for a sharp increase in fake prescription pills laced with fentanyl and methamphetamine. In 2021, more than 9.5 million fake pills have been seized so far, more than the last two years combined, according to the DEA.

The contamination is linked to prescription opioids like Oxycontin, Percocet, Vicodin, Xanax or stimulants like Adderall, which are often sold illegally on social media and e-commerce platforms, according to the DEA. The alert does not apply to drugs prescribed by medical professionals and dispensed by licensed pharmacists.

These fake pills may contain increased potency of already dangerous drugs and contribute to the overdose deaths, which have hit a record high during the COVID-19 pandemic.

“Methamphetamine is extremely potent in one drop,” Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), tells Verywell. “Dealers are not going to be mixing methamphetamine with properly manufactured prescription medication, because they’re much more expensive—it would cost them a lot of money.”

Lacing Already-Harmful Drugs With More Harmful Drugs

Fentanyl is most commonly found in fake pills, but meth contamination is also increasing, according to the DEA. Fentanyl is also a contaminant in some illegal meth drug sales, the combination of which can be increasingly lethal, Volkow explains.

“The moment that you add fentanyl into any of these drugs that are manufactured, you make it much more powerful,” she says.

According to DEA lab testing, two out of every five pills with fentanyl have a potentially lethal dose.

Overdose deaths from meth have nearly tripled in recent years. A national study found that from 2015 to 2019, overdose death from psychostimulant drugs other than cocaine—largely meth—rose 180%. But meth use has only increased by 43% in the same period.

The discrepancy can be explained by riskier drug use patterns and higher drug potency, Volkow says. People might be using drugs alone or in excessive amounts.

The study also showed that American Indian and Alaska Native communities are most at risk for meth misuse. Public health approaches should be tailored to address the needs of underserved communities, Volkow adds.

Ongoing Research for Overdose Interventions

More interventions are needed to reduce overdose rates, as there’s currently no medication approved by the Food and Drug Administration (FDA) to treat methamphetamine use disorder, Volkow says. Scientists are also researching the effects of Naltrexone and Bupropion on people who have methamphetamine use disorder.

Therapeutic strategies like contingency management, a type of behavioral therapy where people are positively reinforced for a changing behavior, can yield positive results, she adds. Unfortunately, this cannot save someone who is actively overdosing.

“If someone is in the emergency department with a methamphetamine overdose, we don’t have any medications to solve that,” Volkow says.

NIDA is currently supporting a study that examines how well monoclonal antibodies could work against meth overdoses. The antibodies may block the drug from entering the brain of the user, thus stopping it from producing harmful physical effects and addictive qualities. 

“If you have the antibodies, then you’re not going to feel anything,” Volkow says. “Importantly, your brain will learn that this drug is no longer decreasing your craving; it’s ineffective. As it learns more and more, it starts to shift from having that craving and the desire to seek out that drug.”

Similar studies are in place to see how well a vaccine could work against methamphetamine toxicity. The vaccine is similarly to the proposed antibody treatment, but it would teach the body to generate antibodies instead. When comparing the two methods, monoclonal antibodies may be able to induce a more robust response, Volkow says.

If the patients are not ready to pursue sobriety, they may gravitate towards a different drug or increase their meth use to try to feel “high,” which would be dangerous, she adds. As a result, the treatment may not be effective for someone who is not ready to end an addiction and should be taken voluntarily.

Phase 2a of the clinical study on antibody use for meth toxicity is expected to complete by September 2022.