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The Unfortunate Rise of Fentanyl-Laced Pills

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Oct 2, 2023 • 8 cited sources

The rise of fentanyl laced pills sold on the street has paralleled an increase in overdose deaths. 

To increase their profits, criminal networks are producing counterfeit pills that look like legitimate prescription drugs, such as oxycodone or Xanax, but are made entirely from fentanyl. They are also cutting drugs like cocaine or heroin with fentanyl because it is cheap and powerful, helping to increase their profits while giving buyers a potent high.[1] 

The components of these products may be trafficked into the U.S. and made here, or the fentanyl-laced drugs may be smuggled in ready to be sold. These drugs are often distributed online through social media and e-commerce websites or on the street. 

The Rise of Counterfeit Fentanyl-Laced Pills 

Fentanyl-laced counterfeit pills have led to an alarming rise in overdose deaths, grabbing the attention of the medical community, lawmakers and the general public.

Fentanyl is a drug that is very inexpensive compared to other illicit substances sold on the black market. It is potent in very small amounts. This makes it an easy way to boost the strength of street drugs quickly and surreptitiously. 

Just a small amount of the powder can be mixed in with a batch of heroin or cocaine and be unnoticeable to the naked eye. Because only a small amount is needed, drug makers may include seemingly innocuous substances like baby powder or cornstarch to bulk up the weight of the final product while saving money.[1]

In some cases, the powders are molded into the shape and size of a commonly requested prescription drug that is hard to find on the street, such as Xanax or OxyContin, complete with the same markings one would find on the legitimate drug. Unfortunately, due to the fentanyl content, the pills do not have the same effect as the drugs that they are designed to look like. Users who believe they are taking a less potent substance often inadvertently overdose because of fentanyl’s potency.[2]

Overdose From Fentanyl-Laced Counterfeit Pills

According to the Centers for Disease Control and Prevention, between July and December 2019 and the same period in 2021, teenage overdose deaths increased by 109% and deaths caused by illicitly manufactured fentanyl increased 182%. About 25% of these deaths were due to the use of fentanyl-laced counterfeit pills.[3]

What Do Counterfeit Pills Look Like?

Counterfeit pills can vary widely in appearance, as they are often designed to mimic the look of legitimate prescription medications to deceive users.[4] 

It’s not just opioids that are laced with fentanyl. Any pill sold on the street, including sedatives like Xanax and stimulants like Adderall, may be made entirely or in part with fentanyl. These counterfeit pills can look exactly like the legitimate prescription pills do.

Specific Types of Counterfeit Pills

The pills commonly sold on the street that might contain fentanyl include the following: 


Opioids are some of the most commonly counterfeited pills on the street. Oxycodone is one of the most desired opioids for misuse. The pills are typically round and come in various hues, depending on the dosage. 

Fake oxycodone pills are so prolific that it is impossible to tell the difference between them and the real thing just by looking at them.[5] It’s very common for street oxycodone to be laced with fentanyl.[7] 


Hydrocodone is slightly less potent when compared to oxycodone.[8] People who unwittingly purchase a fentanyl-laced hydrocodone pill may be more likely to overdose because they are used to taking the less potent opioid.


Xanax is an anti-anxiety medication commonly prescribed to treat anxiety disorders and panic attacks. Counterfeit Xanax pills, often referred to as bars due to their rectangular shape, can be as dangerous as fake hydrocodone pills. Consumers are seeking a less potent substance in Xanax and may accidentally overdose on fentanyl if it is present.[6]

Other Opioids

Dealers sell counterfeit Percocet, codeine and other opioids that are laced with fentanyl. Any opioid drug that is sold on the street can be cut with fentanyl.

How & Where Are Fentanyl-Laced Pills Sold?

Fentanyl-laced pills are often sold online through social media platforms or e-commerce websites.[4] Illicit dealers take advantage of the anonymity and convenience offered by such websites to exchange cash for drugs with very little contact with the buyer. The chances of getting caught online are often lower than they are in person.

These are some of the common ways that fentanyl-laced pills are sold on the black market:

Social Media

Illicit drug dealers may utilize social media platforms like Facebook and Instagram to market and sell fentanyl-laced pills through the sales groups or using the shop function. 

They create private or public accounts where they advertise their product using coded language, emojis or images that hint at what type of pills are for sale.[6] Private messaging or direct messaging features are then used to complete transactions.

Darknet Markets

Darknet markets are hidden websites that are only accessible with special software like Tor. These underground online marketplaces sell all sorts of illegal goods, including counterfeit pills containing fentanyl.[4] Buyers and sellers communicate using encrypted messaging systems in order to arrange the details of transactions.

E-commerce Platforms

Some illegal drug dealers use e-commerce platforms as a way to list and sell their products, either creating fake online stores or listing items using code words or misleading descriptions on legitimate platforms. Transactions take place through private messaging or email.

Forums & Online Communities

Illicit drug forums and communities on either clearnet (regular internet) or darknet double as online venues for individuals to gather and discuss drug-related topics, share information and facilitate transactions related to illicit substances like fentanyl-laced pills in an anonymous setting. 

While these discussions are more likely to take place in darknet settings, they still occur in standard online forums.

Peer-to-Peer Platforms

Some decentralized, peer-to-peer platforms like cryptocurrency marketplaces allow individuals to transact directly without going through intermediaries. These platforms may be used for buying and selling various illicit goods that neither party wants tracked, including drug purchases.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. What is fentanyl and why is it behind the deadly surge in US drug overdoses? UMass Chan Medical School. Published May 10, 2022. Accessed August 19, 2023.
  2. Acting U.S. attorney warns of increasing danger of counterfeit prescription opioids containing fentanyl. U.S. Department of Justice. Published December 8, 2021. Accessed August 19, 2023.
  3. Tanz LJ, Dinwiddie AT, Mattson CL, O’Donnell J, Davis NL. Drug overdose deaths among persons aged 10 – 19 years — United States, July 2019–December 2021. Morbidity and Mortality Weekly Report. 2022;71:1576–1582.
  4. Counterfeit pills fact sheet. Drug Enforcement Administration. Published September 2021. Accessed August 19, 2023.
  5. One pill can kill. Drug Enforcement Administration. Accessed August 19, 2023.
  6. Emoji drug code | decoded. Drug Enforcement Administration. Accessed August 19, 2023. 
  7. Shover CL, Falasinnu TO, Dwyer CL, et al. Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance. Drug Alcohol Depend. 2020;216:108314. doi:10.1016/j.drugalcdep.2020.108314
  8. Walsh SL, Nuzzo PA, Lofwall MR, Holtman JR, Jr. The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers. Drug Alcohol Depend. 2008;98(3):191-202. doi:10.1016/j.drugalcdep.2008.05.007

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