When Charlie, my healthy 22–year–old son, died in May 2020, I had heard of fentanyl; I didn’t know it was common in street drugs. I soon learned that a bootleg formulation of the potent, deadly opioid was the main ingredient in the fake Percocet that killed my son. Of the 108,000 poison pill deaths in 2021, 80% were due to these realistic looking “fentapills,” which are intentionally designed to look like familiar medications, such as Oxycodone and Xanax.
When I recount Charlie’s death, a common reaction is “Wait. What? Fake pills with fentanyl?” I then explain drug traffickers are intentionally making counterfeit prescription pills and selling them as legitimate medications, often to unsuspecting young people who are seeking to relive stress or otherwise self–medicate. This is no fluke. This is their new business model. Regrettably, it is here to stay.
Since Charlie’s death, my wife Mary and I have devoted our time and energy to warning youth and parents about this deadly new risk. We have taken a deep dive into the fentanyl epidemic and related issues, speaking at length to experts in all relevant fields. This is the first time we have published our experience in a peer–reviewed medical journal. We hope physicians and other healthcare professionals will join the effort to flatten the fentanyl poisoning curve.
Essentials of the Fake Pill Death Pandemic
• The drug landscape has changed forever with the emergence of fentanyl, deceptive marketing and social media.
• Counterfeit pills put a new demographic at risk—teens and young adults who are often experimenting or self–medicating.
• Updating our national response takes time. We desperately need to alert kids and parents right now.
• Medical professionals (doctors) are well positioned to educate families.
Seismic Shift: From the Farm to the Lab
The drug landscape has shifted. Back in the day, when drugs were plant–based, we were warned about “getting off on the wrong track” and possibly becoming addicted to booze or coke or, God forbid, heroin. Today, in the age of fentanyl and fakery, the world of street drugs is like a minefield; your next step (or perhaps your first) may be fatal.
The seismic shift started with the migration of drug production from the farm to the lab. For eons, we humans have cultivated and processed plants for their nutritional, medicinal, and euphoric effects. Ultimately, the supply of our intoxicants was subject to the same limitations as our food, like geography, weather, and yield. Not anymore. Synthetic opioids like fentanyl are a mixture of freely available chemical precursors that can easily be produced anywhere, in unimaginable quantity. This is going on 24 hours per day. No sophisticated equipment is required. And what happens when supply of any commodity can rise almost effortlessly to meet demand at any level? The price plummets.
Illicit, street/internet level fentanyl and its many chemical analogues are up to 100 time stronger than morphine and 50 times more potent than heroin. Fentanyl is cheap and potent. The properties equate to enormous profits for drug dealers. Fentanyl is the ‘Mother Lode’ of drugs and dealers at every level are working it into their product lines.
Synthetic fentanyl is the proverbial better mousetrap. Regrettably, there are new substances in the pipeline, like nitazines, another opioid yet more potent than fentanyl. Of course, this new generation of street drug makers are not PhDs.
They are amateurs; keyboard chemists researching compounds online and devising formulations by trial and error. And American drug consumers, many young and unsuspecting, are their lab rats.
Fakery—What You Don’t Know Might Kill You
The earthquake of fentanyl was soon followed by a powerful aftershock—fakery. About 2014, profit–driven drug dealers began cutting fentanyl into heroin without telling their customers. Overdose deaths spiked. Since then, thousands of people have died after taking ecstasy, methamphetamine, or cocaine cut or contaminated with fentanyl.
The most despicable use of illicit fentanyl is when drug traffickers use it as the active ingredient in counterfeit prescription pills. The buyers of these products are usually younger, less savvy kids who are experimenting or self–medicating. They go online seeking legitimate medications, which they expect to be consistent, regulated, and safe. They are offered pills that look and feel like those commercial products. But they are fake. Fentanyl and filler—unevenly dosed and often fatal.
The combination of fentanyl and fakery has permanently upended the drug landscape—from a path with warning signs to an unmarked minefield. And we are seeing the deadly results. Previously unaffected groups—experimenting teens, self–medicators, occasional partiers—have been pulled into the danger zone by the deceptive practice of selling drugs laced with fentanyl without the buyer’s knowledge or consent. Consequently 77% of drug related deaths among teens ages 14–17 involve fentanyl.
The New Drug Talk—Just Say ‘Know’
Mary and I decided early in our journey to take our warning message directly to youths and parents. We partnered with all major social media platforms to target our content to ages 13 to 24 and their caregivers. We have reached over 60 million unique viewers since our campaigns launched in July 2021.
Our online messaging needs a louder voice. We recently commissioned a survey to determine what Gen Z knows about fentanyl. The results hold some promise and present some challenges. Although general awareness of fentanyl is up since 2021 (from 31% to 40%), only 48% have heard about fentanyl in fake prescription pills. We have more work to do.
Physicians and medical workers, this is where you can help. When asked who they trust to provide reliable information about fentanyl, 76% of young Americans ranked healthcare professionals first. You have a unique opportunity to turn the tide of this unprecedented crisis; one–on–one, up close and personal.
COVID serves as an equalizer. As we slowly emerge from the pandemic, mental health issues have become mainstream, less stigmatized. This helps to facilitate conversations about the dangers of self–medication in the age of deadly fentanyl. It makes sense to have the “drug talk” in the context of a public health warning for youth. Acknowledge and honor their stress and anxiety. Tell them they are not alone with these problems. Coach them that relieving stress by self–medicating is no longer an option. As we say, “You can’t solve real problems with fake pills.”
Our strategy is to engage young people and empower them to protect themselves and their friends. This means taking a “Just Say Know” approach—give them the facts they need to make informed decisions and spread the word among their peers. We have designed the website: www.songforcharlie.org as a resource for “real talk about fake pills.”
Originally published in Missouri Medicine and reprinted with permission.
