Inconsistency in counterfeit pills increases risk
When someone takes a tablet containing fentanyl, it’s like they’re looking at a gumball machine knowing it has hundreds of green gumballs and that odd red one.
The green gumballs are the pills that result in the user’s expected high — or sometimes have no effect at all. The red gumballs are deadly. The problem is, it’s impossible to say which gumballs are green and which are red, or even how many red gumballs there are in the machine.
This is why it’s so hard for warnings about counterfeit pharmaceuticals to get traction, says Matthew Young, a senior research and policy analyst at the Canadian Centre on Substance Abuse.
“If you are buying a pharmaceutical in the illicit marketplace, there’s no way of knowing what’s in it, or how much is in it. It’s the random unpredictability of it,” he says.
Such warnings have gained an additional poignance in recent days after the family of 14-yearold Chloe Kotval publicly called on police and public officials to take action against the prevalence of “high-grade counterfeit pharmaceuticals.”
The local teen died on Valentine’s Day from an apparent drug overdose.
Counterfeit drugs may look like prescription drugs — clandestine labs often use pill pressers that make their product look like the oxycodone tablets. But quality control is poor. Bulking ingredients are used to increase the volume of the product without increasing the amount of the active substances such as fentanyl, says the Canadian Community Epidemiology Network on Drug Use.
However, the active substances are not evenly distributed across a batch of tablets. It’s not just the potency or toxicity of the active substance that increases the risk of overdose, but the variability from one tablet to another.
People who buy lottery tickets expect that they will win, even though they know the odds are against them. Taking one of these tablets is “the inverse of buying a lottery ticket,” Young says.
It’s also a problem for those in public health who are delivering warnings about the dangers of taking these drugs. If users get no effect or if they don’t overdose, then it’s easy to dismiss warnings about lethal drugs as exaggeration or hysteria. “I don’t know how much youth are aware, really, of what’s going on. They may falsely believe if they have a good dealer that they can avoid this issue,” Young says.
Teens who use drugs less often may be at greater risk of deadly overdose than habitual users, some of whom will take precautions such as having naloxone available in case of overdose. Teens may also have a poor understanding of their tolerance, and they may mix opioids with alcohol.
I don’t know how much youth are aware, really, of what’s going on. They may falsely believe if they have a good dealer that they can avoid this issue.
Police forces, for example, have been calling for tighter regulations on the pill-pressing machines that are used to turn raw ingredients into counterfeit drugs. The machines can be purchased for a few thousand dollars and are capable of churning out thousands of pills in an hour, police say. The Canadian Association of Chiefs of Police wants federal legislation to regulate the sale of such machines.
Young would also like to see the removal of perceived barriers to calling 911. Bill C-224, a private member’s bill from Liberal MP Ron McKinnon called the “Good Samaritan Drug Overdose Act,” would amend the Controlled Drug and Substances Act, offering immunity from prosecution to anyone who calls 911 to report an overdose.
The bill is now in committee.