Mexican Pharmacies Sell Counterfeit Drugs to U.S. Tourists

By Pat Anson, PNN Editor

With opioid pain medication increasingly harder to obtain in the United States, a growing number of Americans are heading south of the border to get painkillers and other prescription drugs in Mexico.  That’s a risky activity, according to UCLA researchers, who found it was fairly common for Mexican pharmacies to sell counterfeit medication to unsuspecting tourists.

The researchers visited 40 pharmacies in Northern Mexico and purchased samples of oxycodone, hydrocodone, Xanax and Adderall, most of which were obtained without a prescription. Immunoassay testing strips were then used to check each pill for the presence of fentanyls, benzodiazepines, amphetamines and methamphetamines.

Eleven of the 40 pharmacies were found to be selling counterfeit drugs. Of the 27 “oxycodone” tablets purchased, 11 were made with either illicit fentanyl or heroin. One pill sold as “Vicodin” only contained lactose and the weaker opioid tramadol.

Nine of the 11 “Adderall” pills contained methamphetamine, while none of the Xanax pills were found to be counterfeit.  

The study findings were first reported online in medRxiv, a website that publishes new medical research before it is peer-reviewed.

FAKE OXYCODONE PILLS

“It is not possible to distinguish counterfeit medications based on appearance, because authentic and counterfeit versions are often sold in close geographic proximity and are visually and otherwise indistinguishable from one another. Nevertheless, US tourists may be more trusting of controlled substances purchased directly from pharmacies,” the UCLA researchers said, noting that overdoses are poorly monitored in Mexico, making it difficult to know how many people have died from taking counterfeit pills.

Researchers say the growing trade in counterfeit drugs – both north and south of the border – is due in part to a decade-long crackdown on prescription opioids. Since 2010, opioid prescriptions in the U.S. have fallen by nearly 50 percent.

“These decreases have been shown to have affected many patients with known painful chronic conditions, including terminal cancer, and other palliative care patients. Many patients have been rapidly tapered off opioid regimens, which has been associated with increased rates of suicide and drug overdose. A large unmet demand for diverted and legitimate prescription opioids has led to widespread consumption of counterfeit opioids in the US by witting and unwitting consumers,” researchers said.

One such case involves Jessica Fujimaki, a 42-year-old intractable pain patient, who lost access to opioids after the DEA suspended her doctor’s license to prescribe controlled substances last November. Desperate for relief and going into withdrawal, Fujimaki and her husband made two trips to Mexico from their home in Arizona to buy opioids, but were uncertain of the quality of drugs they purchased. She died in December.   

‘These Are Really Strong!’

Perhaps the most widely available counterfeit drug is “Mexican Oxy” – small blue pills that are designed to look like 30mg oxycodone pills. One of the UCLA researchers asked for oxycodone when he visited a Mexican pharmacy:

“We head into the pharmacy and ask for Oxy. The pharmacy employee flashes us a smile and says ‘I have Mexican Oxy or I have American Oxy. American Oxy is 35$ for 20mg, and Mexican Oxy is 20$ for 30mg.’

‘Why is the Mexican Oxy stronger and cheaper?’ I ask.

‘Oh the Mexican oxy is very strong, but it’s cheaper because they give it to us for cheaper,’ he says. ‘You should only take half, and even that’s going to be a lot. The full one might be too dangerous.’

I say, ‘Okay, we’ll take the Mexican Oxy.’ He goes under the counter and pulls out a cardboard box full of syringes. He reaches underneath the needles, and pulls up this false bottom on the box, and the bottom is full of these little blue pills, just loose in the box.

He takes one out of the pile and puts it in a little plastic bag for us. As he hands it to me. He’s says, ‘Okay guys, these are really strong! Please be careful.’”

When that “Mexican Oxy” pill was analyzed later, it tested positive for fentanyl.  

Two reporters for the Los Angeles Times recently found how easy it is to get counterfeit medication in Mexico when they visited pharmacies in Tijuana, Cabo San Lucas and several other northwestern cities. The reporters found that 71% of the 17 pills they purchased were fake. The “oxycodone” and “hydrocodone” pills tested positive for fentanyl, while pills sold as “Adderall” tested positive for methamphetamine.

Asked to comment on the Times investigation, the U.S. State Department, DEA and the White House Office of National Drug Control Policy failed to respond to repeated inquiries. Local and national government agencies in Mexico also ignored requests for comment.

Most of the drug experts interviewed by the Times said they’d never before heard of pharmacies selling counterfeit pills.

“I haven’t seen anything like that,” said Cecilia Farfán-Mendez, a researcher at UC San Diego’s Center of U.S.-Mexican Studies. “I think it speaks to the lack of law enforcement monitoring what’s happening in the pharmacies.”

Medical Examiner: ‘I Can’t Remember Last Death From Prescribed Fentanyl’

By Pat Anson, PNN Editor

A recent statement from the San Diego County Medical Examiner’s Office caught our eye – because it offered a rare distinction between prescription fentanyl and counterfeit painkillers made with illicit fentanyl.

It’s an important point for millions of pain patients who use fentanyl responsibly.

“In the last decade when someone overdosed on fentanyl, it was often when someone was prescribed it, and perhaps put on too many fentanyl patches or altered the patches,” said Chief Deputy Medical Examiner Dr. Steven Campman. “I can’t even remember the last time I saw a death from misused prescribed fentanyl.”

Campman was talking about a 68% increase in fentanyl overdose deaths in San Diego. During the first six months of this year, 69 people overdosed on fentanyl -- compared to 41 the year before – and every one of those deaths was attributed to illicit fentanyl.

“Now, in the deaths we see, the fentanyl is illegally obtained as counterfeit oxycodone or alprazolam (Xanax). Illegal drug makers and dealers make pills to look like oxycodone or alprazolam, but the pills have fentanyl in them, and they are deadly,” Campman is quoted in a press release.

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine that’s been used for decades in palliative care and as an anesthetic during surgery. More recently, fentanyl has been used in transdermal skin patches, oral sprays and lozenges to treat severe pain.

COUNTERFEIT OXYCODONE

“Each of these new uses of fentanyl exposed millions of Americans to the drug without evidence of an inordinate degree of harm if it was used as directed,” Dr. Lynn Webster explained in a recent column.

Only in recent years has illicit fentanyl become a scourge on the black market and given a bad name to a medication that alleviates a lot of suffering. “Mexican Oxy” and other counterfeit pills made with illicit fentanyl have been linked to thousands of overdose deaths around the country. According to a recent analysis by the DEA, one in every four counterfeit pills have a potentially lethal dose of fentanyl.

“The drug isn’t designed to be put in a pill like that, and it takes very little of it to kill someone. And the illicit drug makers don’t have the kind of quality control measures that pharmaceutical companies have either,” Campman added.

Federal prosecutors have called San Diego the “fentanyl gateway” to the U.S. because the city is near ports of entry in southern California that are major transit points for Mexican drug cartels. In July, a drug courier was pulled over by an alert Texas trooper in Amarillo and found to be transporting 73 pounds of illicit fentanyl powder -- enough to kill 10 million people.

The underground fentanyl trade has also given rise to “Breaking Bad” style pill press operations.

In September, DEA agents found five pounds of pure fentanyl in the San Diego apartment of Gregory Bodemer, a former chemistry instructor at the U.S. Naval Academy, who died from an apparent overdose. Also found in the apartment was a pill press, powders, liquids and dyes used in the manufacture of counterfeit drugs.

Bodemer’s death is yet another example of how the opioid crisis has evolved from a prescription drug problem into a fentanyl crisis.

“This is how we are seeing the opioid epidemic here, mostly in the rise in fentanyl deaths,” Campman said.

1 in 4 Counterfeit Pills Have Lethal Dose of Fentanyl

By Pat Anson, PNN Editor

Illicit drug users who buy prescription pills online or off the street are playing a dangerous game of Russian Roulette, according to a new laboratory analysis by the U.S. Drug Enforcement Administration.

The DEA found that about one of every four counterfeit pills (27%) have a potentially lethal dose of fentanyl, a synthetic opioid that is 80-100 times stronger than morphine.

Counterfeit pills laced with illicit fentanyl are appearing across the country and have been linked to thousands of deaths. Many of the overdoses involve blue pills stamped with an “M” and a “30” – distinctive markings for 30mg fake oxycodone tablets known on the street as “Mexican Oxy” or “M30.”

Based on a sampling of 106 tablets seized nationwide between January and March 2019, the DEA found that 29 of the pills contained at least 2 mg of fentanyl, a potential lethal dose. At least one pill seized in California had 4.2 mg of fentanyl — more than twice a lethal amount.

“Capitalizing on the opioid epidemic and prescription drug abuse in the United States, drug trafficking organizations are now sending counterfeit pills made with fentanyl in bulk to the United States for distribution,” said DEA Acting Administrator Uttam Dhillon. “Counterfeit pills that contain fentanyl and fentanyl-laced heroin are responsible for thousands of opioid-related deaths in the United States each year.”

The DEA laboratory analysis found fentanyl in 21% of the heroin samples tested. Fentanyl is often added to illicit drugs to boost their potency.

‘Enough to Kill Entire Population of Ohio’

In recent months, there have been outbreaks of fentanyl-related overdoses around the country. Law enforcement agencies are also seizing larger amounts of fentanyl from drug traffickers.

In September, DEA agents found a pill press and five pounds of pure fentanyl in a San Diego apartment. Prosecutors said that was “enough to kill the city of San Diego” or about 1.5 million people.

That seizure was overshadowed a few weeks later, when 45 pounds of suspected fentanyl were seized in Montgomery County, Ohio. A Homeland Security agent said that was "enough to kill the entire population of Ohio, many times over."  

Public health officials in Seattle recently warned about a spike in fentanyl-related overdoses that killed at least 141 people in King County, including several teenagers. Parents and students are being warned in public service announcements not to consume any pill not directly obtained from a pharmacy or prescriber.

Last week health officials in Virginia predicted the state would have a record number of drug overdoses in 2019. Most of the 1,550 projected overdoses involve illicit fentanyl.

As in other parts of the country, fentanyl related deaths have surged in Virginia, while overdoses involving prescription opioids have remained relatively flat for over a decade.

“In 2015 statewide, the number of illicit opioids deaths surpassed prescription opioid deaths. This trend continued at a greater magnitude in 2016, 2017, and 2018,” the Virginia Department of Health said in its latest quarterly report. “There has not been a significant increase or decrease in fatal prescription opioid overdoses.”

Fentanyl Overdoses Spike in Seattle

By Pat Anson, PNN Editor

Public health officials in the Seattle area are warning about a spike in fentanyl-related overdoses that have killed at least 141 people in King County since June. As in other parts of the country, many of the deaths involve counterfeit oxycodone pills laced with illicit fentanyl.

Three of the recent overdose victims in King County are high school students who took blue counterfeit pills stamped with an “M” and a “30” – distinctive markings for 30mg oxycodone tablets that are known on the street as “Mexican Oxy” or “M30.”

“Teenagers who are not heroin users are overdosing and dying,” said Brad Finegood of Public Health – Seattle & King County. “Do not consume any pill that you do not directly receive from a pharmacy or your prescriber. Pills purchased online are not safe.”

Gabriel Lilienthal, a 17-year-old student at Ballard High School in Seattle, died Sept. 29 from a fentanyl overdose.

“Gabe died from a fake OxyContin called an M30,” the teen’s stepfather, Dr. Jedediah Kaufman, a surgeon, told The Seattle Times. “With fentanyl, it takes almost nothing to overdose. That’s really why fentanyl is a death drug.”

Fentanyl is 50 to 100 times more potent than morphine. It is prescribed legally to treat severe pain, but in recent years illicit fentanyl has become a scourge on the black market, where it is often mixed with heroin and cocaine or used in the production of counterfeit pills. Illicit drug users often have no idea what they’re buying.

As PNN has reported, counterfeit oxycodone pills laced with fentanyl are appearing across the country and have been linked to hundreds of deaths. Yet this emerging public health problem gets scant attention from federal health officials, who are currently focused on an outbreak of lung illnesses associated with vaping that has resulted in 18 deaths.

‘Enough to Kill San Diego’

In San Diego last month, DEA agents found five pounds of pure fentanyl in the apartment of Gregory Bodemer, a former chemistry professor who died of a fentanyl overdose. Prosecutors say that amount of fentanyl was “enough to kill the city of San Diego” or about 1.5 million people.

Also found in Bodemer’s apartment was carfentanil, an even more powerful derivative of fentanyl, along with a pill press, powders, liquids and dyes used in the manufacture of counterfeit medication.  

Bodemer’s body was found in his apartment Sept. 27. Rose Griffin, a woman who also overdosed at the apartment and recovered, has been charged with drug possession and distribution.

Bodemer was an adjunct chemistry professor at Cuyamaca College in 2016. He had previously worked as a chemistry instructor at the U.S. Naval Academy in Annapolis, Maryland.

Overdoses Linked to Fake Pain Pills Draw Little Attention

By Pat Anson, PNN Editor

A mysterious lung illness linked to marijuana vaping has drawn nationwide attention this week. The CDC said there were 6 confirmed deaths and 380 cases of the illness, which one doctor warned was “becoming an epidemic.”

Even the White House has gotten involved in the vaping crisis, with President Trump calling for a ban on flavored e-cigarettes. “People are dying with vaping,” Trump said.

Meanwhile, an even more deadly health crisis continues to spread, drawing relatively little attention from the nation’s media and federal officials. Counterfeit blue pills made with illicit fentanyl are killing Americans from coast to coast.

This week, health officials in California’s Santa Clara County announced that 9 fatal overdoses have been linked to counterfeit oxycodone pills since January, including the recent deaths of a 15 and 16-year old.  

Local law enforcement has seized a large number of the blue tablets, which have an “M” stamped on one side and a “30” on the other side. They are virtually indistinguishable from real oxycodone.

“The extent of circulation of these fake pills is unknown; however, they had been consumed by several of the people who died,” Santa Clara Public Health Director Sara Cody, MD, said in a statement. 

“Many opioid pills, which are made to look like real prescription medications, are now made by counterfeiting organizations. These pills are not prescribed, stolen, or resold by or from verified pharmaceutical companies, and there is no connection between their appearance and their ingredients. Many patients may not be aware of the risks of taking a pill that does not come directly from a pharmacy.”  

Mexican Oxy

The overdoses in Santa Clara County are not an isolated situation. Over 700 miles away, the Yakima County Coroner’s Office in Washington State warned that three recent deaths involved fake oxycodone pills with the same distinctive markings. Yakima is used as a major distribution center by Mexican drug cartels.

"Most of the time it comes from Mexico, but we haven't been able to pinpoint exactly which batch it's from and who is actually dealing it," said Casey Schilperoort, a spokesperson for the Yakima County Sheriff's Office.

Known on the street as “Mexican Oxy,” the pills were also found at the scene of four fatal overdoses near San Diego over the summer.  Ports of entry near San Diego are major transit points for counterfeit oxycodone smuggled in from Mexico. The pills are usually transported in vehicles, often by legal U.S. residents acting as couriers. They sell on the street for $9 to $30 each and have spread across the country.

In February, New York City police announced the seizure of 20,000 fake oxycodone pills. Overdose deaths in New York City are at record levels and fentanyl is involved in over half of them. Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine.

This week federal prosecutors in Cleveland indicted ten people for trafficking in fake oxycodone and other illegal drugs. The leader of the drug ring, Jose Lozano-Leon, allegedly directed operations using a cell phone smuggled into his Ohio prison cell.

Prosecutors say Lozano spoke frequently with the co-defendants and others to arrange drug shipments from Mexico to northeast Ohio. The ring allegedly specialized in counterfeit oxycodone.

"In Ohio and other parts of the country, we are seeing an increase in these blue pills that at first glance appear to be legitimately produced oxycodone, but in fact are laced with fentanyl,” said DEA Special Agent in Charge Keith Martin.

Ironically, the indictments were filed in the same federal courthouse where a major lawsuit against opioid manufacturers and distributors is expected to get underway next month.  

Feds Warn of Counterfeit Oxycodone Deaths

By Pat Anson, PNN Editor

In the wake of four fentanyl overdoses in southern California, federal authorities have issued a public safety alert warning drug users about a lethal strain of counterfeit medication designed to look like 30mg oxycodone tablets.

The blue bills have the letter “M” in a box on one side and the number “30” with a line down the center on the other. On the street they are referred to as blues, M-30s or Mexican Oxy.

The pills were found at the scene of four fatal overdoses in San Diego County last week. The deaths in Poway, Santee, Lakeside and Valley Center were all reported within 24 hours.

Although tests on the pills are ongoing, authorities suspect they are laced with illicit fentanyl or carfentanil, which can be fatal in tiny doses.

SAN DIEGO SHERIFF’S DEPT. IMAGE

“That heroin, that meth, that coke, that oxy you think you are taking? Well, it just might have fentanyl in it, and it just might be the last thing you ever do,” U.S. Attorney Robert Brewer said in a statement. “I cannot be more clear than this: Fentanyl may be the costliest drug you ever do, because you may pay with your life, and you won’t even know you took it.”

Brewer said border seizures, prosecutions and overdoses are on pace to hit all-time highs in San Diego County by the end of 2019. The Medical Examiner’s Office has confirmed 50 fentanyl-related overdose deaths so far this year, plus another 28 suspected but yet-to-be confirmed cases.

If the trend continues, the death toll could potentially reach 130, which would amount to a 47 percent increase over last year’s total of 90 deaths. The victims are overwhelmingly male, with the average age about 36.

“Just when we think it can’t get any worse, the latest numbers prove us wrong,” Brewer said.  “I am alarmed by the dramatic surge in trafficking activity and deaths, particularly of young people. San Diego is the fentanyl gateway to the rest of the country, and we are working hard to close that gate with interdiction, prosecution and education.”

Federal authorities have confiscated 1,175 pounds of illicit fentanyl – more than half a ton -- at or near the international border so far this year. In addition, there has been a record number of seizures involving counterfeit blue pills labeled M-30 that contain fentanyl. The pills sell on the street for $9 to $30 each and are appearing around the country.

Ports of entry near San Diego are major transit points for illicit fentanyl smuggled in from Mexico. The fentanyl is usually transported in vehicles, often by legal U.S. residents acting as couriers.

A recent report from the Wilson Center found that Mexican cartels are playing an increased role in the fentanyl trade.

San Diego is the fentanyl gateway to the rest of the country.
— U.S. Attorney Robert Brewer

“Chinese companies produce the vast majority of fentanyl, fentanyl analogues, and fentanyl precursors, but Mexico is becoming a major transit and production point for the drug and its analogues as well, and Mexican traffickers appear to be playing a role in its distribution in the United States,” the report found.

“Both large and small organizations appear to be taking advantage of the surge in popularity of the drug, which is increasingly laced into other substances such as cocaine, methamphetamine, and marijuana—very often without the end-user knowing it. To be sure, rising seizures of counterfeit oxycodone pills laced with fentanyl illustrate that the market is maturing in other ways as well.”

Last week a former Mexican police officer was indicted for fentanyl trafficking by a federal grand jury in Texas. Assmir Contreras-Martinez, 30, was pulled over by a Texas trooper on Interstate 40 in Amarillo in May. About 73 pounds of illicit fentanyl powder was found inside his 2007 Ford Explorer, enough to kill 10 million people, according to DEA experts. 

Contreras-Martinez admitted he was paid $6,000 to transport the fentanyl from California to Florida and that it was his second such trip. Before his unlawful immigration to the United States nine months ago, Contreras-Martinez had been employed for eight years as a municipal police officer in Cananea, Sonora, Mexico.