Counterfeit prescription drugs are a growing threat in the US. Whether bought from an online pharmacy or from a local drug dealer, you have absolutely no way to know if the prescription pills you bought are real or counterfeit and that's a problem that can kill you.
More and more people are sharing prescription drugs left over from an illness or injury or obtained from family members. Some people feel more confident using prescription drugs than illegal drugs like heroin or cocaine. They assume if it is used medically, it is safer to use but this is wrong on two counts.
The physician writes a prescription for an individual with the health history and conditions of that specific person in mind. If you're not that person, you may be taking a drug that could worsen conditions or allergies you have. However, for the sake of argument, let's say you are very healthy with no known allergies or chronic conditions and you decide to try a prescription med to get high. There are an increasing number of counterfeit prescription pills out there and they look exactly like the real thing. The color, texture, markings are the same as the prescription pills. So how can you tell if what you're taking is genuine? Short of having a drug testing lab in your basement, you can't.
The short answer to that is also unknown. As long as there have been people using drugs, there are people who will try to sell fake drugs or "cut" a real drug to extend it and make a better profit. These are always risks with any drug you ingest if it isn't directly from a pharmacy. Lately, however, the risks have changed as the extenders used by some illicit drug manufacturers have moved from baby powder, cornstarch, and crushed aspirin to adding fentanyl and carfentanil into their pills.
US Customs border agents have reported increased seizures of pill presses to manufacture pills and tablets, illegal drugs like fentanyl and carfentanil, and already manufactured counterfeit prescription pills tainted with fentanyl and carfentanil. Fentanyl is 50 times more potent than morphine or heroin. Even a seasoned narcotics user who is used to their typical dose can overdose on fentanyl. The risk of fentanyl or carfentanil in counterfeit prescription drugs is that the user is unaware that it is in the pill. Even a few grains of fentanyl or carfentanil can be enough to cause an overdose. Carfentanil is even more potent than fentanyl, heroin, or morphine and has never been approved for human use, as it is used solely as a large animal tranquilizer.
It is likely that Prince's cause of death was as a result of ingesting a counterfeit prescription pill marked "Watson 853" that was in an aspirin bottle. While the tablets looked like the prescription pills manufactured by Watson Laboratories, the pills in Prince's bottle actually also contained fentanyl. Even someone like Prince,with the wealth and access to anything he wanted, was unable to tell the difference between a counterfeit prescription pill and the real thing. Asking at the time of purchase is no assurance as most illicit manufacturers have a wide and complicated distribution process so your dealer likely can't assure you of what is in a pill and may not tell you if he does. This truly is a case of buyer beware on the highest level.
Fentanyl and carfentanil have been found in heroin, cocaine, and counterfeit prescription pills from coast to coast. They are adulteration agents that are easy for illicit drug manufacturers to transport, store, and require only very tiny amounts to boost their potency. The down side is if you receive a pill or drug that has a small fraction too much, it can kill you.
Narcan can be used to reverse opioid overdoses but if fentanyl or carfentanil are involved, it can take many times more doses of Narcan to attempt to reverse the overdose. While a heroin overdose may require 1-3 doses of Narcan to reverse it, fentanyl can require easily 4-6 and sometimes more doses to have an effect. With carfentanil, it is sometimes impossible to reverse the opioid overdose. Counterfeit prescription pills are a real danger nationwide. If you are considering buying prescription pills, be aware you may not be getting what you paid for.