Clinician Alert: Risk of fatal overdose from counterfeit pills containing fentanyl

April 27, 2021

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Warn patients and clients who get pills from anywhere other than a pharmacy that they should assume the pills contain deadly amounts of fentanyl; offer harm reduction advice and naloxone


Cheap, counterfeit opioid pills containing fentanyl are thought to be fueling an increase in fatal drug overdoses across the Portland Metro region. The deaths include teens and other people who don’t regularly use illicit drugs. Here is the local press release from last week. 

We are asking Multnomah, Clackamas, and Washington County health care and social service providers to:

  1. Ask patients about use of pills obtained from friends, on the street, or online.

  2. Warn them to avoid these pills because of the risk of fatal fentanyl overdose.

  3. For those who choose to use these pills, provide naloxone and harm reduction advice.

Patient education

Signs of opioid overdose include:

  • Pale or clammy skin

  • Bluish or pale lips and fingernails

  • Limp body

  • Slow or no breathing

  • Vomiting or foaming at the mouth

  • Difficult to or not able to awaken

Harm reduction advice:

  1. Test the pills first with a fentanyl test strip 

  2. Start with using a small amount. 

  3. Don’t use pills when you’re alone or with alcohol.

  4. Carry Naloxone.

Anyone who uses any drugs can talk to a doctor or pharmacist about getting nasal Narcan; it’s usually covered by insurance, including the Oregon Health Plan. Most pharmacies carry naloxone, and a prescription is not required, but clients may have to pay out of pocket. 

Syringe service programs often provide free test strips and naloxone. Test strips can also be purchased online for about $1.00 per strip. Oregon’s Good Samaritan Law protects both the person who administers naloxone and the person who is overdosing from prosecution. 

Summary background

Health officials are concerned about pills, called “Blues” for their common color, or “M30s” for the stamp commonly found on each pill. The tablets are so well-made that even experienced users say they can’t tell the difference between a counterfeit pill and a pill manufactured by a pharmaceutical company. They often look like pharmaceutical-grade oxycodone.

Regional emergency response to opioid overdoses the last week of March were the highest they had been since the region began tracking a few years ago. The rise comes after an already deadly year in Oregon and across the nation, where overdose deaths spiked then remained elevated, even as prescriptions for opioids continued to drop. 

The Centers for Disease Control and Prevention issued a health alert in December because of an increase in synthetic opioids that hit the western United States — and the Interstate 5 corridor — hardest. Law enforcement and medical experts say illegally manufactured fentanyl is to blame.

Other Resources

County harm reduction services:

Safe Oregon: participating schools and their students can report when they see drugs advertised on social media platforms.

Thank you for your partnership,

Dr. Jennifer Vines, Health Officer, Multnomah County 

Dr. Ann Loeffler, Deputy Health Officer, Multnomah County 

Dr. Sarah Present, MD, Health Officer, Clackamas County

Dr. Christina Baumann, MD, Health Officer, Washington County