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Adverse Effects From Counterfeit Alprazolam Tablets. Arens AM et al. Ann Emerg Med 2016 Aug 8 [Epub ahead of print]
In March of this year,there were 9 deaths reported in Pinellas County, Florida (the Tampa/St. Petersburg area) associated with fake alprazolam (Xanax) tablets containing fentanyl. Earlier, similar counterfeit pills had been seen around San Francisco and in Monroe County Southern Illinois.
This letter, from the University of California-San Francisco and the California Poison Control System describes 8 cases — including 1 cardiac arrest — from that region. An additional victim found at the same location as two of the cases was pronounced dead at the scene. All 8 cases occurred during the two-and-a-half month period from october 15 to December 31, 2015.
Seven of the 8 patients had blood and/or urine positive for fentanyl. Four patients had serum positive for etizolam, a benzodiazepine analog that is not FDA-approved for medical use in the United States. Additional drugs identified in these patients included cocaine, levamisole, chlordiazepoxide, diphenhydramine, sertraline, and diazepam.
Cardiac effects seen in this case series included ischemia, biventricular heart failure with pulmonary edema, and reversible cardiac arrest.
Because of the mixture of drugs involved, it’s hard to draw definite conclusions from this case series, except as a reminder that fentanyl is showing up in a variety of phony medications sold on the street, including Norco. There are also suggestions that this phenomenon may have been responsible for the death of the musician Prince.
I did a Google search and could not find any reports of counterfeit alprazolam containing fentanyl after March 2016.
As the following picture from the San Francisco Health Department shows, the phony pills look quite similar to the real thing: