Levels of fentanyl, acetaminophen, and hydrocodone were quantified. Additional drugs were also detected in the serum Table. Analysis of a tablet obtained from patient 6 indicated that it contained 3. All patients had serum fentanyl levels of 1.
Specimens from all patients contained promethazine. Response to this outbreak has included notification of the California Department of Public Health, local media outlets, and law enforcement officials. No information has been released regarding the source of the counterfeit tablets, and an investigation is ongoing.
The distribution of counterfeit medications, especially those containing fentanyl, is an emerging and serious public health threat. Opioid abuse is the fastest-growing drug problem in the United States; despite prevention strategies at federal, state, and local levels, deaths caused by ingestion of opioid analgesics continue 6. In addition to prescription drug abuse, nonpharmaceutical illicitly produced opioid-containing products have received much attention in recent years. Fentanyl, in particular, was responsible for more than 1, deaths during — 7.
In March , DEA issued a nationwide alert about the dangers of illicitly produced fentanyl and fentanyl compounds, describing these products as a threat to health and public safety 8.
In California, during October—December , seven persons, including two who died, were found to have been exposed to fentanyl-adulterated counterfeit Xanax 9. Efforts to identify the source of the current counterfeiting are ongoing. Patients with signs and symptoms of acute opioid overdose including central nervous system and respiratory depression, and in whom larger doses of naloxone are required to reverse symptoms, should raise suspicion for intoxication with a counterfeit product containing fentanyl.
Physicians should inquire about the illegal purchase of prescription medications in these cases and notify their local poison control centers and health departments. Efforts should also be made to communicate to the general public the significant risks to life and health when purchasing what appears to be prescription medications from any source other than a reputable pharmacy or health care provider, because it might be difficult to distinguish a counterfeit pill from the legitimate pharmaceutical product Figure.
Corresponding author: Kathy T. Vo, kathy. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U. CDC is not responsible for the content of pages found at these sites. This conversion might result in character translation or format errors in the HTML version.
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What is added by this report? What are the implications for public health practice? Last year in California, seven people took fentanyl-contaminated counterfeit Xanax, an anti-anxiety drug; two of them died, according to the CDC.
The addition of the booster promethazine — seen in the Bay Area but not Sacramento overdose cases — additionally worries public health officials, because it strengthens the effects of already powerful fentanyl. The recent Bay Area cases may strengthen the arguments of some California lawmakers trying to pass a bill, SB , which would increase prison sentences and fines for major traffickers of fentanyl.
The bill remains in committee. But typically, she said, fentanyl is purchased from China, shipped to Mexico and transported into the United States across its southwest border. At some point in Mexico or in the U. By Barbara Feder Ostrov April 28, You must credit us as the original publisher, with a hyperlink to our khn.
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