Harm Reduction: Spotting Counterfeit Pills

Recently I was popping codeine tablets out of their blister packs and came across a defect:  one pill was cut in half inside its blister.  This sent my OCD mind into a tailspin, researching counterfeit medications from around the world.  Previously I assumed that if something came in its original box inside a sealed blister pack it couldn't be fake.  Apparently that's not the case.  

Before you freak out, the problem with these overseas "fakes" is not the same as America's street pills that often contain pressed fentanyl or other heavy drugs made to look like Xanax, Percocet or hydrocodone.  No, in countries like South Africa or Malaysia, medications such as Panadol (Tylenol) or codeine-containing meds are sometimes counterfeited using things like baking soda or Plaster of Paris and contain lower doses of the stated active ingredients which is still problematic but not quite as deadly.  

When we talk about counterfeits, we're not talking about generic or off-brand pills which are perfectly safe medications made by less well-known pharmaceutical companies than the big brands like Eli Lilly or Pfizer.  Counterfeits are fake pills made to look like the real medications they mimic.  They contain a combination of wrong ingredients pressed into the shape of the real thing.  There seems to be some confusion about this when it comes up online.  

(This article contains photos and excerpts from various articles I found around the internet.  Direct quotes and lifted photos are used.  If any author has a problem with what's re-posted here, please contact me and I'll take it down.  My intent is to educate and spread knowledge to keep people safe).  

Can you spot the fakes?  (Answer below).

The clues are subtle: the tablet at the top has a slightly longer 'f' in the company logo, while the bottom two tablets are a greyish blue and have rougher edges.

The tablet at the top is a genuine medicine. The two lower tablets are fake. They could be diluted, contaminated, or even just chalk.

A counterfeit medicine could have:

• no active ingredient
• substandard ingredients
• undeclared ingredients
• illegal or dangerous ingredients
• incorrect dosage (too much, too little or variation in dose across tablets)
• contaminants from unhygienic manufacture.
  

 

Misspellings ("ClaxoSmithCline")

Rough edges on Malaysian pills = counterfeit

Nguyen Van Gia, the owner of a drugstore on Hai Ba Trung street, said painkillers/antipyretic drugs are the most easily counterfeited and can easily be sold because they are usually sold without a doctor’s prescription. 

Gia said the drug counterfeiting technology now is sophisticated. “You just need to make some phone calls to Guangzhou, China to order the machines for counterfeiting. Chinese partners will also provide wrappings of some well-known pharmacy firms in the world,” he said. 

“They either 100 percent counterfeit the drug, i.e there is no active element in the drugs, or make the drug with the wrong dose. For example, a drug product is declared as containing 500 mg of active element, but in fact, it has 400 mg or lower,” he said.  --- Excerpt from Vietnamese article

Excellent guide to spotting counterfeits

Contrast this with America's counterfeit pills, such as these "Adderall" tablets made by Mexican cartels and trafficked into the U.S.  They actually contain meth as the active ingredient.  This is a direct consequence of the drug war and is not common with over-the-counter medications like low-dose codeine, tramadol or Viagra medicines in countries like Peru or India.

Counterfeit Adderall tablets on top

So while you may receive counterfeit medication from overseas, it's still safer than buying prescription black market pills in the U.S. or Canada due to the rampant problems with fentanyl and other dangerous adulterants in our drug supply.  This goes equally for the dark web and your local drug dealer.  If you don't personally see your dealer walk out of the pharmacy with the prescription, assume it's fake.  People are dying from counterfeit meds at an alarming rate here, and no one's immune.  Celebrities including Prince, Shock G, Lil' Peep, Tom Petty, Mac Miller & Michelle McNamara died from accidental fentanyl overdoses in recent years.  

The only way to be 100% certain what's in your drugs is to test them.  There are labs that will do this for you if you send in a sample, or you can buy a reagent testing kit for yourself.  There is no foolproof way to "eyeball" it and know for certain that what you've got is the real deal, but using the tips above you can rule out the obvious counterfeits.  

 

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