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The public health risks of counterfeit pills
Open accessAbstract
Synthetic illicit drugs, such as nitazenes and fentanyls, are becoming commonplace in countries around the world, including in Europe, Australia, and Latin America, which raises concern for overdose crises like those seen in North America. An important dimension of the risk represented by synthetic drugs is the fact that they are increasingly packaged in counterfeit pill form. These pills-often indistinguishable from authentic pharmaceuticals-have substantially widened the scope of populations susceptible to synthetic drug overdose in North America (eg, among adolescents experimenting with pills or tourists from the USA seeking psychoactive medications from pharmacies in Mexico). The non-medical use of diverted prescription medications is relatively more common, and less stigmatised, than the use of powder drugs. Many consumers of counterfeit pills are unaware that they contain synthetic illicit drugs, believe them to be authentic pharmaceuticals, and would be unlikely to consume those drugs knowingly or if in powder form. Given these issues, we recommend the expansion of educational and awareness campaigns, pill testing programmes to help consumers shift demand to safer products, increased monitoring in routine clinical scenarios and overdose death toxicology, and expanding medically managed safer alternatives to counterfeit pill use.
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“Nitazenes may be present alone or in combination with other novel psychoactive substances, which further causes more toxicity [41, 44].”
From Novel 2-Benzylbenzimidazole Opioids: Emerging Drugs of Abuse and Pharmacological Considerations with Nitazene Analogs (2026) · cites this paper as [44]
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“Nitazenes are found in counterfeit and misrepresented drug products, which adds to its high-risk profile, as it is found in products sold as heroin and false prescriptions such as other opioids or benzodiazepines [44].”
From Novel 2-Benzylbenzimidazole Opioids: Emerging Drugs of Abuse and Pharmacological Considerations with Nitazene Analogs (2026) · cites this paper as [44]
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“This creates a major risk of unintentional exposure, especially among individuals unaware of consuming synthetic opioids [44].”
From Novel 2-Benzylbenzimidazole Opioids: Emerging Drugs of Abuse and Pharmacological Considerations with Nitazene Analogs (2026) · cites this paper as [44]
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References 46 · Cited by 32
Research works printed but not linked: 40
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Metadata
- Authors
- Friedman, J., & Ciccarone, D.
- Affiliations
- University of California San Diego (US)
- University of California, San Francisco (US)
- Corresponding author
- Friedman, Joseph
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2025-01
- Volume
- 10
- Issue
- 1
- Pages
- e58-e62
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC12101522
- OpenAlex
- W4406071335
- Cited by
- 32
- References
- 46
- Citations by year
- 2026: 21 · 2025: 10
- FWCI
- 15.80
- Type
- journal article
- Language
- en
- Update notices
- erratum (2025-03-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute on Drug Abuse
- National Institutes of Health
- Intramural Research Program, National Institute on Drug Abuse (R01 DA049644, R01 DA054190-01)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Keywords
- synthetic drugs, nitazenes, fentanyl analogs, drug overdose, pill testing, public health risk, consumer awareness, safer alternatives, adolescents
- MeSH terms
- Humans, Public Health, Illicit Drugs, Counterfeit Drugs, Drug Overdose
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