What is fentanyl found in? The drugs being contaminated

Fentanyl contamination of the illicit drug supply has expanded far beyond heroin. Understanding which substances are at risk can help you or someone you know make more informed decisions — and could save a life.

Counterfeit prescription pills

This is currently the fastest-growing source of fentanyl deaths. Counterfeit pills are manufactured to look identical to legitimate pharmaceuticals — Percocet (oxycodone), Xanax (alprazolam), Adderall (amphetamine), and hydrocodone pills are the most commonly counterfeited. The DEA reports that approximately 6 out of every 10 counterfeit pills tested contain a potentially lethal dose of fentanyl. These pills are purchased on the street, through social media, and online. There is no way to determine by appearance whether a pill is legitimate or counterfeit. The only safe prescription medication is one dispensed by a licensed pharmacy from a legitimate prescription.

Heroin

The original pathway for fentanyl into the drug supply. In many regions, what is sold as heroin is actually fentanyl or a fentanyl-heroin mixture. Some areas report that pure heroin is essentially unavailable — everything contains fentanyl. This is why the overdose death rate among heroin users has skyrocketed.

Cocaine

Fentanyl contamination of cocaine is increasing and is particularly dangerous because cocaine users typically have zero opioid tolerance. Even trace amounts of fentanyl can be lethal for someone with no opioid tolerance. Contamination may be intentional (to create a "speedball" effect) or accidental (cross-contamination from shared processing equipment).

Methamphetamine

Fentanyl has been detected in methamphetamine samples in multiple states. Like cocaine, meth users are at extreme risk because they have no opioid tolerance.

How to reduce risk

Never use alone — if you overdose, someone needs to be present to administer naloxone and call 911. Carry naloxone (Narcan) — it is available over the counter at most pharmacies. Use fentanyl test strips — while not 100% reliable, they can detect fentanyl in a sample before use. Start with a small test dose — if a substance is contaminated, a small amount is less likely to be fatal. Never assume a street drug is what it is sold as. The safest approach is not using street drugs at all — if you have an opioid use disorder, MAT provides pharmaceutical-grade medication without the contamination risk.

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Authoritative sources

This article references guidelines from: NIDA · SAMHSA · CDC · FDA · ASAM

Frequently asked questions

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.