One pill can kill: Parents 411 about Fentanyl poisoning 

Elizabeth McNamara, MD

Parents, the drug landscape has changed. Drug overdoses no longer only impact people fighting the disease of addiction — deaths from counterfeit pills containing fentanyl are surging across the U.S. and unknowing teens, some as young as 13, are dying from fentanyl-related poisonings. 

My child doesn’t use drugs — how does this apply to us? For a variety of reasons, from stress management to peer pressure, teens and young adults may choose to ‘self-prescribe’ or recreate with medications like Adderall, OxyContin, Percocet, or Xanax. This may mean turning to counterfeit pills, which may be laced with fentanyl. 

What is fentanyl? Fentanyl is a powerful synthetic opioid used for pain relief in medical settings. But increasingly, counterfeit fentanyl, the black market version of the drug, is being obtained or made by dealers and mixed into almost all forms of counterfeit pills. 

Teens may purchase what they think are brand name pills via social media or friends of friends, but are actually getting counterfeit pills containing fentanyl. 

Fake pills widely detected to contain fentanyl include, but are not limited to, Percocet, Xanax, Oxycontin, Norco, Vicodin, and Valium. Street drugs with detected fentanyl are heroin, cocaine, MDMA (ecstasy/ Molly), and methamphetamine. 

Why would dealers use fentanyl? Counterfeit fentanyl, as a raw material, is cheap and potent, meaning only a tiny amount of fentanyl is needed to manufacture a large amount of counterfeit drugs. It is easy to press into counterfeit pills and is highly addictive.  

What does a counterfeit pill look like? Fentanyl is odorless, tasteless and colorless. Counterfeit pills can look exactly like pharmaceutical prescription pills. Teens never know what they are getting. 

To be clear, these are not pharmaceutical-grade painkillers; they are pills made by drug dealers. There is no quality control. Pills in the same batch can have wildly varying levels of fentanyl. Even a very small amount of fentanyl, the amount in one pill or less, can be enough to overdose and die. One pill can kill. The first pill can kill. 

How can you help your teen avoid counterfeit pills? Start an ongoing conversation with your child: 

  • Talking to your kids about the dangers of fentanyl helps keep them safe. It does not make them more likely to try drugs. 
  • Be open, honest, and empathetic. Tell your kids what you found surprising or scary about fentanyl and counterfeit pills. 
  • Keep the conversation going. Instead of trying to say everything at once, have multiple short talks.  
  • Check in with your child about their mental health on a regular basis. Encourage them to let you know if they are struggling with stress, anxiety, depression, or pain, so you can help. 
  • Have naloxone (Narcan) available at home and give it to your teens. Even if they are not using pills, they may be in a situation to help someone else. 

What else should we do? If you or your child witnesses an overdose, it’s important to take action right away. Call 911 and tell them someone is unresponsive. 

Naloxone (Narcan) is a medicine that rapidly reverses an opioid overdose and can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. Naloxone is readily available as Narcan nasal spray, recently approved for over-the-counter distribution, but not yet in stores. In the meantime, Narcan is available to pick up for free at the following locations: 

  • Barton Health Emergency Department 
  • Barton Community Health Center 
  • Barton Family Medicine 
  • Tahoe Coalition for the Homeless 
  • El Dorado County Behavioral Health Services 
  • South Lake Tahoe Library 

What is the bottom line? Fentanyl is in our community and no pill obtained from a friend, dealer, etc. is safe. Talk with your kids and be vigilant about continuing the conversation. Consider keeping naloxone on hand — it’s easy to use, small to carry, and free to pick up. 

Dr. Elizabeth McNamara is an emergency room physician at Barton Memorial Hospital. Dr. McNamara and Azzy Soave recently presented information about opioid-related overdoses, watch the recording at 

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