Counterfeit Pills
Counterfeit pills can be made to resemble legitimate prescription medications. Their color, shape or imprint does not prove what is actually inside.
Fentanyl Small pills. Big danger.
Fentanyl is a powerful synthetic opioid. Illegally manufactured fentanyl can appear in powders, counterfeit pills and other drugs, sometimes without the person taking them knowing it is present.
Understanding fentanyl
What is fentanyl?
Fentanyl is a synthetic opioid. Pharmaceutical fentanyl is used medically for surgery and for some forms of severe pain under medical supervision.
Illegally manufactured fentanyl is produced outside the regulated pharmaceutical system and distributed through illegal drug markets. It may be sold directly, pressed into counterfeit pills or found with other drugs.
These are very different exposure settings. A medication used under medical supervision should not be treated as equivalent to an unknown powder or pill from an illicit source.
The illicit drug supply
How fentanyl can appear in the illegal drug supply
The illegal drug supply is not uniform. Contents can vary by product, supplier, location and time. Fentanyl may be intentionally sought or encountered unexpectedly.
Powder Form
Illegally manufactured fentanyl may be sold as a powder or combined with another substance. The contents cannot be determined by appearance alone.
With Other Drugs
Fentanyl has been detected with other drugs, including stimulants and opioids. This exposure may be intentional or unintentional.
What the evidence tells us
Contents vary
The composition of illegal drugs can vary by region,
supplier, product and time.
Counterfeit does not mean one ingredient
Counterfeit pills may contain fentanyl, another drug,
an unexpected dose or other substances.
Appearance is not testing
A familiar-looking pill, powder or package does not establish
chemical contents or authenticity.
Risks & effects
Why fentanyl can be dangerous
Like other opioids, fentanyl can slow breathing and suppress the central nervous system. An overdose can become life-threatening quickly.
- Breathing may become slow, irregular or stop.
- A person may become extremely drowsy or lose consciousness.
- The risk can be harder to recognize when several substances are involved.
- A person may not know fentanyl is present in a counterfeit pill or other illicit drug.
- Product strength and contents can vary.
Know the signs
Possible signs of opioid overdose
An opioid overdose is a medical emergency.
- The person cannot be awakened or is unresponsive.
- Breathing is slow, shallow, irregular or has stopped.
- The person is only gasping.
- The person has collapsed or cannot respond normally.
If you suspect an opioid overdose
Call 911. If naloxone is available and opioid overdose is possible, give it according to the product instructions. More than one dose may sometimes be needed. Emergency medical care is still necessary.
Frequently asked questions
Common questions about fentanyl
Clear answers based on current public-health guidance and source-based research.
What is fentanyl?
Fentanyl is a synthetic opioid. Pharmaceutical fentanyl is used
medically in controlled settings. Illegally manufactured fentanyl
is produced outside the regulated pharmaceutical system and is
distributed through illegal drug markets.
Why is illegally manufactured fentanyl dangerous?
Fentanyl can strongly suppress breathing. Illicit products may also
have uncertain contents, dose and manufacturing quality, making
exposure difficult to predict.
Can fentanyl be found in other drugs?
Yes. Fentanyl has been detected in counterfeit pills and with other
drugs. This does not mean every illicit drug contains fentanyl; the
illegal supply varies by place, product and time.
Can you tell if a pill contains fentanyl by looking at it?
No. A pill's appearance, color, shape, imprint or packaging cannot
establish its chemical contents or prove that it is authentic.
Does a negative fentanyl test mean a drug is safe?
No. Fentanyl test strips can provide useful information about
fentanyl under the conditions of the test, but they do not identify
every possible substance or establish that a product is safe.
What should I do if I think someone is overdosing?
Call 911 immediately. If naloxone is available and opioid overdose
is possible, give it according to the product instructions and remain
with the person until emergency help arrives.
Educational resources
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Information sources:
Centers for Disease Control and Prevention, “Fentanyl,” updated June 9, 2025;
U.S. Food and Drug Administration, “Counterfeit Medicine”; and CDC opioid
overdose prevention guidance. Drug Educators Alliance reviews significant
medical, scientific and statistical claims before publication.
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