The Los Angeles Department of Public Health has issued a health alert warning residents that fentanyl and other illicit narcotics have been found in pharmaceuticals in Mexico. Residents should be aware that a new report indicates the pills were purchased at legitimate pharmacies.

The Los Angeles Times reported that 55 pills purchased from 29 pharmacies in eight cities in Mexico were tested and more than 50% of the pills were determined to be counterfeit. More than a third of the 40 opioid pain medications purchased tested positive for illicit fentanyl rather than a prescription opioid medication. Twelve of 15 Adderall samples tested positive for other substances, including methamphetamine and ecstasy. Sometimes entire bottles that appeared to be factory-sealed were tainted.

According to the Los Angeles Times, the pharmacy locations included Playa del Carmen, Cozumel, Tulum, Tijuana, Nuevo Progreso, Los Cabos and Puerto Vallarta. The pills that were purchased included Adderall, Percocet or oxycodone.

Fentanyl is a colorless and odorless opioid that is used for pain and anesthesia when prescribed by medical clinicians, but it is also illegally manufactured in clandestine labs and sold illicitly both on its own and mixed with other illicit substances such as methamphetamine and heroin. It is also being laced into counterfeit pills, including those resembling Xanax, MDMA and powders such as heroin, methamphetamine, or cocaine. When taken, fentanyl can rapidly cause someone to stop breathing and die. Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.

The presence of fentanyl is causing an increased rate of overdose and death. The landscape of overdose deaths no longer primarily affects those who are using substances regularly. Due to fentanyl, we are seeing people overdose and die the first time they try an illicit substance or counterfeit pill.

Recommended Actions for the Public:

— The safest course of action is to avoid using pills from any sources besides those that come from an FDA-licensed pharmacy or are prescribed by your healthcare provider.

— Avoid using substances alone.

— If using substances, use with a trusted person who can respond in case of an overdose. If you are using substances alone, there are resources to keep you safe.

–Never Use Alone (http://neverusealone.com) is an organization that offers phone-based support while individuals use a substance and can notify emergency services if the individual stops responding.

— The Brave App (https://www.thebraveapp.com) provides virtual overdose prevention support by contacting 911 or an emergency contact if you stop responding while using substances.

— Test substances for the presence of fentanyl using fentanyl test strips before using.

Fentanyl test strips identify drugs contaminated with fentanyl and can help individuals make informed decisions about the drugs they use. Fentanyl test strips require dissolving a small amount of the drug supply in water, dipping the test strip into the liquid and waiting 15 seconds for a result.

Fentanyl Testing Strips can be Purchased Online at:

Team Awareness Combating Overdose Inc: http://www.tacoinc.org/teststrips

Dose Test: http://dosetest.com/product/fentanyl-test-strip

Dance Safe: http://dancesafe.org/shop

Fentanyl testing strips can be obtained through AIDS Project Los Angeles (APLA): http://aplahealth.org/fentanyl lists locations where to get testing strips.

Recognize the Signs of an Opioid Overdose:

— Excessive sedation and appearing unresponsive.

— Slowed breathing, or gurgling sounds.

— Slowed heart rate.

— Cold, clammy skin.

— Bluish lips or nails.

— Slurred speech.

Obtain and Keep Handy Naloxone for Overdose Rescue:

— Naloxone is a lifesaving medication that reverses an opioid overdose.

— It can be administered via a nasal spray or intramuscular injections that will restore normal breathing in someone who has overdosed on an opioid and stopped breathing.

Over the Counter Naloxone Access:

Naloxone has been approved to be sold over the counter and will be available in the late Summer 2023.

Obtain a Naloxone Prescription From a Healthcare Provider

Healthcare providers may prescribe naloxone to patients who are at an increased risk of opioid overdose or who have household members, including children, who are at risk for accidental ingestion or opioid overdose. Ask your primary healthcare provider about being prescribed naloxone if not automatically co-prescribed to you.

Pharmacy Naloxone Access

Pharmacies in California may now provide naloxone without a prescription, although availability is pharmacy and pharmacist dependent.

Community-based Naloxone Distribution Points

Community members who are unable to access naloxone through their primary healthcare provider or via a local pharmacy can visit a community-based naloxone access point or a mail-based naloxone distributor. You can find a list of participating naloxone access points here.

Obtain Substance Use Disorder Treatment

Find substance use treatment services and bed availability in Los Angeles using an online, filterable service locator known as the Services and Bed Availability Tool, going to RecoverLA.org on their mobile devices, or by calling the Substance Abuse Service Helpline. Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management and Opioid Treatment Programs.

Services and Bed Availability Tool: http://sapccis.ph.lacounty.gov/sbat.

Mobile-friendly RecoverLA platform: RecoverLA.org.

Substance Abuse Service Helpline: (844) 804-7500.

Refer to the information sheet: Fentanyl in LA County.

This information sheet contains frequently asked questions, describes harm reduction steps to reduce the risk of fentanyl overdose and includes information about how Los Angeles County residents can obtain naloxone.