Counterfeit Xanax Linked to 5 Deaths

NOVEMBER 05, 2015
Two young men from Santa Cruz County, California, recently died after ingesting what they thought was Xanax. These 2 separate incidents follow 3 very similar deaths of men in San Francisco who appear to have died from ingesting what they also assumed was Xanax.
 
Based on newspaper reports, all of the individuals taking the alleged counterfeit Xanax were using it as a recreational drug and obtained it through some manner other than a legal prescription. 
 
Xanax is a schedule IV controlled substance that requires a legal prescription from a licensed prescriber.   
 
As health care providers, pharmacists know that alprazolam—the active ingredient in Xanax—has the potential to cause serious central nervous system (CNS) and respiratory adverse reactions; however, it is extremely uncommon for a medical emergency and death to follow the ingestion of a single dose.
 
Upon examination, the counterfeit Xanax seemed strikingly similar in appearance to the manufactured version. It had the long rectangular shape, 3 scores, and the name XANAX spelled across the top of the tablet, which is all very similar to the actual product.
 
Police evaluation of the deadly counterfeit drug showed that it may have been laced with illicitly manufactured fentanyl, a potent opioid analgesic. 
 
With an estimated annual market of $200 billion, counterfeit medications are making a huge impact on the current prescription drug market. It is estimated that Internet sales alone account for more than $75 billion of this illicit market.
 
Counterfeit medications are manufactured, packaged, and sold by any entity other than the genuine manufacturer. These products may be labeled and packaged with meticulous care to look exactly like the original product. 
 
This packaging is performed to look like the genuine medication; however, ingredients may be nothing more than talc or, in the case of the counterfeit Xanax, a lethal dose of a narcotic medication. 
 
The FDA mentions on its website that it has received multiple reports of consumers purchasing anti-anxiety, antidepressant, and sleep medications such as Xanax, Ativan, Lexapro, and Ambien over the Internet. These consumers experienced side effects requiring immediate medical attention such as difficulty breathing and severe muscle stiffness. 
 
Upon evaluation, all of the medications were manufactured with haloperidol, a potent antipsychotic medication.  
 
When a prescription medication does not come from a licensed pharmacy, there is no way to tell whether it is a counterfeit or genuine medication without putting it through a detailed laboratory analysis. 
 
Given the risks, pharmacists, students, and other health care professionals should take a moment to inform their patients about the dangers of obtaining a prescription medication in any manner other than through a legal prescription.

Steve Leuck, PharmD
Steve Leuck, PharmD
Steve Leuck, PharmD, has been practicing both hospital and community pharmacy for over 30 years. He founded AudibleRx, in 2011, which provides Consumer Medication Information which is both Useful and Accessible. Content designed to meet health literacy guidelines. Format designed to "read along" with the audio presentation in a simple to use web application. More information at AudibleRx.org.
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