RI's illicit drug supply is almost all contaminated with fentanyl. Here's what a study found

PROVIDENCE – Illicit drug buyers beware: A study of Rhode Island's counterfeit oxycodone pills found that 99.3% were contaminated with fentanyl.

The recently published study looked at more than 1,000 counterfeit pills seized by police in Rhode Island.

The study is a collaboration between researchers at Warren Alpert Medical School at Brown University and the state Health Laboratory.

Here's what they found:

  • In 2022, a shocking 99.3% of counterfeit oxycodone prescription pills contained fentanyl.

  • 67% contained an illicit fentanyl analog – a drug similar to fentanyl.

  • Xylazine, a powerful animal tranquilizer also known as “Tranq,” was detected in almost 40% of counterfeit oxycodone pills, and always with fentanyl.

  • Often the seized pills contained methamphetamine or novel benzodiazepines, such as bromazolam, an emerging drug that is not licensed for human use.

  • The percentage of fentanyl in seized pills has climbed steeply since 2017.

Why it matters:

It’s the first large study of a local counterfeit drug and was published in the Journal of the American Medical Association. And it shows that Rhode Island's illicit drug supply is becoming more complex, more toxic and more potent.

“I think it’s important to recognize that any pill not purchased from a pharmacy can contain fentanyl and other substances,” study author Dr. Rachel Wightman, an associate professor of epidemiology and emergency medicine at Brown, said in an interview last week.

A fentanyl drug testing kit warns about the dangers of xylazine, a powerful animal tranquilizer that is not yet detectable in street testing.
A fentanyl drug testing kit warns about the dangers of xylazine, a powerful animal tranquilizer that is not yet detectable in street testing.

Study results echo what police are seeing in Rhode Island

The findings reflect what law enforcement officials are seeing on the ground.

"Fentanyl is pretty much everywhere at this point," Rhode Island State Police Lt. Derek Melfi said Friday.

Though heroin was the drug of choice in 2012, counterfeit pills have taken over, with China producing the precursors and Mexican drug cartels making and trafficking the pills, Melfi said.

"We'll keep fighting the good fight and hopefully it will slow down someday," he said.

How the drugs were studied

The study analyzed 1,176 counterfeit pills seized by law enforcers throughout the state from 2017 to 2022 and were sent to the state Department of Health.

The pills, which are nearly indistinguishable from medication purchased at a pharmacy, were classified into five categories:

  • Oxycodone

  • Alprazolam, an anxiety drug

  • Amphetamine/dextroamphetamines

  • Clonazepam

  • Unknown

Testing of the seized pills was performed via comprehensive gas chromatography and mass spectrometry screening at the state Department of Health Laboratories.

The results show the percentage of fentanyl in counterfeit oxycodone pills steeply climbing since 2017.

The equipment used by Brown and state Department of Health researchers to test Rhode Island's counterfeit drug supply.
The equipment used by Brown and state Department of Health researchers to test Rhode Island's counterfeit drug supply.

'I wasn't surprised'

Wightman and Glen Gallagher, associate director of the state health lab, were not surprised by the findings. Wightman said they reflect what is being seen in emergency rooms.

“Unfortunately, I wasn’t surprised,” Gallagher said, adding that the results correlates with the toxicology analysis of drug overdose deaths in the state.

Wightman emphasized that the analysis provides vital information for treatment providers and community agencies dedicated to preventing overdose deaths. They hope it will improve patient care by giving doctors increased insight into the contents of counterfeit prescription pills, as the effects of active ingredients may be different from those of the prescription pills they replicate.

Study contributors included Leslie Nolan and Ben Hallowell at the Department of Health, Bryan Volpe of the HIDTA New England Overdose Task Force and Thomas Chadronnet of the CDC Foundation. The research was supported in part by the U.S. Centers for Disease Control and Prevention.

Going deeper: Increasingly complex supply

Also published recently in the International Journal of Drug Policy was a qualitative study involving interviews of people who use drugs and observational fieldwork to broaden the understanding of the local street drug supply.

“The supply is changing quickly,” said researcher Alexandra Collins, an assistant professor of epidemiology at Brown and a member of the People, Place & Health Collective at Brown's School of Public Health.

Those interviewed described striking changes and an increasingly toxic drug supply. They characterized street drugs as “synthetic” with evolving textures, colors and tastes, Many emphasized bad outcomes while using, including intense burning sensations and heavy sedation, ongoing withdrawal, and death of body tissues.

Given the complex supply, participants highlighted the increased risk of overdose and shared what steps they took to lessen the risks.

“They’re getting exposed to substances they don’t want to be exposed to. The supply is really potent,” Collins said.

Collins, along with Wightman, began collecting samples two years ago and have seen a rise in the presence of xylazine, which causes skin lesions. Some pills tested in the flight mass spectrometer contained 10 to 12 adulterants, Collins said.

“The key takeaway is we have to really expand our options for folks who use drugs. We need more funding for testing … We really need to support people who use drugs, not criminalize them,” she said.

This article originally appeared on The Providence Journal: RI illegal drug supply contains huge amounts of fentanyl: Brown study