Officials at the West Virginia Poison Center are warning the public in the wake of several unverified reports of overdoses from pills that closely resemble Xanax but contain the powerful opioid fentanyl.
An advisory issued Monday by the center said that several states, including neighboring Ohio, had confirmed cases of overdoses caused by 2-milligram counterfeit Xanax tablets that were laced with fentanyl, a synthetic narcotic drug that is estimated to be 80 times as potent as morphine and "hundreds of times" more potent than heroin, according to the Centers for Disease Control and Prevention. Between June 11 and June 20, the poison center had been notified of three cases of opioid overdose where patients, upon awakening, insisted they had taken Xanax.
Dr. Elizabeth Scharman, director of the West Virginia Poison Center, said the fake Xanax seen in other states is made to look like 2-milligram tablets of Xanax, a formulation that isn't as common and may be harder for people to recognize as illegitimate.
"You can tell it's not really Xanax - if you look at the two they look the same, but not quite," she said. "The brand-name 2-milligram Xanax tablets are not that popular, so many people haven't seen them before, and to them they look the same."
The problem of street drugs laced with fentanyl is one that already is affecting West Virginia - reports of fentanyl-laced heroin circulating are on the rise, and overdoses caused by fentanyl, also known by its street name "China White," increased from 55 deaths in 2014 to 154 deaths in West Virginia last year.
"The number of deaths has gone to alarmingly high levels," Dr. Rahul Gupta, commissioner of West Virginia's Bureau of Public Health, told the Gazette-Mail in March. "With fentanyl, people are going into overdose and dying more quickly."
Unlike heroin, Xanax is a benzodiazepine, a class of drugs separate from opioids that also cause respiratory depression during an overdose.
Because benzodiazepine overdoses and opioid overdoses aren't treated the same way - naloxone, for example, will help reverse a heroin overdose but not a Xanax overdose - overdoses where the drug in question is unclear can be disastrous for those who don't seek medical attention.
"We haven't gotten too many calls, but we've gotten enough that I'm concerned that we've got a problem," Scharman said. "It's not confirmed, but it's been confirmed in Ohio right next to us, and we've gotten enough calls that I'm concerned that we might have the problem here."
According to a 2014 report by the Substance Abuse and Mental Health Services Administration, the predicted risk of more serious outcomes - hospitalization or death - was greater than 20 percent among all age groups for benzodiazepines alone, but that risk increased by 24 to 55 percent when benzodiazepines were combined with opioids or alcohol.
"[Fentanyl] is extremely potent, so even for people who have abused drugs like heroin or other opiates, the amount of fentanyl in these tablets can be way too much," Scharman said. "It can cause death."
Scharman said the center is recommending that anyone who has gotten Xanax from anywhere other than a pharmacy should dispose of it properly and ensure it is not anywhere where others have access to it.
"This is a necessary alert for law enforcement, so they can be on the alert for this product, but also to let people in the public know that if they have purchased Xanax through their pharmacy as they would normally get their prescription filled, they're fine. There's nothing wrong with brand-name Xanax provided through normal pharmacies, but borrowing or using drugs purchased for someone else is never a good idea," she said. "If they can't guarantee that it's not one of the fake Xanax, then that could lead to death."
Scharman said another concern is that benzodiazepines, which are sometimes used to help control the symptoms of opioid and alcohol withdrawal, are sometimes used by opioid users to come down from a high, increasing the risk of death for those who may already have other opioids in their system and mistakenly ingest fentanyl.
"Some people who abuse other drugs will take a benzodiazepine to come down from a high - they take a benzodiazepine to offset it, and they didn't intend to take any more opiates," she said. "That wasn't their purpose, and that can lead to them taking too much opiate and they can die from opiate poisoning."
The West Virginia Poison Center is asking people to report suspected cases of overdose with fentanyl-laced Xanax to the center for monitoring, and to submit suspected counterfeit Xanax pills for testing.
Reach Lydia Nuzum at lydia.nuzum@wvgazettemail.com, 304-348-5189 or follow @lydianuzum on Twitter.