Bag of Counterfeit Fentanyl Pills
Source: U.S. Attorney's Office

What began in 2015 as an outbreak of counterfeit opioid painkillers and Xanax that contained potentially deadly doses of fentanyl or fentanyl analogues has spread to all 50 states, and has killed residents in 42 of them.

Illegal pill presses have given drug counterfeiters the ability to adapt. In 2020, they expanded their offerings with pills mimicking Adderall, Aleve, aspirin and even the diabetes drug metformin, and new, dangerous ingredients such as methamphetamine, isotonitazene, clonazolam and etizolam.

Mexican drug cartels smuggle millions of these pills over the border, but the U.S. also has homegrown traffickers who import ingredients and pill presses from China and manufacture their own deadly pills.