Fake blister packs and misrepresented prescription meds - what’s going on?

In the last month, our drug checking partners at the New Zealand Drug Foundation came across some presumed alprazolam pills in an unopened blister pack that actually contained tramadol, and no benzodiazepine. The packaging looked legitimate.

Internationally, there have been reports of blister packs containing misrepresented OxyContin tablets circulating in the European drug market. These tablets contain a nitazene compound and no oxycodone. While we’ve seen fake oxy tablets containing nitazenes in New Zealand as loose tablets, it is highly unusual and concerning to find these tablets in seemingly authentic blister packaging.

Medications found in blister packs have traditionally provided people who use non-prescribed drugs a level of certainty that the product is authentic, but these cases show that the packaging of medications is no longer a sign of legitimate supply.

Why do these fake blister packs matter?

Fake prescription medications are becoming an increasing concern, as people often assume that pills in blister packs are authentic and therefore safe. In reality, these fake pills can contain dangerous potent substances like nitazenes, with unpredictable effects.  

People consuming these tablets believing them to contain legitimate medication may inadvertently consume multiple doses of something else increasing their risk of overdose. This risk can be further compounded by the difficulty in accurately dosing such potent substances.

These illicitly pressed tablets often have little to no quality control meaning these tablets can have unpredictable dosages and vary in size, increasing the risk of unintentional overdosing. Many of these types of tablets have been shown to have varying doses even within the same batch.

There is a significant risk of harm for people consuming these tablets believing them to be actually pharmaceuticals diverted from legitimate supply. Counterfeit pharmaceutical tablets have been linked to serious hospitalisations and deaths in New Zealand.

High Alert has previously issued notifications about misrepresented benzodiazepines, including fake Xanax bars, (view the notifications here) and opioids, including fake oxycodone tablets (view the notifications here).

How do reduce the risks of fake blister packs

High Alert urges caution should you choose to use medications sourced from the illicit market – blister packs are no guarantee of authenticity. Drug checking is recommended to help minimise the risk. KnowYourStuffNZ, the New Zealand Drug Foundation and the New Zealand Needle Exchange Programme’s DISC Trust are running regular drug checking clinics. Information on upcoming clinics can be found on The Level.

If you choose to use medications sourced from the illicit market: 

• Avoid using alone. Have a friend who can help, and call an ambulance, if things go wrong. Use a buddy system if needed - where someone is on the phone or calls you to check you are ok.
• Lower doses are less risky. Start off with an extremely small amount (a typical dose is in micrograms) to check how it affects you. If you notice unexpected effects avoid taking more. Any substance in an illicitly pressed pill is unlikely to be evenly distributed, meaning some parts will be stronger than others. Crushing the pill, mixing it, and measuring out an extremely small amount helps to distribute the active ingredient more evenly, and avoid overdose.
• In general, swallowing a substance has a slower onset than other methods and means there might be more time to get medical help if needed.
• Avoid using it at the same time as other substances and medications, especially other depressant drugs such as alcohol, opioids, GHB/GBL, ketamine, and benzodiazepines, as these can increase the risk of slowing or stopping breathing.
• Have naloxone with you – a drug that can temporarily reverse the effects of an overdose and give you more time to get medical help. Talk to your GP about this. High potency opioids like nitazenes may require more than one dose of naloxone.
  • Remember, nitazenes can be fast acting and you may not initially realise you require naloxone. Have someone with you who can administer naloxone if needed because you will not be able to administer it by yourself.
  • If you aren't sure whether someone is experiencing an opioid overdose, you should use naloxone anyway. Naloxone won't hurt the person if they aren't overdosing. There is no maximum dose of naloxone - meaning that you are not at risk of giving someone too much.

Call 111 and ask for an ambulance immediately if you are concerned, or if you or someone else has any of the below signs after taking this substance. Tell them what has been taken and that it could contain heroin, it could save a life. Don’t leave the person alone and treat it as an overdose if unsure. 

The signs of an opioid overdose include: 

• They may not be completely awake or are unresponsive.
• They are breathing slowly or not at all (they may be snoring).
• The person’s face is extremely pale and/or feels clammy to the touch.
• Their body goes limp.
• Their fingernails and/or lips have a purple or blue colour.
• They start vomiting or making gurgling noises.
• Their pupils become very small.
• Their heartbeat slows or stops. 

If you have any concerns about your own alcohol or drug use, or that of a friend, get in touch with the Alcohol Drug Helpline. Call 0800 787 797, or text 8681, to speak with a trained counsellor – they’ll be able to provide you with helpful information, insight and support. They’re available 24/7, all calls are free and confidential. You can also chat with the team through their website.