Beware of Counterfeit and Unregulated Drugs

The Mississippi State Department of Health (MSDH) is urging Mississippians to be aware of the serious and potentially unpredictable risks associated with counterfeit pills, illicitly manufactured drugs and other psychoactive products obtained from unregulated or unverifiable sources. 

The warning comes as the drug environment continues to change, with counterfeit pills, emerging substances and products sold in a variety of forms and through a growing number of channels. A product’s appearance, packaging, labeling or place of purchase may not reliably indicate what it contains. 

Counterfeit pills can be manufactured to closely resemble legitimate prescription medications. Other unregulated psychoactive products may be sold as tablets, gummies, liquids, shots or other commercially packaged products. In either case, consumers may be unable to determine a product’s actual ingredients, concentration, purity or potential effects simply by looking at it. 

“The most important message for Mississippians is that you cannot determine what is in an unregulated product simply by looking at it,” said Jon Hubanks, director of the Center for Injury Prevention & Recovery. “A familiar appearance, professional packaging or even previous experience with a product does not guarantee that the next product contains the same substances or the same concentration.” 

A Changing Drug Environment

Counterfeit medications remain an important public health concern. The Centers for Disease Control and Prevention (CDC) has warned that pills obtained illicitly or without a prescription may contain highly potent substances, including illegally manufactured fentanyl. Counterfeit prescription pills are often made to resemble legitimate medications and may contain substances that the person taking the pill did not intend to consume. 

At the same time, emerging risks are not limited to counterfeit prescription pills or drugs obtained through traditional illicit markets. Federal agencies have identified potent psychoactive substances in commercially packaged products available online and through retail locations. The U.S. Food and Drug Administration (FDA) has warned consumers about concentrated 7-hydroxymitragynine, or 7-OH, products sold as tablets, gummies, drink mixes and shots, including products available at gas stations, smoke shops and corner stores. The FDA states that 7-OH is not approved for medical use and cannot lawfully be marketed as a dietary supplement or added to conventional foods. 

More recently, the U.S. Department of Justice announced the emergency scheduling of three manufactured compounds related to mitragynine or 7-OH: mitragynine pseudoindoxyl (MGPI), MGM-15 and MGM-16. The department described the action as a response to a rapidly developing market for manufactured opioid compounds. 

These developments illustrate a broader public health concern: the unregulated drug market can evolve rapidly, and new substances, formulations and combinations may emerge faster than consumers recognize them. 

Retail Availability Does Not Mean a Product Is Safe

MSDH cautions consumers against assuming that a psychoactive product is safe simply because it is professionally packaged, labeled or available for purchase at a retail establishment or online. 

The FDA has documented concentrated 7-OH products being sold through ordinary retail channels despite not being approved for medical use. The agency has also taken enforcement action involving concentrated 7-OH products sold as foods and dietary supplements. These examples reinforce the importance of distinguishing availability from verification of safety, quality and consistency.

“Today’s drug environment requires us to think beyond the traditional image of an illicit drug,” Hubanks said. “A potentially dangerous substance may resemble a prescription medication, or it may be sold in professional-looking consumer packaging. Where something is sold or how it looks cannot tell you everything you need to know about what is in it.” 

MSDH Recommends

Mississippians can reduce the risk of overdose and other serious adverse effects by taking several precautions:

• Take prescription medications only when they are prescribed to you and obtained from a licensed pharmacy.

• Do not assume a pill is legitimate based on its color, shape, markings or packaging.

• Use caution with psychoactive products obtained from unregulated or unverifiable sources.

• Do not assume that commercial packaging or availability in a store or online means a product has been evaluated or approved by the FDA for safety, effectiveness, quality or consistency.

• Keep naloxone available. Naloxone can rapidly reverse an opioid overdose, including an overdose involving fentanyl.

• Consider fentanyl test strips when appropriate. Fentanyl test strips can detect fentanyl in many drug products but do not identify every potentially dangerous substance. A negative result should not be interpreted as proof that a product is safe.

• Avoid using unknown or unregulated substances.

• Call 911 immediately if an overdose or serious adverse reaction is suspected. 

A Message for Students and Young People

Young people can play an important role in preventing overdose, even if they do not use drugs themselves. Carrying naloxone does not mean you use drugs, and you do not have to tell anyone that you have it. A student can keep naloxone in a backpack, vehicle, dorm room or other personal space and have it available in case a friend or someone else experiences an opioid overdose. 

“Having naloxone with you can be a simple way to be prepared,” Hubanks said. “You may never need to use it, but if you are with someone experiencing an opioid overdose, having naloxone could save that person’s life.” 

Signs of a possible opioid overdose include:

•       Inability to wake or respond

•       Slow, shallow or stopped breathing

•       Choking, gurgling or snoring-like sounds

•       Blue, gray or discolored lips or fingernails

•       Pinpoint pupils 

If an opioid overdose is suspected, administer naloxone if it is available and call 911 immediately. Naloxone will not harm someone if an opioid is not involved. 

How to Get Naloxone at No Cost

Naloxone is available at no cost from MSDH to Mississippi residents. Individuals can complete an online request and have a naloxone kit shipped directly to them at no charge. MSDH also accepts requests from organizations that need naloxone in bulk for community distribution. 

There is no need to wait until an emergency to obtain naloxone. People at risk for opioid exposure, as well as family members, friends, students and others who may be in a position to respond to an overdose, are encouraged to keep naloxone nearby and know how to use it. 

To request naloxone:

• Through MSDH: Visit the MSDH naloxone webpage, complete the online request process and request a kit to be mailed to you at no charge.

• Through ODfree.org: Visit ODfree.org and select “Get Naloxone at NO COST” for information about accessing naloxone and other overdose-prevention resources. 

Avoid Speculation About Specific Substances

Because the unregulated drug market can change rapidly, MSDH also encourages the public to avoid concluding the identity of a substance based solely on social media reports, appearance, packaging, product names or preliminary information surrounding an overdose. 

Determining which substance or combination of substances contributed to a serious illness or death may require laboratory testing, toxicology and investigation. Public health precautions, however, do not need to depend on identification of a single emerging substance. Counterfeit and unregulated products can present risks regardless of the particular substance circulating at a given time. 

“Our message is not about one drug, one product or one emerging substance,” Hubanks said. “It is about recognizing that the drug environment is changing. If you cannot verify the source and contents of a product, do not assume that its appearance, label, packaging or previous use tells you what is in it. Carry naloxone, know the signs of an overdose and call 911 when an overdose is suspected.” 

For more information about naloxone, overdose prevention and substance use disorder resources in Mississippi, visit Opioids and Substance Use - Mississippi State Department of Health 

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