Fake prescription pills are easy to buy on social media. They are a deadly and growing threat to anyone but especially to children, experts say.

Terry DeMioCincinnati Enquirer

But Daniel was still.

"His eyes were half open and there was a tinge of blue on his upper lip," Puerta said. "I immediately knew something terrible had happened."

The distraught father called paramedics. They got Daniel's heart beating and rushed him to a hospital. Five days later, on April 6, 2020, Daniel Puerta-Johnson, 16, of Santa Clarita, California, was pronounced dead. His death was among those counted in a spike in teenagers and young adults who died from an unintentional overdose that year. 

His killer was a pill. It was disguised as an oxycodone tablet. But it contained fentanyl. 

"These aren’t overdoses. These are flat-out poisonings." Jaime Puerta

Daniel bought the tablet on Snapchat, his father says, and although the investigation is continuing, similar stories are popping up across the United States as counterfeit prescription pills pour into the United States.

"It is a tsunami," Puerta said.

Counterfeit OxyContin, Percocet, Xanax and Adderall flood the region, U.S.

Regionally, the Hamilton County Crime Laboratory has analyzed pills seized by an array of law enforcement agencies. Evendale police, Hamilton County Park Rangers, Cincinnati police, the region's U.S. Drug Enforcement Administration, Butler County sheriff's deputies and Lockland police are some of those that have submitted pills.

The crime lab saw a 99% jump in individual pills from 2020 to 2021. Chemists there saw a 63% increase in cases that year, records show.

The pills have steadily entered the United States for years but the rate at which they are being made and dumped here is soaring. A National Institutes of Health-funded study released March 31 shows that seizures of counterfeit pills across the United States' High Intensity Drug Trafficking Areas alone ballooned by nearly 5,000% from 2018 to 2021 – from 42,202 to 2,089,186.

The specialized  DEA operations are located in 33 regions in the United States. Several Ohio counties including Hamilton, Franklin, Butler and Warren, and Northern Kentucky's Boone, Campbell and Kenton counties are included in Ohio High Intensity Drug Trafficking Areas.

Among the counterfeit pills seized were fake OxyContin, Percocet, Xanax and Adderall.

What was sold on the street as Adderall actually contained methamphetamine.LAURA KIMBLE/PROVIDED

Addiction experts, police foresaw evolution of fentanyl-tainted counterfeit drugs

The Enquirer published a story in 2016 predicting the fake pills would become a new way for cartels to prey on Americans because of the ease of transporting and selling the substances – and reaping a high financial reward.

Those studying the opioid epidemic saw how fentanyl and a seemingly endless array of fentanyl analogues were dropped into heroin then, causing unprecedented overdose deaths among people who had built a tolerance to heroin. Fentanyl is 50 to 100 times its strength. 

"This might be the new epidemic as heroin is pushed out of the market," Dr. Adam Bisaga, professor of psychiatry at Columbia University Medical Center, told The Enquirer then. "These substances can be sold as 'heroin' or made into fake prescription painkillers."

Heroin has dwindled in supply in recent years, replaced by fentanyl and its varying forms.

Fentanyl and its analogues are synthetic opioids often made in China and sold to Mexican drug cartels. The Mexican criminal drug networks mass-produce the pills and flood the nation with them, the U.S. Department of Justice says.

It is a cheap way to make a lot of money, drug enforcement experts say.

"A cartel would make $80,000 per kilo of heroin. A kilo of fentanyl will yield $1.6 million, noted Benjamin Suver, director of law enforcement initiatives for the Ohio Department of Public Safety.

Some police are finding lower-level drug dealers with pill presses. They may be buying ingredients online from China. But most pills are pressed outside the United States and pushed over the border, the DEA says.

"We've been sounding the warning for years," said Newtown Police Chief Tom Synan, a coordinator with the Hamilton County Addiction Response Coalition. He and Dr. Lakshmi Sammarco, Hamilton County's coroner, have warned the public repeatedly about the deadly danger of taking street drugs of any kind.

The counterfeit pills are spreading across the country at such an alarming rate that the DEA recently pushed out a public service campaign, "One Pill Can Kill." The Ohio Department of Public Safety has issued alerts urging people to stay away from ill-gotten pills that appear to be legitimate prescription medications.

Laura Kimble, senior drug chemist and forensic scientist with the Hamilton County Coroner's Crime Laboratory located in Blue Ash, shows some of the fake oxycodone that was seized in a large drug bust. The fake pills contain fentanyl and acetaminophen.LIZ DUFOUR/CINCINNATI ENQUIRER

Dealers use social media, emojis to sell counterfeit drugs

"The ease of access is terrifying," Suver said. "You can order it on Facebook. They are selling through social media."

The pills are shipped to homes through UPS, FedEx, the United States Postal Service, he said. Hand-to-hand selling and buying on the street still happen in Ohio, Suver said, but "it's getting easier" to purchase through the internet.

And that's where there's a bigger threat to adolescents, who are adept at using the internet and expert at traversing social media, DEA officials say.

Jason Schumacher, assistant special agent in charge of the DEA's Cincinnati district office, said kids use smartphones to get and talk about the pills.

"They'll order these pills and they'll use different emojis, like for instance, Adderall. They may have an 'A,' and a rail station and a school bus (emoji), which means, 'I'm looking for Adderall, can you bring it to school?' "

Inexperienced drug users are more likely to use pills than powdered fentanyl, and they're at higher risk of overdosing than experienced drug users, who've built a tolerance to opioids, said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse.

Watching his son who did not have a substance use disorder die from a pill convinced Puerta: “These aren’t overdoses. These are flat-out poisonings.”

A graphic from DEA.gov site shows how people, especially young people, are purchasing and selling counterfeit prescription drugs.LIZ DUFOUR, LIZ DUFOUR/CINCINNATI ENQUIRER

In addition to fentanyl, pills are tainted by benzodiazepine, methamphetamine and more

About 40% of the drugs that the DEA seizes contain fentanyl.

But other counterfeit prescription pills contain imprecisely made benzodiazepine analogues, methamphetamine and more substances. Hamilton County crime lab chemists even have analyzed pills that had nothing but powder filler.

And although not every pill is pristine – some are discolored or the wrong color, some have rough stamps, others are improperly sized – it's nearly impossible to tell whether the pills are fake, said Erin Reed, special projects manager for Ohio Narcotics Intelligence Center.

 A former forensic chemist who analyzed drugs, Reed has watched the development of the pills over the years and has talked to chemists who cannot detect differences in some of the fakes with the naked eye.

"The sophistication of these counterfeit pills today is unparalleled,” she said.

A photo taken by Laura Kimble, senior drug chemist and forensic scientist with the Hamilton County Coroner's Crime Laboratory, shows what was sold on the street as Xanax, but actually contained the street drugs clonazolam and bromazolam. Kimble pointed out the difference in the size of the pills, which were confiscated in a drug bust.LAURA KIMBLE/PROVIDED

Pills not just used for a 'high,' experts say

It's exam season, Reed said, and that is another way the counterfeit pills pose a threat to people who do not typically use drugs.

There is a perception – untrue, research shows – that prescription medications for ADHD will enhance learning – even if the user hasn't been prescribed the medication.

Adderall is among the medications for ADHD. It is also among drugs that college students have been known to take as study aids. And fake Adderall is among the pills commonly found in the United States, including in Butler County, and not prescribed to those with attention-deficit/hyperactivity disorder.

Another threat is that kids or others who have depression or anxiety are seeking the pills to feel better. The DEA is offering parents strategies to help prevent their kids from using drugs and information for parents about online access to drugs.

"Never trust your own eyes to determine if a pill is legitimate," the DEA warns in its One Pill Can Kill campaign. "The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist."

Talk to your kids, DEA's Schumacher urged parents.

Father of dead child works to prevent more kids' deaths

Jaime Puerta and his son, Daniel Puerta-Johnson, smile as Daniel's mom takes a photo in their home state, California. Daniel died in April 2020 at the age of 16 after taking one counterfeit pill, which was disguised as a prescription oxycodone pill. He had been suffering from ADHD and depressive disorder and sought to self-medicate, his father said, buying the pill via a social media app.PROVIDED.

Daniel Puerta-Johnson purchased the counterfeit pill that killed him in an attempt to self-medicate, his father said.

“My son suffered from ADHD and severe depression," Puerta said. And while Daniel was being treated with medications for both disorders, he'd stopped taking them at the right times.

"So I had, for the past three or four days, taken it upon myself to wake him so he could take his meds," Puerta said.

Daniel was a gentle and compassionate boy, his father said. He'd been struggling because the novel coronavirus pandemic isolated him from his friends, mostly girls. “He wasn’t able to socialize with his friends," Puerta said.

Puerta remembers clearly the evening before Daniel took the fatal pill. He'd asked his dad if he could take Birdy, their rescue dog, out for a walk.

"He was only gone, like, 15 minutes," Puerta said.

He later learned that Daniel had walked to meet the person who sold him the counterfeit pill – delivered about three blocks from their home. 

"Children are being deceived into thinking they are buying a pharmaceutical-grade opioid when it’s a counterfeit pill. Who stands a chance with any of that?" Jaime Puerta

That night, Puerta told Daniel he loved him and tried to reassure Daniel that things would be OK.

But Puerta's life unraveled when he entered Daniel's bedroom the next morning and saw his son.

"I knew my beautiful boy was gone," he said.

His grief – and his outrage at drug-trafficking organizations – led Puerta to start a nonprofit foundation called Victims Of Illicit Drugs (or VOID), a parent-driven organization that works to alert the public about deadly fentanyl drug trends and advocates for legislative change. The nonprofit can be found at StopTheVoid.org.

With the endeavor, Puerta learned about one child after another – some as young as 14 – who died from ingesting a counterfeit pill or another fentanyl-tainted drug. 

"Children are being deceived into thinking they are buying a pharmaceutical-grade opioid when it’s a counterfeit pill," Puerta said. “Who stands a chance with any of that?" 

"Nobody.”

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