For immediate Release:

October 23, 2013


Contact: Colleen Chawla 415 554-2769

MEDIA AVAILABILITY at 10:30am today at 101 Grove Street, Room 300 with Tomás J. Aragón, MD, DrPH, San Franciso Health Officer and Phillip Coffin, MD, MIA, Director of Substance Use Research, San Francisco Department of Public Health
Severe Opioid Overdoses in San Francisco Caused by Counterfeit “Xanax” Pill Containing Fentanyl

Sale of street drug causing harm and death

Public warned not to buy prescription drugs on the street


(San Francisco) – The San Francisco Department of Public Health is warning people not to purchase “Xanax” on the street, as there are counterfeit pills circulating that contain fentanyl, an extremely potent, short-acting opioid that can cause overdose and death.

From October 15 to 17, 2015, three individuals between the ages 20-40 years were hospitalized after ingesting a pill inscribed and sold as “XANAX,” purchased on the street. All three patients suffered complications of opioid overdose, including sedation, weakness in extremities, muscle breakdown that can lead to kidney damage, and fluid in lungs. Two of them became critically ill. A fourth person was found deceased in the community, with the same pill on their person. Analysis of pills demonstrated fentanyl; one also had etizolam. The source of the pills is unknown.
Fentanyl is particularly dangerous when used illicitly as it is normally dosed in tiny (microgram) quantities. This summer, fentanyl was found in the community as a source of overdoses among people who were buying heroin and got fentanyl instead. At this time we do not know whether the fentanyl in the “Xanax” is connected to that phenomenon.
Fentanyl may be more difficult than other opiates to reverse with naloxone, possibly requiring extra doses. Etizolam is a short-acting sedative that produces central nervous system depression. These two agents, when taken together, can result in marked respiratory and central nervous system depression. Pills purchased on the street may contain contaminants or may be replaced


“We know there is a dangerous counterfeit drug being sold on the street as ‘Xanax,’ and people should be very careful and avoid the risk of overdose and death,” said Tomás J. Aragón, MD, DrPH, San Franciso Health Officer. “Under no circumstances should you accept medication from someone else, or purchase prescription medicine on the street.”


The Health Department alerted physicians in the community to this problem yesterday (Oct 22). For people who do purchase prescription drugs on the street, or who are exposed to opioids, the San Francisco Department of Public Health encourages them to have access to naloxone to combat overdose. Naloxone is a short-acting opioid antagonist that is sprayed intranasally or injected to reverse an overdose. Naloxone is not a controlled substance, can be prescribed by any licensed health care provider, and can be administered by witnesses as a first aid measure. The San Francisco Police Department, in partnership with the Health Department, has started to use naloxone to respond to overdoses. Naloxone is covered by Medi-Cal, Healthy SF, and most health plans and can also be furnished by pharmacists registered to do so without a prescription. Naloxone is also available at no cost from the DOPE Project, targeting drug users and their friends and family via syringe exchange sites. These means of naloxone provision and use are protected by California law (AB635 and AB1535).


Health care providers or members of the public can contact the California Poison Control Center at 800-222-1222 with any questions regarding overdose or symptoms after ingesting a pill.


Counterfeit “Xanax” on red background. Real Xanax on grey background.