Blues are counterfeit pills pressed to look like 30 mg oxycodone, stamped “M” on one side and “30” on the other, and they contain illicit fentanyl rather than oxycodone. They are sold on the street as prescription opioids. The person taking one has no way to know the dose inside it.
The Drug Enforcement Administration attributes the ongoing opioid crisis primarily to illicit illicit fentanyl addiction, and counterfeit pills are how most people encounter it.
What Are Blues Drugs?
Blues are counterfeit opioid pills containing fentanyl. The nickname comes from their color, and “M30” from the markings pressed into them. They imitate 30 mg oxycodone tablets and are also produced in red, orange and yellow, sold as “rainbow” fentanyl.
Counterfeit oxycodone pills sold as blues are small and round. Their resemblance to candy drives concern about accidental ingestion by children.
Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine, per the National Institute on Drug Abuse. The Food and Drug Administration approves it as an analgesic and anesthetic, under the brand names Actiq, Duragesic and Sublimaze. It carries a high risk of dependence, and withdrawal from it requires medically supervised detox. NIDA reports that synthetic opioids are now the drugs most commonly involved in overdose deaths in the United States.
Why Are Blues Drugs So Dangerous?
A counterfeit pill carries an unknown fentanyl dose. The DEA identifies 2 milligrams as a potentially lethal amount, roughly the weight of a mosquito, and pressing is not uniform, so two pills from the same batch can differ.
Any pill not dispensed by a pharmacy carries this risk. The DEA reports that counterfeit pills are pressed to imitate oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), alprazolam (Xanax) and amphetamines such as Adderall, and that they are cheap, widely available and sold through social media and e-commerce platforms.
The Centers for Disease Control and Prevention lists the signs of fentanyl overdose:
- Pinpoint pupils, small and constricted
- Loss of consciousness, or an inability to stay awake
- Weak breathing, slowed breathing, or no breathing
- Choking or gurgling sounds
- A limp body or muscle weakness
- Cold, clammy skin
- Discolored skin and nails, the lips especially
Call 911 immediately if someone shows these signs. Naloxone reverses a fentanyl or opioid overdose and is sold at most pharmacies as Narcan. Give naloxone even if you are unsure what the person took, because it does not harm someone who has not taken opioids.
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Why Teenagers Face Particular Risk
Counterfeit pills reach young people through social media platforms rather than street dealers, which removes the barriers that once limited access. The DEA warns that criminal networks advertise fake pills on those platforms. Teenagers are also less likely to carry naloxone, and more likely to swallow a pill than to inject a drug, which makes a counterfeit tablet a plausible-looking first exposure.
How Opioids Produce Dependence
Opioids occur naturally in the opium poppy; fentanyl is manufactured synthetically. Fentanyl binds the body’s opioid receptors, which govern pain and emotion. Repeated exposure drives the brain to adapt, and that adaptation blunts pleasure from anything other than the drug. Continued use despite harm defines addiction, the most severe form of substance use disorder. The prefrontal cortex loses regulatory strength over the same period, which is why impulse control weakens as tolerance climbs.
How Do You Avoid Counterfeit Opioid Pills?
Take opioids only as a clinician prescribed them to you, obtained from a pharmacy. A pill from any other source cannot be verified by appearance, because counterfeits copy the markings, color and shape of the real tablet.
- Take prescription opioids only as prescribed
- Never buy opioids from illegal sources or online sellers
- Fill prescriptions at a licensed pharmacy
- Avoid combining opioids with alcohol or other sedatives
- Dispose of unused opioids properly, and never share them
Carry naloxone if you or someone close to you uses opioids, and learn how to give it.
What Are the Signs of Opioid Addiction?
Opioid addiction shows as loss of control over use: taking more than prescribed, continuing after the prescription ends, withdrawal on stopping, and use that persists despite damage to responsibilities and relationships.
- Taking opioids more often, or in larger amounts, than prescribed
- Continuing to use after the prescription has ended
- Neglecting responsibilities or relationships
- Using in dangerous situations, such as while driving
- Withdrawal symptoms on attempting to stop
Seek professional help if these apply. Opioid withdrawal is treatable, and medical supervision makes it safer.
How Is Opioid Addiction Treated?
Opioid use disorder is treated with medically supervised detox followed by continuing care, with medication-assisted treatment such as buprenorphine (Suboxone) where clinically indicated, rather than detox alone.
Detox handles the physical dependence. It does not address what drives the use, which is why detox without continuing care carries a high relapse rate, and why the return carries overdose risk: tolerance falls during abstinence while the counterfeit supply does not become any more predictable.
SAMHSA’s National Helpline, 1-800-662-HELP (4357), gives free confidential treatment referral 24 hours a day in English and Spanish. If you are in crisis or thinking about suicide, call or text 988, or chat at 988lifeline.org/chat.
Riverside Recovery of Tampa provides medical detox, residential treatment, day and night treatment, intensive outpatient and outpatient therapy on one campus. Contact our clinical intake team to discuss treatment for opioid use disorder.
References
- Drug Enforcement Administration. One Pill Can Kill. U.S. Department of Justice. Available from: dea.gov/onepill
- Centers for Disease Control and Prevention. Fentanyl Facts. Atlanta, GA: CDC. Available from: cdc.gov/overdose-prevention
- National Institute on Drug Abuse. Fentanyl DrugFacts. Bethesda, MD: National Institutes of Health.
- Fentanyl | Opioids | CDC. (n.d.). https://www.cdc.gov/opioids/basics/fentanyl.html
Data Overview | Opioids | CDC. (n.d.). https://www.cdc.gov/opioids/data/index.html
Opioid overdose | Drug overdose | CDC Injury Center. (n.d.). https://www.cdc.gov/drugoverdose/deaths/opioid-overdose.html#synthetic
DEA announces results of enforcement surge to reduce the fentanyl supply across the United States. (2022, September 27). DEA. https://www.dea.gov/press-releases/2022/09/27/dea-announces-results-enforcement-surge-reduce-fentanyl-supply-across
One pill can kill | DEA.gov. (n.d.). https://www.dea.gov/onepill