This post originally appeared on VICE Canada.
When Prince was found dead in his home in Minnesota in April of this year, rumors swarmed around the cause of his death being a drug overdose. In June, reports confirmed that the potent opioid fentanyl, which is typically 100 times more potent than morphine and many times more powerful than heroin, was the substance that caused the pop icon's overdose death. But on August 21, an anonymous official source involved with the investigation into Prince's death told the Associated Press that it might not have been prescription fentanyl that killed the musician—counterfeit pills containing bootleg fentanyl had been found on his estate.
The AP source said that close to there were nearly two dozen such pills found in a bottle marked as Aleve on Prince's estate. These pills were imprinted with a label, "Watson 385," which is a mark typically used for a prescription hydrocodone-acetaminophen pill—but these particular pills that were found actually contained fentanyl, lidocaine, and one other drug.
Though fentanyl is known as a prescription drug that is most commonly available as a patch that is placed on the skin, in recent years, a bootleg version of fentanyl believed to derive from China has flooded the illicit opioid market in both the US in Canada. In 2014, a reported 28,647 Americans died from opioid overdoses. Fentanyl is increasingly playing a role in those overdose deaths in the United States: More than 700 people died due to overdoses from the potent opioid between 2013 and 2015, though this number is likely higher than reported because fentanyl isn't always tested for.
In Canada, opioids are also killing more people than they ever have: Fentanyl was involved in at least 655 deaths in the country between 2009 and 2014. When it comes to opioid-related fatalities in Canada, counterfeit fentanyl pills have been increasingly played a role in overdose deaths.
Related: Watch our documentary on Fentanyl, the drug deadlier than heroin
Though counterfeit fentanyl has created an unfathomable problem that law enforcement, the government, and medical professionals are being challenged by, the origins of of the opioid overdose crisis can be traced back to overprescribing of opioids by doctors, which inevitably inflicted some people with opioid addiction. By a large margin, the US and Canada are the top two opioid prescribers in the world.
Dr. Hakique Virani, public health and addictions specialist in Edmonton who appeared in VICE's documentary on fentanyl, DOPESICK, said there are a few things that Prince's death should make us reflect on. "Opioid overdose death is affecting every demographic and socioeconomic class, the opioid demand that medicine has contributed to in North America through our approach to pain continues to have tragic consequences, and the illicit opioid supply is more toxic and less predictable than ever before."
Dr. Virani said he thinks trafficking bootleg fentanyl into North America is likely a lucrative market in the illicit drug trade. "When we say that fentanyl is 100 times more toxic as morphine, what we're saying is that a pound of fentanyl is the same as 100 pounds of morphine or 50 pounds of heroin," Virani said in DOPESICK. "If you're a drug trafficker, you can move a million doses of fentanyl in a shoebox or a glasses case, compared to requiring a skid for morphine."
As well, the way that bootleg fentanyl pills are produced makes them even more dangerous to those using them. Much like making chocolate chip cookies, not every cookie is going to have the same amount of chocolate in it. The same goes for these pills: Because the amount of fentanyl that can cause an overdose is such a small amount—an equivalent to the difference between a few grains of salt—counterfeit fentanyl in fake prescription pills can be especially dangerous.
In 2012, when Canada banned the original form of OxyContin in lieu of a "safer" alternative that was harder to abuse, OxyNeo, the illicit drug market saw an opening to introduce counterfeit OxyContin containing bootleg fentanyl into the illicit drug market. As one fentanyl user, A'lisa Ramsey, put it, "When I started getting Oxys off the street, I didn't know it at first, but it was fentanyl. I used fentanyl for three-and-a-half years, and I realized that it wasn't Oxy when we went to the dealer over the guy who was selling to me, and he was like, 'No, those aren't Oxys, that's fentanyl.'"
Michael Parkison, coordinator for the Waterloo Region Crime Prevention Council, flagged fentanyl to the Ontario provincial government back in 2008. "After 15 years and billions of dollars in legal opioid sales, the black market for bootleg opioids is now well established across North America," Parkinson said. "Given that anyone with an internet connection can get in on the action, the fentanyl-related death rates will continue to climb to record levels."
In Alberta, which has been plagued with fake OxyContin pills costing about $20 each on the street and commonly referred to as "beans," nearly 300 people died due to fentanyl in 2015—an increase of over 75 percent up from the previous year. The following type of counterfeit prescription pills containing fentanyl have been found in Canada so far: Percocet, Xanax, OxyContin. As well, fentanyl has been found in recreational drugs in both the US and Canada, including in cocaine, meth, and most notably, heroin. In Vancouver, a city known for its history with the opioid trade, there is little heroin left on the market today—most of it is actually fentanyl.
"The level of attention this problem is receiving in the US is encouraging for them—Obama himself is involved," Virani said. " In October last year, he demanded that addiction treatment finally reflect best evidence including medication assisted treatment, or lose federal funding."
In the US, the Obama administration has pledged $1 billion to address the American opioid overdose crisis. In Canada, no such move has been seen at the federal government level.
"It would be wise to establish emergency preparedness plans now if we are to have any hope of minimizing the harms that come with bootleg opioids," Parkinson said. "Governments need to be part of that collaboration, but to date, there has not been much interest [in Canada]... Experts are again left to watch a preventable crisis of death unfold."
Follow Allison Tierney on Twitter.