Image copyright TSA Image caption DEA is warning people who use a potentially lethal pill to treat pain to stop using it
You may not realise it, but paracetamol, ibuprofen and oxycodone are just the highlighters of the three main classes of painkillers.
However, what one uses to ease your pain may in fact be laced with deadly fentanyl, a synthetic opioid that can be as strong as heroin.
“That’s an incredibly dangerous substance,” one doctor told the BBC.
Health Canada data show there are now 582 documented deaths linked to fentanyl – more than quadruple the fatalities from fentanyl between 2010 and 2014.
Deaths linked to fentanyl-laced opioids have been steadily rising in the US since 2014.
Such an increase has always concerned authorities and it now looks as though Russia may be increasing the amount of fentanyl that it is producing.
In response, the US Drug Enforcement Administration (DEA) has issued a serious alert, warning people that the drug may be disguised as legitimate painkillers.
The guidance points out that opioids can be very effective in managing the pain of a number of people, however some patients may be provided with no detectable quantities of the drug when they go to visit a doctor.
It’s dangerous to be using painkiller without an accurate sense of your dosage
Dr La Puente
In these cases, the doctor can prescribe medications without regard to the prescription drug patient, such as opioid blockers and even opiate-free drugs.
This risk can exist when a doctor is unaware of the patient’s ability to recognise and manage doses.
One doctor, who works on rheumatoid arthritis patients, said they had a number of patients who started taking paracetamol, ibuprofen and opiates to ease pain.
“These people don’t know that the painkillers could be, or the fentanyl could be in the pills,” he told the BBC.
When their prescriptions ran out, they would simply have more paracetamol or other medications, without treatment for their ongoing pain.
The doctor also said the issue was making it more difficult for doctors to be aware that someone was using painkillers to treat an ongoing condition.
“It’s dangerous to be using painkiller without an accurate sense of your dosage, especially if someone is receiving controlled doses of a medication in addition to their first-line therapy,” he said.
The DEA says it is aware of one group of people, known as an “opioid-relief specialist”, who “lend their expertise and competence to individuals suffering from chronic pain”.
The DEA warns that these individuals could be buying large amounts of fentanyl, which could be laced with other drugs.
To minimise the risk of fentanyl slipping into your regular drug cabinet, it advises:
To minimise risk and therefore have a low risk of encountering fentanyl at the pharmacy, don’t buy a large quantity of an opioid-relief specialty drug and don’t buy multiple quantities of the same drug
Don’t keep opioid-relief drugs in sight and hide them away or administer at home
Don’t keep prescription medicines in your car (including oral misoprostol) and don’t go to the doctor in your car or to other services such as the post office
Use Tylenol in very small doses and only give it as a first line treatment.
If taking antibiotics, do not prescribe more than a three-day course.
When buying painkillers at a pharmacy or from a supplier, the DEA advises you:
Avoid multiple sale/purchases from multiple sources
Keep the pharmacy’s name clear
Keep the product in a compartment
Don’t cross the street or use the bus or subway in case it’s stolen.
Keep in mind that if you go to a hospital with a prescription for a painkiller, you will need to provide proof of a receipt.
One doctor said it is not always difficult to spot a potentially deadly fentanyl pill.
“I’ve seen many occasions when they have been very smooth, just like [the “opioid-relief specialist”].
“But when I see it, I’m like ‘Oh my goodness! They have fentanyl in the pill.’
“If you feel the hard edge in the middle, it’s there. So it’s super easy. Just open up a container, look inside and see what the powder is.”