Who the hell has a real perc anymore?

Understanding the makeup and effects of pressed (counterfeit) pills in the Rhode Island drug supply

Pressed pills are pills made to resemble common prescription medications that have been manufactured with pill press machines illegally. Pressed pills are made to replicate the pharmaceutical versions in size, shape, color, and general effect on the user. ​​They often contain fentanyl, fentanyl analogs, or other active cuts. The following a zine on pressed pills.

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(1) “Who the hell has a real perc anymore?” : Understanding the makeup and effects of pressed (counterfeit) pills in the Rhode Island drug supply. By: Claire Macon and Abdullah Shihipar. Brought to you by testRI & the People, Place and Health Collective. The page is black. A white pill bottle wearing a disguise (glasses and a mostache) is shown in the center.

(2) What exactly are pressed pills? What exactly are pressed pills?

Pressed pills are pills made to resemble common prescription medications that have been manufactured with pill press machines illegally. Pressed pills are made to replicate the pharmaceutical versions in size, shape, color, and general effect on the user. ​​They often contain fentanyl, fentanyl analogs, or other active cuts.

[image of a industrial presser and three sets of pills next to it]

Pressed pills vary in quality and composition. We see this in the color, textures, and markings on the pill. However, some pressed pills can be virtually indecipherable from the pharmaceutical grade version.

[a pill bottle wearing a disguise (glasses and a mostache) is shown]

Due to stricter regulations around prescribing opioids, benzodiazepines, and amphetamines, it is unlikely that pills obtained outside of a pharmacy are real.

[A confused person is shown rubbing their hand on their head with a question mark]

“You know, wherever you get ’em from, they’re gonna be pressed. Like people aren’t gonna tell you the honest truth ever.”

(3) What has been tested? In the following pages we highlight three types of pill samples we’ve tested in Rhode Island that were sold as: Percocets, Adderall, and Xanax. We’ve highlighted these due to the popularity of these substances locally, but these are not the only types of pills being pressed and sold nor are the contaminants listed below the only cuts in the supply.

A common assumption is that pressed pills are less likely to be cut with other substances, but as these preliminary results show, that isn’t the case. Without further stigmatizing individuals who use any and all types of substances, it’s important to share information about what is in the drug supply so that people who use drugs and others can stay safe and be informed.

Visit testri.org for more information about substances we’ve tested recently and how to donate a sample.

(4) What has been tested? Percocet

So far, we tested 6 pressed Percocet samples. Below are the results of the makeup of some of the individual samples that were sold as Percocet.

*denotes major component

in a Baggie tested on 9/22

Xylazine*

Fentanyl*

Cocaine

Acetylfentanyl

Para-fluorofentanyl

Beta-hydroxyfentanyl

AcrylFentanyl

Acetaminophen

Delta-9THC

Procaine

Lidocaine

Mepivacaine

in a Baggie tested on 9/22

Fentanyl*

Cocaine

Xylazine

in a pill tested on 9/22

Fentanyl*

Para-fluorofentanyl

Beta-hydroxyfentanyl

Xylazine

Caffeine

Tramadol

Phenacetin

Acetylfentanyl

Cocaine

Levamisole

Acrylfentanyl

(5) What has been tested? Adderall

So far we’ve seen two samples of pressed Adderall. Harm reduction groups such as DanceSafe have reported an uptick in pressed Adderall in their community and in September 2022 there was a drug bust of over 660,000 methamphetamine-contaminated pressed Adderall pills and 1,000 pressed fentanyl-contaminated oxycodone pills in Cumberland, Rhode Island. We anticipate seeing more of this as the landscape of the drug supply continues to shift.

*denotes major component

in a pill tested on 12/22

Methamphetamine*

Caffeine

Cocaine

Etizolam

in a Baggie with orange residue tested on 1/23

Methamphetamine*

Cocaine

Ketamine

(6) What has been tested? Xanax

In January 2023, we tested multiple samples of pills sold as Xanax. Two out of three of the Xanax samples shown here contained multiple designer benzodiazepines (etizolam, flualprazolam, clonazolam, and bromazolam). Designer benzos are non-pharmaceutical benzodiazepines that have been found in the US, Canada, and Europe. These have not been well-studied and can be more potent and unpredictable than prescription benzos.

Pill Fragment with “X” tested on 1/23

Etizolam*

Flualprazolam*

Ketamine

Desalkylflurazepam

Lidocaine

Clonazolam

white Pill in blister pack tested on 1/23

Alprazolam (Xanax)*

off white / light blue pill no markings on 1/23

Bromazolam*

Flubromazolam

Alprazolam (Xanax)

(7) Harm Reduction and Pressed Pills

A major reason pressed pills can be dangerous is the lack of consistency and knowledge of the supply. It’s important to note when using that pills can vary in contaminants and potency from pill to pill. We heavily recommend several key harm reduction strategies when using any pills that are not directly from your pharmacy.

[an icon of a spedometer with the dial on slow] Go slow & take test bumps: Consider using smaller amounts at a time to see the effect before consuming the pill in its entirety or multiple pills at once.

[an icon of a mixing bowl] Avoid mixing substances: Mixing alcohol, opioids, and/or benzodiazepines increases the risk of overdose.

“Like, I’ve mixed Percocets with alcohol, and it’s not a good experience. That’s what led me to overdosing……the first time. Because you’re not supposed to mix those two substances, And I learned the hard way.” — testRI participant

[an icon of a group of people] Don’t use alone: If you do, let a friend know you’re using

[icon of narcan nasal spray] Always have Narcan accessible: Narcan saves lives.

(8) Harm Reduction and Pressed Pills:

[icon of a testing kit for testing drugs] Test your supply: We have found that pressed pills contain numerous contaminants including fentanyl. If you are trying to avoid fentanyl exposure, consider testing your drugs with fentanyl test stips before using.

You can pick up fentanyl test strips and Narcan for free at local agencies such as AIDS Care Ocean State and Project Weber/RENEW.

Visit https://preventoverdoseri.org/people-who-use-drugs/ for more information about where you can find fentanyl test strips and other harm reduction resources across Rhode Island.

(9) Works Cited

[logos for testRI and PPHC are shown]

Works Cited

Arya, S., Nagappala, S., Krawczyk, N., Gu, Y., Meacham, M. C., & Bunting, A. M. (2022). Fentanyl in pressed oxycodone pills: A qualitative analysis of online community experiences with an emerging drug trend. Substance Use & Misuse, 57(13), 1940–1945. https://doi.org/10.1080/10826084.2022.2120365

Canadian Centre on Substance Use and Addiction. (n.d.). Retrieved February 3, 2023, from https://ccsa.ca/sites/default/files/2019-05/CCSA-CCENDU-Oxycontin-Fentanyl-Alert-2014-en.pdf

Cumberland man to plead guilty in largest meth-laced pill seizure. The United States Department of Justice. (2022, September 19). Retrieved February 3, 2023, from https://www.justice.gov/usao-ri/pr/cumberland-man-plead-guilty-largest-meth-laced-pill-seizure

DanceSafe, (@Dancesafe). (2023, January 12). Yall, almost all of the “Adderall” we see from people who bought it online or from a plug just contains meth. If it’s not from a script, it ain’t legit. People are out there wondering why they’ve been up for 24 hours rearranging their closet. (Tweet). Twitter https://twitter.com/DanceSafe/status/1613666381588795395?cxt=HHwWhsC4ycjB8uQsAAAA

Daniulaityte, R., Sweeney, K., Ki, S., Doebbeling, B. N., & Mendoza, N. (2022). “They say it’s fentanyl, but they honestly look like perc 30s”: Initiation and use of counterfeit fentanyl pills. Harm Reduction Journal, 19(1). https://doi.org/10.1186/s12954-022-00634-4

Larnder, A., Saatchi, A., Borden, S. A., Moa, B., Gill, C. G., Wallace, B., & Hore, D. (2022). Variability in the unregulated opioid market in the context of extreme rates of overdose. Drug and alcohol dependence, 235, 109427. https://doi.org/10.1016/j.drugalcdep.2022.109427

Palamar, J. J., Ciccarone, D., Rutherford, C., Keyes, K. M., Carr, T. H., & Cottler, L. B. (2022). Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug and Alcohol Dependence, 234, 109398. https://doi.org/10.1016/j.drugalcdep.2022.109398