PITTSBURGH — Seizures of pills containing fentanyl have skyrocketed in the U.S., underscoring the country’s struggle to curb deaths from a highly potent, synthetic opioid that has been detected in an array of drugs, including counterfeit versions of non-opioids such as Xanax.

Data showing more than a 2,300% increase in pills with fentanyl seized by American law enforcement from 2017 to 2023 were in a report commissioned by the National Institute on Drug Abuse and published in the International Journal of Drug Policy on Monday.

“Fentanyl is in everything,” said Heather Richards, medical director for the Center for Recovery Medicine at Allegheny Health Network and a physician. “I don’t think I've seen any substance that at some point along the line has not had fentanyl.”

Just 2 milligrams of fentanyl — or a few grains small enough to fit on the tip of a pencil — are lethal to most Americans.

In 2023, the Drug Enforcement Administration alone seized more than 80 million fentanyl-laced fake pills and nearly six tons of fentanyl powder — enough to kill every American and still have more than 45 million lethal doses left over.

While many people who use opioids have learned how to live with fentanyl, many others don't have a tolerance to opioids at all — making one-off overdoses from a counterfeit pill containing fentanyl all the more dangerous.

“Fentanyl has continued to infiltrate the drug supply in communities across the United States, and it is a very dangerous time to use drugs, even just occasionally,” said Nora Volkow, National Institute on Drug Abuse director, in a news release about the study. “Illicit pills are made to look identical to real prescription pills, but can actually contain fentanyl.”

The study gathered data from the High Intensity Drug Trafficking Area program, which receives reports about drug seizures from law enforcement. Researchers state in the study that drug seizures can be seen as a “proxy” for drug availability.

Allegheny, Westmoreland, Washington, Beaver and Lawrence counties are all considered “high-intensity drug trafficking areas” by the Office of National Drug Control Policy.

According to the website for the Drug Enforcement Administration, an area qualifies as a high-intensity drug trafficking area if it “is a significant center of illegal drug production, manufacturing, importation or distribution.”

Allegheny, Beaver and Washington counties were added to the program in 2018, followed by Westmoreland in 2020 and Lawrence in 2022. Western Pennsylvania’s high-intensity drug trafficking area enforcement is overseen by the Ohio program. Butler County is not part of the program yet.

“We do see a lot of first-time, unintentional overdoses from pills (at Allegheny General Hospital),” said Richards. In many cases, that person got the pill from a friend, who said they got it from a pharmacy. “I try to tell people, ‘You can’t trust even your friend in this situation,'” she said. “Unless you see a pharmacist dispense it, it may contain fentanyl.”

Anecdotally, Richards said the people who come to the emergency department after overdosing from a pill tainted with fentanyl tend to skew younger — between 20 and 40 years of age.

Michael Lynch, the assistant medical director of the UPMC Pittsburgh Poison Center, also has seen more people visiting the emergency department from fentanyl laced-pills, a trend that began to tick upward around 2018.

“(These pills) would be indistinguishable to any of us,” he said.

It's not just pain pills either, said Lynch. Fentanyl is being added into, or masquerading completely as, benzodiazepines and sleeping pills. People seeking these pills may not have a tolerance to opioids, compounding their danger.

“These types of overdoses are very common,” said Dan Farmer, medical director for the WVU Medicine Center for Hope and Healing. “People think they're getting some (other drug).”

Farmer started to notice a large uptick in people overdosing on fentanyl-laced pills around 2020. As far as demographics, he said it's affecting everybody. In 2022, West Virginia had the highest drug overdose rate in the nation, per the Centers for Disease Control and Prevention.

A main concern is that industrial pill presses are being used to craft fake pills, right down to specific numbers and indents — all the signs someone might use to identify an authentic prescription pill. In October 2023, the Pittsburgh DEA office seized two industrial pill presses and about four pounds — multiple bags — of fake oxycodone and Xanax pills containing suspected fentanyl.

And in February, the DEA sent a letter to e-commerce companies warning that pill presses were regulated under the Controlled Substances Act and that companies must follow the federal law's regulations for recording and reporting sales of the product.

Even with the crisis skyrocketing, experts still encourage preventive and safe-use techniques.

Fentanyl test strips, which were decriminalized in Pennsylvania in 2022, can detect the opioid in a drug sample. They are free to pick up at many harm reduction centers around Pittsburgh, including Prevention Point, Unity Recovery and Second Avenue Commons, as well as online.

“We do recommend them for pills and stimulants, but no test is perfect,” said Lynch.

Many people who actively use opioids don't test for fentanyl at all: The supply is so saturated that there's no point.

But for people recreationally using pills, cocaine or MDMA (ecstasy), experts do recommend the strips.

It's important to keep in mind that fentanyl is not always evenly distributed across a drug sample, something the CDC calls the “chocolate chip cookie effect”: Testing a small part of a sample and getting a negative result does not necessarily mean you're in the clear.

“A negative test is not a guarantee,” said Lynch.

Richards said she hopes a new and more effective method for testing is on the horizon.

That’s why experts also recommend carrying Narcan and knowing how to use it.

“The more naloxone out in the community, the better,” said Farmer. “It's not just a medication made for people using (drugs), but for anybody. If everybody has it, these people have a chance.”

Richards also suggested that people planning on using a newly acquired substance should always use together, and Lynch called Narcan “an easy way to save a life.”

While national and local reports are showing that 2023 overdoses may be slightly lower than previous years, experts aren't overly optimistic that we’re out of danger. Zooming out, CDC numbers demonstrate an overall uptick in drug overdoses — and in Allegheny County, preliminary overdose data suggests fentanyl was involved in 85% of all overdose deaths last year.

Notably, people aren’t dying at equal rates. Black residents of Allegheny County see an overdose death rate triple that of whites. It's crucial that health disparities are front-and-center when talking about the opioid crisis, said Lynch.

“We talk about the numbers so much that it's easy to forget that each of these is a life, with family and friends and loved ones,” he said. “This is not a new thing, but an explosion of growth.”

Eagle staff writer William Pitts contributed to this report.