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Often students seek out prescription medications like Xanax, Adderall, and OxyContin to achieve a goal but unknowingly end up with fake versions of the real medicines. This includes all pills not just capsules.

The fake or counterfeit versions of these pills may look nearly identical to the real medications but can have different or deadly effects due to their unknown and often dangerous and deadly composition.

These counterfeit pills can have a profound effect on student’s mental health, safety, and physical well-being. More importantly, one pill can kill.

High school and college students sometimes misuse prescription drugs in an effort to:

  • Improve academic performance
  • Improve athletic performance
  • Gain a competitive advantage
  • To make it easier to socialize at parties
  • Induce sleep
  • Reduce pain (physical or emotional)
  • Increase energy
  • To stay awake or sharpen focus
  • To self-medicate for anxiety, depression, grief, or some kind of trauma
  • To counteract the effects of another drug

Common University Scenario:

Diane’s classes have been demanding with overlapping due dates so she feels unprepared for an exam the next day in one of her classes and decides to pull an all-nighter. She is struggling in this class and could lose her college scholarship if she doesn’t make at least a C+. She decides to do what her boyfriend does and get Adderall from the guy in his frat to help her stay awake and focused all night. She has never done anything like this before and says she is not going to make this a habit but this is important. After all, most kids say it’s a “smart drug.” Everybody does it so how harmful could it be?

Some students begin using prescription stimulants like Adderall, often referred to as “study drugs,” believing it will improve their academic performance.1 Instead it becomes a crutch, robbing the person of the ability to develop the coping skills to manage a challenging schedule or ask for help from an advisor.

So it becomes the “go-to” solution which not only can lead to an addiction to that substance or multiple substances they don’t even know are in the pills. It also raises the risk of dependence, addiction, an overdose, an overdose death, and can trigger suicide or violent behavior.

Common High School Scenario:

Ben is anxious about his upcoming SAT. He doesn’t want to end up at his backup school but make sure he gets into his first choice university so that he is in a better position to get into a good law school. He’s done the research and knows the best trajectory. But his anxiety is getting in the way and making him overthink that every SAT question is a trick question and he believes that self doubt is affecting his score. He needs only 100 more points to put him in the best position for his goals. So he decides to find the kid in high school that sells xanax to calm his nerves. Others of his friends have done it. What could it hurt?

Getting into the “right” school has become very competitive. And while some universities no longer require SAT and ACT scores, students often seek substances to treat their anxiety prior to important exams and interviews. Because some kids see failure or a less-than-ideal score or performance as ruining their future.

So they look for a substance to help calm their nerves instead of seeking strategies that will work for them better long term.

Drugs Most Often Counterfeited

For reference, here is more information on the drugs most often counterfeited that pose a serious risk on college campuses. While there are others, these are the most prevalent.

Brand name Xanax®, generic name Alprazolam

  • Xanax is the brand name of a benzodiazepine. Benzodiazepines are depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures. Other common benzodiazepines go by the prescription brand names of: Valium®, Xanax®, Halcion®, Ativan®, and Klonopin®. All addictive.
  • A quote from a college student about why she did Xanax- “…Doing cocaine led to taking Xanax to come down, taking Xanax led to more cocaine to wake up, and the combination led to more alcohol in my life.”

Brand name Adderall®, generic name amphetamine/dextroamphetamine salts

  • Adderall is a stimulant, a combination of amphetamine and dextroamphetamine, two central nervous stimulants prescribed for those with ADD to improve focus and reduce impulsivity by increasing dopamine and norepinephrine levels in the brain. It is addictive.
  • A story from a college student about why he used Adderall“I went to my doctor and claimed I struggled with attention even gazing out the window to add to the effect. I wanted to be able to raise my average from a B to A to get into a good school. Once I got addicted to it, I had to find other ways to get it and the dark web was one of my sources.”

Brand name OxyContin®, Percocet®, generic name oxycodone acetaminophen

  • Oxycodone acetaminophen is a potent opioid prescribed for pain and often overprescribed for minor procedures like wisdom tooth removal. It is a combination of opiate and Tylenol (acetaminophen) and can cause physical dependence and addiction, especially for those under 25. The Tylenol part can cause serious liver damage for those who misuse and overuse it.
  • A story about why one student started using Oxycodone“My twin brother died right before the semester and I had a hard time finding any joy and my leftover prescription from having my wisdom teeth removed felt like a great escape from all that pain ….”

The Risks of Counterfeit Pills

Counterfeit pills can contain incorrect dosages, and unknown ingredients like cement, meth, rat poison, bath salts, and even fentanyl. Counterfeited pills are often crafted to mimic the effects the person would expect with the intended drug which can make it harder to suspect it’s a fake. Many times those who end up in the ER after taking counterfeit pills have no idea what’s in them therefore making treatment for an overdose very complicated.

Why Fentanyl?

When fake pills contain harmful substances such as fentanyl, a powerful synthetic opioid that is many times stronger than heroin, it can lead to overdose and death even in small amounts. Of the fentanyl-laced fake prescription pills analyzed in 2022 by the DEA lab, six out of ten contained a potentially lethal dose of fentanyl. 

“Some drug dealers are mixing fentanyl with other drugs… This is because it takes very little to produce a high with fentanyl, making it a cheaper option. This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose.2” (NIDA)

why drug traffickers mix fentanyl with other drugs
NIDA: National Institute on Drug Abuse,

Besides that, when someone does overdose, it’s not always easy to treat it as the practitioner has to find out what substances are involved which is often more than one. So most overdoses should be reported as a 911 call and naloxone administered as it can reverse the effects of the opioid substances at least.

Where do Students Get Counterfeit Pills?

A significant number of high school and college students purchase Adderall, Oxycodone, and Xanax from the dark web drug markets or through social media channels3, which market deadly versions of these drugs tainted with fentanyl and/or methamphetamine and other mixtures. It’s all about accessibility and affordability within your specific community.

Counterfeit pills are often obtained from:

  • illicit online pharmacies
  • the “dark web” which requires special, covert access
  • social media channels using hashtags and emojis
  • street dealers
  • peer networks

When buying online, students may mistakenly believe they are buying legitimate medications or recreational drugs when, in fact, they are purchasing counterfeit products. Many times a “dealer” who might be another student on campus may not even know they are selling counterfeit versions of illegally obtained prescription medications or illicit drugs.

Many times students will order them online and have them delivered by mail, look for social media hashtags and messages through that app, or most commonly find someone in the peer network who is a “dealer.”

My son Charles would order his drug of choice by text and it would be delivered to him sitting in his car in front of our home. (See the emoji chart below for symbols of drug seeking in social media and take note that this changes often.)

How to Distinguish Counterfeit Pills From the Real Thing

Distinguishing counterfeit pills from genuine ones is challenging and nearly impossible for a normal person. But you can look out for variations in color, shape, size, markings, and packaging. If you have doubts about the authenticity of a medication, consult a medical professional, or don’t take it.

Source of the image above DEA Drug Fact Sheet. Counterfeit Pills (pdf)

Educate Students About the Existence and Risk of Counterfeit Medications

Many adults remember the time they tried something but these days experimentation has a much higher price tag and can result in addiction, overdose, medical problems, psychological problems, overdose death, or suicide.

We need to educate students on what these medications contain through social channels, speakers, student centers, on the back of bathroom doors, in front of urinals, and in dorms and other places where students gather.

example of a social media image to educate students on fake pills
example of a social media image to educate students

For up-to-date information, statistics, and resources about counterfeit pills on college campuses, consider exploring sources like:

If You Suspect Someone Has Overdosed

A friend has passed out and is unresponsive?

Please seek medical attention immediately if you know they’ve taken pills or used other drugs and report the situation to campus authorities or law enforcement. Students in fear of getting caught often abandon another who is passed out but not yet deceased.

Don’t be afraid of being “wrong.” It’s better to call and be wrong than it is to not call and the person dies because everyone else was afraid of getting caught.

Abandonment can cost the one who is unconscious their life if friends don’t call for help

Many states have a Good Samaritan Law similar to this one in NC so please call even if you have been using! The NC 911 Good Samaritan law states that individuals who experience a drug overdose or persons who witness an overdose and seek help for the victim can no longer be prosecuted for possession of small amounts of drugs, paraphernalia, or underage drinking.

drug seeking emojis
Drug-seeking emojis used in social media. Source: DEA, PDF here




1- Montana State University, Counterfeit Pills

2- NIDA – Fentanyl Drug Facts

3- #DrugsforsaleMoyle L, Childs A, Coomber R, Barratt MJ. #Drugsforsale: An exploration of the use of social media and encrypted messaging apps to supply and access drugs. Int J Drug Policy. 2019 Jan;63:101-110. doi: 10.1016/j.drugpo.2018.08.005. Epub 2018 Dec 7. PMID: 30530252.