Jenna* started experimenting with alcohol and weed when she was 18. In her early 20s, she moved on to pharmaceutical drugs like Adderall and oxycodone, popping them while partying or, in the case of meds like Xanax, to self-medicate for anxiety. She didn’t have actual prescriptions for any of them, but it wasn’t a problem—securing pills was easy at the restaurant where she worked. Someone was always willing to share.

Jenna knew there were risks, of course, as there would be with any recreational drug use, but she rarely had any issues. She was high-functioning and knew her limits. She never had cause to worry about what was actually in the pills she took. “Everything was pretty much what it appeared to be,” she says. Plus, she trusted her sources. But today? A totally different story.

“The landscape is so much more nefarious,” says Jenna, now 35 and working in harm reduction. “You can’t trust anybody to give you what they say they’re giving you.” As more and more women are coming to realize, it’s also nearly impossible to trust the pills themselves. Any obtained on the illicit market (as in anywhere other than a legitimate medical pharmacy) may be laced with illegally made fentanyl, a super-potent synthetic opioid that has been the cause for most fentanyl-related deaths, according to the Centers for Disease Control and Prevention (CDC). These so-called “fentapills” are indistinguishable from the legitimate prescription drugs they’re pretending to be (like Adderall, Xanax, Percocet, or oxycodone), explains Nabarun Dasgupta, PhD, MPH, a senior scientist in opioid disorders and overdoses at the University of North Carolina Injury Prevention Research Center.

“People are getting their hands on pills that are different from what they were seeking,” says Nora Volkow, MD, director of the National Institute on Drug Abuse, “but with a high risk of overdosing.” As little as half a milligram of fentanyl hidden in a drug could lead to an OD, according to DanceSafe, a non-profit drug-checking resource at party scenes around the country. In June 2021, 20-year-old Sophia Humphreys died after taking a fake Percocet laced with fentanyl that she bought from a dealer on Snapchat. Almost a year later, in May 2022, 21-year-old Tiffany Iler and 22-year-old Jessica Lopez, two students at Ohio State University, died from fentanyl poisoning at an off-campus apartment. And the potential for further incidents is enormous: In 2023, the Drug Enforcement Administration found 74.5 million fentapills in the U.S. Seventy percent of them contained a deadly dose of fentanyl.

So What Does All This Mean?

The obvious answer: You shouldn’t take any pills that you haven’t gotten at a legitimate pharmacy via your own doctor-written prescription. But if you are going to dabble in recreational, non-prescribed pill use—for partying purposes or even to relieve anxiety or help you focus—and those pills come from anywhere other than a fully licensed pharmacy, read the rest of this story closely. (Actually, read it closely regardless, because what you learn could save someone else’s life.)

Part of staying safe is being extremely careful about where you get pills. One of today’s most common procurement methods—contacting a dealer through social media—is also among the most dangerous, says Lemrey “Al” Carter, PharmD, executive director of the National Association of Boards of Pharmacy (NABP). “You don’t know what anything that anyone is selling on social media contains.” Be wary also of some online pharmacies, even if they appear legitimate and safe, adds Carter: “96 percent of these are acting illegally.” If an online pharmacy is willing to sell prescription drugs to patients who don’t have prescriptions, you can assume it’s not properly licensed or regulated. (That’s not to say all digital pharmacies are fakes—you can use NABP’s Buy Safely site and the FDA’s BeSafeRx to vet any you come across.)

Once you have pills in hand, remember that there aren’t any obvious clues that they may contain fentanyl. It’s odorless, tasteless, and impossible to discern visually. Pretty much your best option is to evaluate your supply with fentanyl test strips, says Darcy Michero, director of events and program fundraising at End Overdose. “This is one of the best behaviors to help you ensure what you’re taking is actually what you think you’re taking.” Harm reduction experts recommend testing an entire batch (more on that below) of illicitly purchased drugs because any fentanyl may not be equally distributed among pills. A negative result in one doesn’t mean the others are also clear. DanceSafe’s brand of test strips is reputable, if you need a recommendation, says Dasgupta.

And now for the most crucial part of all: It’s imperative that you learn how to spot a fentanyl overdose. Someone who is OD’ing may have “pinpoint” pupils (when they’re extra small), start nodding off, or lose consciousness or the ability to breathe altogether. Choking, gurgling, and discolored lips or nails are also red flags, according to the CDC. If you see any of this happening, get out your Narcan, the over-the-counter nasal spray that can reverse opioid overdoses (see how it works down below), which everyone should carry, says Maggie Luna, executive director of Texas Harm Reduction Alliance. Then call 911.

Is this a lot and sort of a downer, especially for those who are just looking to blow off some steam or find a moment of peace? Maybe. But drug use in 2024 comes with specific risks and potentially unpredictable situations—and it behooves everyone, user or friend or even passerby, to stay savvy enough to prevent catastrophe.

Test Your Drugs, Please

Test strips are relatively simple to use: You start by crushing an entire pill into a powder and diluting it with water. Stir, then stick a test strip in the solution for 15 seconds. After removing it and laying it flat for around 3 minutes, you’ll see the result. If it’s negative, you can drink the solution—testing doesn’t ruin a drug’s effects. Directions can vary by test strip brand, so be sure to read all instructions carefully every time. False negatives and positives can happen if you don’t follow the guidelines exactly.

Narcan 101

First, read the Narcan directions very closely before using it (you can find it at most drugstores for around $45). To help someone showing signs of a fentanyl overdose (which can include “pinpoint” pupils, gurgling, and loss of consciousness or the ability to breathe), put the nasal spray tip into one of their nostrils and press hard on the applicator to release its single dose. Call 911, then wait up to 3 minutes for the person to wake up. Stay until help arrives. A fentanyl OD may require multiple doses (i.e., multiple Narcan bottles). If the person remains unconscious, continue doses every 2 to 3 minutes until they wake. If they get drowsy again after becoming alert, give more. For complete and detailed instructions on how to administer Narcan, refer to the Narcan instructions and the CDC website.

*Names have been changed.

This story was originally published online in 2024.