Synthetic illicit drugs, such as nitazenes and fentanyls, are becoming commonplace in countries around the world, including in Europe, Australia, and Latin America, which raises concern for overdose crises like those seen in North America. An important dimension of the risk represented by synthetic drugs is the fact that they are increasingly packaged in counterfeit pill form. These pills—often indistinguishable from authentic pharmaceuticals—have substantially widened the scope of populations susceptible to synthetic drug overdose in North America (eg, among adolescents experimenting with pills or tourists from the USA seeking psychoactive medications from pharmacies in Mexico). The non-medical use of diverted prescription medications is relatively more common, and less stigmatised, than the use of powder drugs. Many consumers of counterfeit pills are unaware that they contain synthetic illicit drugs, believe them to be authentic pharmaceuticals, and would be unlikely to consume those drugs knowingly or if in powder form. Given these issues, we recommend the expansion of educational and awareness campaigns, pill testing programmes to help consumers shift demand to safer products, increased monitoring in routine clinical scenarios and overdose death toxicology, and expanding medically managed safer alternatives to counterfeit pill use.

中文翻译：

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假药丸的公共卫生风险


硝氮腈和芬太尼等合成非法药物在世界各国变得司空见惯，包括欧洲、澳大利亚和拉丁美洲，这引起了人们对北美等过量危机的担忧。合成药物所代表的风险的一个重要方面是它们越来越多地以假药丸形式包装。这些药丸（通常与正药没有区别）大大扩大了北美易受合成药物过量影响的人群范围（例如，在尝试药丸的青少年或从墨西哥药店寻找精神药物的美国游客中）。与使用粉末药物相比，转移处方药的非医疗用途相对更常见，且污名化程度更低。许多假药丸的消费者不知道它们含有合成非法药物，认为它们是真正的药物，并且不太可能故意或以粉末形式食用这些药物。鉴于这些问题，我们建议扩大教育和宣传活动，扩大药丸检测计划，帮助消费者将需求转向更安全的产品，加强对常规临床场景和过量死亡毒理学的监测，并扩大医疗管理的更安全的假药替代品。