Unusual Cluster of Severely Symptomatic Patients from Counterfeit Opioid Pills

Over the past week, the Illinois Poison Center and Cook County Department of Public Health have received reports of five probable cases of counterfeit opioid pill-related overdoses, including two fatalities, among young people between the ages of 19- 23 years, with several additional possible cases under investigation.

Patients referred to the pills as “M30,” “Percocet,” or oxycodone, and they were purchased on the street. The pills are small, blue, round tablets stamped with an “M” that is surrounded by an imprinted box.

Based on hospital reports, there were multiple presenting symptoms which may not fit the typical symptom pattern associated with oxycodone or Percocet overdose. In addition to respiratory depression, cases were notable for multisystem organ failure with hemodynamic instability, including cardiac instability and significant new heart failure (RV, LV), abnormal liver enzymes and renal function, rhabdomyolysis; one case developed severe loss of hearing and later, pulmonary emboli. Initial urine tox screens have been negative, with full panels pending.

Emergency responders are advised to be aware of a potential spike in cases of overdoses among young people who have taken these pills, who present with significantly altered mental status, respiratory depression, hypotension, hypothermia, hypoglycemia, cardiac instability, or other evidence of multisystem organ dysfunction.

The ingredients in the counterfeit pills causing this current overdose outbreak in Illinois are not yet known. There have been previous outbreaks in other parts of the country attributed to pills labeled “M30,” which contained fentanyl instead of oxycodone. Of note, patients reported taking such pills occasionally for sleep, and were not daily opioid users. The patients stated that they did not remember getting a high before “blacking out” very quickly after ingesting only 1-2 tablets, and observers noted labored breathing and foaming at the mouth.
If this outbreak grows in number or widens in scope, EMS systems and hospitals may need to stock additional naloxone for treatment of affected patients. Harm reduction and substance use disorder treatment and recovery groups are also asked to continue outreach and naloxone distribution efforts.

Please report potential cases of overdose due to counterfeit oxycodone to the Illinois Poison Center at 1-800-222-1222 for tracking purposes and treatment recommendations as needed.