Genuine and counterfeit prescription pill surveillance in Washington, D.C.

For the first time in Washington, D.C., an in-depth analysis of counterfeit pills has been performed as part of a larger initiative to understand the city's illicit drug supply. Over a 56-month period, 567 pills that were physically identified as a pharmaceutical were analyzed using gas chromatography mass spectrometry (GC-MS) and gas chromatography flame ionization detection (GC-FID). Out of the 567 pills submitted to our laboratory, 119 were confirmed to be counterfeit. Beginning in 2018, an increase in counterfeit pills was observed in suspected pharmaceutical submissions. By 2021, 62.5% of all pill exhibits were determined to be counterfeit. Most of the counterfeit pills submitted during this time frame had a '30M' imprint with blue coloring, consistent with the physical identification of a 30 mg Oxycodone tablet. Fentanyl was the number one identified psychoactive substance detected in counterfeit pills (75.4%), however, other opioids, precursors, and a novel benzodiazepine were also identified. This preliminary research hopes to illustrate counterfeit pill trends in Washington, D.C. and highlight the importance of analyzing pharmaceuticals in addition to suspected illicit substances. This surveillance is ongoing and collaboration with neighboring jurisdictions is anticipated in the future.

Analysis of drug residue in needle-exchange syringes in Washington, D.C.

For the first time in Washington, D.C., an analysis of drug residue from used needle-exchange syringes has been performed. This analysis is part of a larger initiative to understand the District of Columbia's illicit drug supply and its intravenous (IV) user's consumption trends as our nation faces the opioid epidemic. The goal of this study is to develop a more comprehensive monitoring program that provides real-time analysis necessary for public health organizations, in addition to providing initial observations of drugs detected. A total of 1187 syringes were analyzed over a period of nine months. Of these, 732 syringes (61.7%) were confirmed to contain a controlled dangerous substance (CDS). Fentanyl was detected in 490 syringes, the most observed CDS in all syringes analyzed. Heroin was the second most detected CDS, observed in 192 syringes. The third most detected CDS was cocaine, which was observed in 132 syringes, followed by the fourth most detected CDS, methamphetamine, observed in 82 syringes. Novel findings of this study include the first reported detections of methamphetamine, synthetic cathinones, and synthetic cannabinoids in used syringes in D.C. Ninety-seven syringes that contained no CDS contained a non-controlled substance of interest, such as diphenhydramine, xylazine, and etizolam. One limitation of this study is that this method cannot determine whether mixtures present in syringes stem from mixtures present prior to injection, back-to-back usage, or sharing of needles. This preliminary study illustrates the strength of surveillance to monitor drug trends and can be used to detect emerging novel dangerous substances in the future.