Dear Community Partner,

The Georgia Department of Public Health (DPH) has been alerted of a possible cluster of overdoses related to counterfeit pills which may be sold as Xanax or Percocet and contain fentanyl. These counterfeit pills may be driving increased overdoses in Richmond County, the Coastal Health District, and the Northwest Health District. There is also limited evidence that these counterfeit pills may be in other areas across Georgia (see data summary below).
If you are seeing unusual overdose activity or suspect the presence of possible counterfeit pills in your area, please call the Georgia Poison Center at 1-800-222-1222 or contact the Drug Surveillance Unit at
Summary of Suspect Cluster of Possible Counterfeit Opioids

Syndromic Surveillance Data
Syndromic Surveillance (SS) data1 detected first signs of possible clustering among patients residing in neighboring zip codes in Richmond county (District 6-0) mentioning an opioid during the week starting 1/17/21.
• East Central District 6-0 2 , 1/17/2021 – 3/13/2021), total number= 125
 o 99 Patients reside in neighboring zip codes (30901, 30904, 30906, 30907, 30909, 30813, 30814, 30815)
▪ 68 patients were aged 25-49 o 21 visits mentioned an opioid
o 18 visits mentioned heroin
o 3 visits mentioned fentanyl
o 7 visits mentioned a specific prescription opioid (Xanax/Percocet/Oxy/Roxicodone/Hydrocodone)
o During this time: 5 suspect cluster notifications sent to district staff
• Coastal District 9-1 3 , 2/28/2021-3/6/2021
o 2 patients mention taking heroin that may have been laced with fentanyl
o 1 patient found unresponsive and responded to Narcan, reported taking 1 unknown pill
• Northwest District 1-1 4 , 2/28/2021-3/6/2021
o 1 patient mentioned taking Xanax they think may have been laced with fentanyl
1 Because syndromic surveillance is based on chief complaint upon admission to an ED, it does not always reflect the true diagnosis, and can have limited detail to understand the true nature of the visit. For this reason, cases picked up by syndromic surveillance are only SUSPECT overdoses until further investigation is completed.
2 East Central Health District contains Richmond, Burke, Jenkins, Screven, Emanuel, Jefferson, Glascock, Warren, McDuffie, Columbia, Lincoln, Wilkes, and Taliaferro Counties.
3 Coastal Health District contains Chatham, Effingham, Bryan, Liberty, Long, McIntosh, Glynn, and Camden Counties.
4 Northwest Health District contains Floyd, Bartow, Paulding, Harrison, Polk, Haralson, Gordon, Chatooga, Walker, Dade, and Catoosa Counties.
Emergency Medical Services Data
• Chatham county (District 9-1)
o 1 unknown pill from unknown person on street, 3/5
• Gwinnett county (District 3-4)
o Patient took pill of fentanyl, 3/5
o Patient ingested unknown pill, 3/7
• Douglas county (District 3-1)
o Patient took pill at gas station and believes it is fentanyl, 3/6
• Fulton county (District 3-2)
o Patient took unknown pill, 3/8
• Chattooga county (District 1-1)
o Patient took a pill they thought was Roxicodone, 3/15
• DeKalb county (District 3-5)
o Patient took unknown pill from his friend, 3/15
o Patient took unknown pill, 3/15

Follow-up Investigation and Actions to date
• East Central Health District 6-0 Opioid Public Health Analyst (PHA) has been keeping local Law Enforcement (LE) and partners updated after each District notification, and is following up with healthcare facilities to investigate patient visits further
o Received reports from local harm reduction partner of pressed Xanax pills that are “pure fentanyl”
o Anecdotal reports from local deputies corroborate report from harm reduction
▪ No tox results confirming yet, samples submitted to GBI for testing
• On 3/16/21, DPH received additional notification from the Coastal Health District 9-1 PHA of anecdotal reports of “pressed Fentanyl being marketed as Xanax” from Chatham County Police Department via informants
o Chatham County PD are in the process of identifying hotspots and currently working with the DEA on investigation

Response and Next Steps
This drug is likely dangerous and should not be handled without Personal Protective Equipment (PPE). It could possibly be inhaled or absorbed through the skin and are extremely toxic in even the smallest quantities. Early recognition of symptoms of overdose and appropriate PPE is critical to preventing overdoses and protecting first responders.
If a counterfeit pill is found:
• Wear adequate PPE when handling the substance.
• Specific recommendations from the GBI include double gloving, gown, n95 mask and goggles (please see the attached guidance for more specific details).
• Double bag the substance with a bio-hazard label on the outside and handle per agency protocol. Whenever possible, Naloxone should be carried when working in an environment where an overdose incident may occur
• Georgia has a Standing Order for Prescription of Naloxone for Overdose Prevention, which makes naloxone available at any pharmacy without a prescription. For details on the standing order, please see the attached document.
• When administering naloxone, please note that multiple doses may be necessary.

To report suspected cases or for any additional questions, please call the Georgia Poison Center at
1-800-222-1222 or contact the Drug Surveillance Unit at DPH will continue to monitor this situation and provide updates as they are warranted. I ask that you continue to keep DPH informed of any relevant updates.

Thank you for all that you do.
Sincerely, Cherie L. Drenzek, DVM, MS
State Epidemiologist