Beyond the Label: Counterfeit Pills in Canada’s Drug Supply

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Canada’s unregulated drug market is now characterized by the widespread presence of counterfeit pills that imitate familiar prescription medications while containing far more potent and often unexpected substances. These products circulate across the country, and their risks are acutely relevant for students and young adults who may assume that a pill’s familiar shape or imprint guarantees safety. 

What the Data Show Nationally 

A report from the Canadian Centre on Substance Use and Addiction (CCSA) found that in samples of unregulated, opioid-containing drugs, about 13%contained at least one additional psychoactive substance beyond what the user likely expected. The same report shows that nearly 62 percent of these samples contained fentanyl or fentanyl analogues, demonstrating the degree to which synthetic artificially modified opioids are in the drug supply. The report is available at here. 

Recent law-enforcement investigations reinforce these findings. The Hamilton Police Service reported seizing more than two thousand pills believed to be oxycodone that were later confirmed to contain Protonitazene, a powerful synthetic opioid more potent than fentanyl. In a separate 2024 national investigation, the RCMP seized hundreds of thousands of counterfeit tablets marked with the “M/30” oxycodone imprint that contained These incidents show that counterfeit pills are not isolated incidents but part of a broader shift in the unregulated supply. 

Hidden Mixtures and Health Risks 

Another dimension of risk involves mixtures of substances. Counterfeit pills sold as opioids sometimes contain benzodiazepines or novel sedatives. These compounds increase overdose risk and complicate overdose response, particularly because naloxone, while effective against opioids, does not reverse the sedative effects of benzodiazepines. Details are discussed in the CCSA report above. 

Health Canada’s warning page on counterfeit drugs notes that these products may contain too much, too little or none of the intended medicinal ingredient and may include dangerous contaminants such as fentanyl or carfentanil.  

A person’s drug tolerance does not protect them when the substance mixture suddenly shifts. A dose that was tolerated safely in the past may become dangerous when the underlying substance changes. 

Regional and Local Context: Ontario and Kingston 

Although western Canada often receives national attention for its drug-supply toxicity, eastern Canada is not exempt. Canadian Centre on Substance Use and Addiction  

(CCSA) andthe Canadian Centre on Substance Use and Addiction (CCENDU) networks report that counterfeit pills, fentanyl analogues and nitazenes appear in samples across Ontario and Quebec. the local Kingston South East Health Unit recently reported a concerning increase in drug-poisoning events, with early drug-checking detecting fluorofentanyl in local samples. The alert is available here.  

Kingston now participates in community-based drug-checking. The Integrated Care Hub at 661 Montreal Street provides supervised consumption services, harm-reduction supplies and access to drug-checking. A recent update from Kingston Police describes the early stages of this initiative and its findings. The document is available here. 

Drug-checking services across Ontario contribute valuable public-health and behavioural data. A systematic review by Public Health Ontario explains that people who use drugs frequently adjust their behaviour when they receive information about drug contents and that testing provides insight into local supply dynamics. The review can be found here. 

Why This Matters for Students 

For students in Ontario, and particularly at Queen’s University, the relevance is immediate. Pills obtained informally or off campus are not regulated, monitored or screened. Even pills that look identical to prescription products may contain highly potent synthetic opioids or multiple sedating substances. A person’s prior familiarity with a drug does not protect them when the composition suddenly shifts. A dose that once felt safe may become dangerous when the underlying substance changes. 

Practical Harm-Reduction Strategies 

Several harm-reduction practices can reduce risk for students and community members who choose to use substances: 

• Use drug-checking services where they are available, including the program linked to the Integrated Care Hub in Kingston. 

• Avoid using drugs alone so that help is available if something goes wrong. 

• Carry naloxone and know how to use it. Naloxone kits are available free of charge in Ontario through pharmacies, community organizations and many campus health services. 

• Avoid mixing opioids with other depressants such as alcohol or benzodiazepines, because these combinations significantly increase overdose risk. 

• Start with a very small amount of any new or unknown substance and wait to observe effects. 

• Monitor local alerts from Southeast Health Unit and Kingston Police for information about counterfeit pills or unusually toxic batches in circulation. 

• Call the National Overdose Response Service (NORS) when using alone to have someone stay on the line, check in and call for help if needed. 

• If using with others, stagger use so at least one person remains alert and able to respond in an emergency. 

Students can get support through Student Wellness Services. Queen’s University, like other post-secondary institutions, provides harm-reduction education and referrals to local services. Queen’s First Aid (QFA) and Campus Security carry naloxone, and students can obtain their own kits for free at local pharmacies.  In Kingston, the Integrated Care Hub offers supervised consumption services, harm-reduction supplies and testing. 

The most important message is that drug appearance should not be trusted. A pill’s familiar shape, imprint or colour does not reveal what it contains. Canada’s unregulated drug market now includes counterfeit products that are visually indistinguishable from legitimate pharmaceuticals yet contain potent, unpredictable and sometimes lethal combinations. Awareness, caution and access to harm-reduction tools remain essential for navigating an increasingly complex and volatile drug supply.