It’s one thing how dangerous too many legitimate prescription pills for people may be.

It’s another how deadly counterfeit prescription pills may be, such as those containing fentanyl, an opioid painkiller that is 50 times more potent than even heroin. It has so much, unfortunately, that is packed in so little:

The Drug Enforcement Administration says that a powerful dosage of fentanyl can be counted as a microgram. Let’s put it this way: just a few granules of table salt.

Fentanyl represents the latest drug-related crisis. The DEA says that many fentanyl pills are being sold “underground” as oxycodone or other opioids, often unknown to the buyers. Fentanyl also is mixed into or sold as heroin, again, without the purchasers having a clue.

Illicit traffickers are cashing in by counting on the “high demand for authentic prescription drugs as an incentive to produce the counterfeit drugs, and thus increase their revenue,” the DEA says.

In the words of the DEA, “hundreds of thousands of counterfeit prescription pills have been introduced into the market.”

“The DEA is facing an unprecedented threat in battling fentanyl and fentanyl-related compounds, many of which are more deadly or lethal than heroin,” the agency says in statements to HealthDataBuzz and in recent reports, including the DEA’s intelligence brief released last month, “Counterfeit Prescription Pills Containing Fentanyls: A Global Threat.”

Between late 2013 and late 2014 alone, there were more than 700 deaths related to fentanyl in this country. But that may not be the whole story, says the DEA, noting that some of those deaths – which may be linked to fentanyl – may be attributed solely to heroin. As the DEA puts it: “Those figures may be under-estimated.”

Since 2014, law enforcement agencies have been seizing the counterfeit pills, which in many ways resemble “the authentic medications they were designed to mimic,” the DEA says. Fentanyl is hard to detect, and can only be done through a laboratory analysis, the agency adds.

Prince’s Death

Was the singer Prince, who died April 21 following an accidental overdose of fentanyl, a victim of what was up the road essentially a counterfeit scheme?

Pills seized inside the singer’s Paisley Park compound were labeled as hydrocodone but actually contained fentanyl, which was responsible for Prince’s death, the Minneapolis Star Tribune reported, according to its source. Investigators are “theorizing” that Prince did not know the pills contained fentanyl, according to the news account.

Even more counterfeit drugs

There have been several incidents earlier this year in which the DEA made arrests related to counterfeit prescription pills.

Earlier this year, DEA officials said they arrested an alleged counterfeit prescription pill producer in New Jersey and the agency also issued a search warrant in Los Angeles targeting similar operations involving fentanyl and other synthetic opiates.

In the New Jersey case, the pill producer was charged with allegedly producing 6,000 pills, the DEA said. And, indeed, the pills were made to “resemble” 30-milligram Oxycodone pills, but lab results showed they contained either fentanyl citrate or acetyl fentanyl.

The DEA noted deaths in other cases this year in Florida and California from counterfeit Xanax and counterfeit Norco pills containing fentanyl.

Although Norco is an opioid like fentanyl, Xanax  is a benzodiazepine. “This demonstrates,” the DEA said, “that though traffickers are interested in expanding the fentanyl market to the other counterfeit opioid medications, they are also willing to utilize fentanyl in other non-opiate drugs with exploitable user populations.”

For law enforcement and emergency responders, fentanyl also could have significant adverse consequences. Just touching fentanyl or accidentally inhaling the substance can result in sudden absorption through skin, the DEA said.

As a result, officials could face “disorientation, coughing, sedation respiratory distress or cardiac arrest,” the agency said in an alert. Such an impact could be “very rapid and profound,” the agency says, “usually occurring within minutes of exposure.”

That can be said, too, about the widespread illicit trafficking and use of fentanyl: rapid and profound.