Notes from the Field: Counterfeit Percocet–Related Overdose Cluster — Georgia, June 2017

MMWR / October 20, 2017 / Vol. 66 / No. 41 1119 US Department of Health and Human Services/Centers for Disease Control and Prevention multiagency press conferences on June 6 to notify the public about the presence of the dangerous counterfeit pills. A counterfeit Percocet cluster case was defined as 1) an opioid toxidrome (i.e., with central nervous system depression, respiratory depression, and pupillary miosis) requiring resuscitation, ventilation, naloxone, or all three; 2) a history of purchasing street pills; and 3) ingestion of as few as one or two pills, resulting in disproportionately severe central nervous system, respiratory, or cardiovascular depression occurring in a person evaluated by EMS or at an ED since June 1, 2017 (1). During June 6–13, EMS providers and EDs reported possible cases daily, and district epidemiologists reviewed medical records to determine whether patients met the case definition. Concomitant syndromic surveillance was conducted by reviewing Georgia statewide ED admission data received daily, using a text-search for drug overdose syndrome. This surveillance was used to determine whether the cluster extended beyond the initially identified area. Local law enforcement personnel delivered pills obtained from one patient to the Georgia Bureau of Investigation crime laboratory for chemical analysis. Syndromic surveillance demonstrated a sharp increase in overdoses reported by EDs on June 5 (Figure). Chemical analysis of obtained pills identified cyclopropyl fentanyl and U-47700, two rare and potent illicit synthetic opioids. The source of the pill was not identified.