{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:52:15Z","timestamp":1784299935635,"version":"3.55.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The NC Office of the Chief Medical Examiner regularly assumes jurisdiction over deaths that are suspicious, unusual or unattended by a medical professional. In recent years, the presence of counterfeit pills is occasionally suggested by investigatory notes and\/or scene findings that document reported consumption of prescription drugs, or prescription drugs on scene, which are not reflected in the final autopsy findings after toxicological analysis of the decedent\u2019s blood samples. Counterfeit pill consumption is a major public health hazard worthy of attention from the forensic toxicology community. Seventy-five cases from January 2020 to December 2022 serve as a convenience sample of cases where prescription pills including formulations of alprazolam, oxycodone and hydrocodone were specifically referenced during the death scene investigation as recently consumed, yet an unexpected substance was found during toxicological analysis rather than the expected pharmaceutical drug. Of note, novel benzodiazepines detected included flualprazolam, etizolam, clonazolam metabolite (8-aminoclonazolam), bromazolam, flubromazolam and desalkylflurazepam. Decedents\u2019 ages ranged from 16 to 69, across 33 different NC counties. Case notes indicated that eight of the decedents obtained pills through direct personal relationships, six decedents obtained them from \u201cthe street\u201d and one decedent likely purchased pills online. Pills were largely consumed orally or through insufflation. Seven case reports contained indication that decedents knew or suspected the counterfeit nature of their pills. This study describes the context and characteristics of 2020\u20132022 suspected counterfeit pill-involved deaths in NC to further the understanding of the forensic science community, law enforcement partners, public health stakeholders and those potentially at risk through the consumption of counterfeit pills.<\/jats:p>","DOI":"10.1093\/jat\/bkae027","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T08:28:36Z","timestamp":1714206516000},"page":"242-251","source":"Crossref","is-referenced-by-count":8,"title":["Suspected North Carolina counterfeit pill-involved deaths, 2020\u20132022"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2536-1535","authenticated-orcid":false,"given":"Laura W","family":"Friederich","sequence":"first","affiliation":[{"name":"Toxicology Department, North Carolina Office of the Chief Medical Examiner , 4312 District Dr, Raleigh, NC 27607, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E","family":"Cox","sequence":"additional","affiliation":[{"name":"Injury and Violence Prevention Branch, North Carolina Division of Public Health , 5505 Six Forks Rd, Raleigh, NC 27609, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian E","family":"Hyson","sequence":"additional","affiliation":[{"name":"Investigations Department, North Carolina Office of the Chief Medical Examiner , 4312 District Drive, Raleigh, NC 27607, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-457X","authenticated-orcid":false,"given":"Sandra C","family":"Bishop-Freeman","sequence":"additional","affiliation":[{"name":"Toxicology Department, North Carolina Office of the Chief Medical Examiner , 4312 District Dr, Raleigh, NC 27607, United States"},{"name":"Department of Pathology and Laboratory Medicine , University of North Carolina at Chapel Hill, 160 Medical Dr, Chapel Hill, NC 27559, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"2024052212125170300_R1","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2022.109398","article-title":"Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021","volume":"234","author":"Palamar","year":"2022","journal-title":"Drug and Alcohol Dependence"},{"key":"2024052212125170300_R2","article-title":"Public Safety Alert: Sharp Increase in Fake Prescription Pills Containing Fentanyl and Methamphetamine","author":"Drug Enforcement Administration","year":"2021"},{"key":"2024052212125170300_R3","doi-asserted-by":"crossref","DOI":"10.1016\/j.forsciint.2022.111414","article-title":"Genuine and counterfeit prescription pill surveillance in Washington, D.C","volume":"339","author":"Nguyen","year":"2022","journal-title":"Forensic 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