AUSTIN (KXAN) — They look identical to pills prescribed by a doctor, but they’re actually being pressed in homes and garages and they could be laced with a fatal dose of fentanyl.

Increasingly, Central Texas families are reporting their loved ones took a pill they thought to be a Xanax, Adderall or Valium, but instead of receiving the expected benefits of anxiety relief or focus, a single pill is a death sentence.

That was the case for Casey Copeland, a born and raised Austinite, who died in August after taking a Valium that was laced with fentanyl, his mom said.

“The day that I found him in his condo, the next day on his calendar he had written ‘make doctor’s appointment,'” said Carilu Bell, Copeland’s mom, explaining she had just had a discussion with her son about getting help for depression and anxiety. ” I know my son did not want to die.”

Bell described her son as someone who was “born with orange blood,” an avid fan of all University of Texas sports. He attended Lake Travis High School until junior year and then graduated from Westlake High School and “football was his life.”

Copeland was also someone who took his health very seriously, Bell said. Copeland was a certified personal trainer, had a bachelor’s degree in exercise and sports science and was “always concerned with his health and physique.” He died at 44 years old.

What is fentanyl?

Fentanyl is a synthetic opioid that helps deal with intense pain. In hospital settings, it’s used regularly and safely.

“We use fentanyl in the medical setting in a variety of intensive situations,” explained Maxim Eckmann, president of the Texas Pain Society and professor of anesthesiology and pain medicine at the University of Texas Health Science Center. “These might include the operating room, when we give fentanyl for surgical pain, or for rendering patients able to tolerate having the breathing tube put in their throat.”

Eckmann said they also use fentanyl in the intensive care unit, as a sedative for patients who are on ventilators and to manage extreme pain for terminal illnesses like cancers.

‘Mad chemist’ pills versus what’s being given in the hospital

The difference between what people are being given in the hospital and what’s being handed out on the street comes down to dosage and quality, Eckmann explained.

In medical settings, patients are being given fentanyl in micrograms. In pressed pills, it’s being distributed in milligrams.

“That’s a 1,000-fold difference,” Eckmann said. “When you’re getting it from a counterfeit pill, you have no idea how much has been put into that and I think that’s why we’ve seen so many deaths.”

While pills are made in very controlled and regulated settings to be distributed at a pharmacy, that’s not the case for what’s being handed out on the street.

Can people actually make fentanyl?

Yes. Eckmann explained the medical industry historically thought it wasn’t possible to make these synthetic opioids, but are now realizing that many of the compounds used to make fentanyl are becoming available on the black market.

Fentanyl is also being smuggled and bought, and then mixed into pressed pills.

“Right now basically you have some mad chemist in the garage making these pills,” Daniel Comeaux, the special agent in charge of the DEA’s Houston division, said at a news conference after several people died from a fentanyl-related overdose death earlier this year. “It’s not pharmaceutical companies. It’s not a doctor prescribing them. It’s individuals literally in the garage with a $10 machine putting together these pills, so there’s no true medical use for them, and it’s causing overdose.”

Why would you put something in your product that could kill your customers?

It’s a question we get a lot at KXAN. Isn’t it a bad business model to kill your customers? We took that question to the Drug Enforcement Agency out of Houston.

“Drug trafficking organizations are focused on one thing: making money. The illegal drug trade is a half-trillion-dollar business,” Sally Sparks, a spokesperson for the agency, said. She also added the following:

• They aren’t trying to kill their customers; they’re trying to get people addicted to their product, and fentanyl is highly addictive. But it’s also highly potent, so only a small amount can be lethal.
• To illustrate how potent fentanyl is, a potentially lethal dose is considered to be 2 milligrams. That can fit on the tip of a pencil. When you’re at your dinner table tonight, try to count out 10-20 grains of salt. That’s what 2 mg looks like.
• Criminal drug networks put fentanyl and methamphetamine in drugs to drive addiction so that people will come back for more.
• The drug traffickers don’t follow regulations or employ quality control measures to keep their product “safe.” There’s no consistency; one pill could have only a trace of fentanyl, and another, made in the same batch, could have a lethal dose.