CHICAGO — It’s hard to be sure what Alissa Saunders thought she was taking the night she died of a drug overdose — a ground-up Percocet, maybe, or a pulverized bar of Xanax.
One thing seems clear enough, though: She didn’t know it was fentanyl.
Saunders, a 22-year-old certified nursing assistant who loved to camp, fish and hang out with her family, was found unresponsive last March in the New Lenox townhouse she shared with a roommate, a straw flecked with powdered residue on the nightstand beside her.
Detectives investigating her death found text messages and a Snapchat video suggesting a friend had introduced her to black market prescription pills, which drug users often smash and snort for a more intense high. But what was in her bloodstream was fentanyl, a synthetic opioid 100 times more potent than morphine.
Drug dealers have used the lab-made chemical for years as a cheap and powerful additive to heroin, or even as an outright substitute. Experts say that’s still the main problem in the overdose epidemic, but more and more, fentanyl is showing up in entirely different drugs — cocaine, methamphetamine and MDMA, among others.
Some believe that’s the result of sloppiness among traffickers, who often process multiple substances and aren’t exactly fastidious about avoiding cross-contamination. Others think it’s done intentionally to increase the addictive power of nonopioids.
But the most ominous threat, many agree, is counterfeit prescription pills.
The Drug Enforcement Administration says fentanyl has been passed off as legitimate painkillers, anti-anxiety drugs and medication for attention deficit hyperactivity disorder. Just last month, the Kane County sheriff arrested a Hoffman Estates man who allegedly took delivery of more than 2 pounds of phony OxyContin pills loaded with fentanyl.
“Buying a pill on the street is gambling,” said Robert Bell, special agent in charge of the DEA’s Chicago field division. “It’s extremely dangerous.”
So far this year the agency has seized millions of fakes — near-perfect copycats pressed on industrial equipment. Test strips that reveal the presence of fentanyl in powdered heroin aren’t as simple to use with pills, and many users, believing they have the genuine article, might not even know about that precaution.
“That’s the issue,” said Taylor Wood, a drug checking technician with the Chicago Recovery Alliance. “They’re ignorant to (fentanyl) being a risk, and then it’s a surprise and a terrible tragedy.”
Saunders grew up in North Riverside and suburban Orland Hills, and her mother, Janell Donegan, described her as “an old soul” who worked hard and placed family above all. After she graduated from Andrew High School in 2016, she moved to Michigan to act as her grandfather’s caregiver.
“She wrote bills, took him to the doctor, cooked dinner, took him outside to roast marshmallows,” Donegan said. “She painted his nails different colors. She showed him TikTok. She made his life fun.”
After he died, Saunders returned to Illinois and began work as a certified nursing assistant and a bus driver for an after-school program. Once the pandemic began, she picked up plenty of overtime work at her assisted living facility as others quit, all the while aiming to go to school to become a registered nurse.
Donegan said her daughter wasn’t into hard drugs, an assertion supported in police reports by her roommate and a work friend, who said they knew her only to drink alcohol and smoke weed. But that appeared to change when she started hanging out with a former high school classmate who, the friend said, liked to snort crushed Percocet pills.
“Saunders told her that (the former classmate) was trying to get her to try new drugs that she had never tried before,” one report says. “(The friend) advised Saunders not to try the new drugs and only do what she is comfortable doing.”'
Police later found messages from the former classmate on Saunders’ phone talking about his Percocet use and inquiring if Saunders wanted to share a bar of Xanax. Investigators also uncovered a Snapchat video recorded in Saunders’ bedroom a week before her death, in which the man was apparently preparing to crush and snort pills.
The classmate told police he had spent time with Saunders the day she died, slipping out after she fell asleep, and that she had been snorting what he assumed to be Xanax or OxyContin. He denied supplying the drugs.
A detective questioned the man’s credibility, noting he lied about losing a cellphone that was subject to a search warrant. But after consulting with Will County prosecutors, police ended their investigation in August pending further leads.
A spokeswoman for state’s attorney James Glasgow said the case is still under review.
An autopsy found no trace of Xanax, OxyContin or Percocet in Saunders’ system, but it did detect fentanyl at twice the level that typically proves fatal, Coroner Laurie Summers said.
Reflecting a nationwide trend, most drug overdoses in Will County are now due partly or entirely to fentanyl (relatively few involve heroin). Summers said she suspects fake pills are behind some of the deaths, especially when bodies have no injection marks.
“It scares the hell out of me, to be perfectly honest,” Summers said. “(People) are thinking they’re getting Xanax and they’re not.”
Bryce Pardo, a drug policy researcher at the RAND Corp., said even though Xanax is a benzodiazepine, traffickers might be substituting fentanyl because of its similar sedating effect. That makes the phonies especially dangerous for unwitting users who haven’t built a tolerance to opioids.
“Those are the ones who are at the most risk,” he said. “With heroin, people use more slowly (in case it contains fentanyl). With a counterfeit tablet, they just won’t know.”
Harm reduction groups routinely distribute fentanyl test strips to heroin users, and the Biden administration is pushing for their wider adoption to combat the overdose epidemic. But the strips can be used only after a substance has been dissolved in water, which means pill users must scrape off a portion to be tested.
Wood, of the Chicago Recovery Alliance, said that technique presents a risk because the fentanyl can be lurking in a part of the pill that isn’t sampled: Just 2 mg of the drug, an amount small enough to fit on a pencil tip, can be deadly.
The most surefire analysis would mean dissolving the entire pill, Wood said, but that isn’t realistic advice for most drug users.
“I think if people knew they had to do that, they probably wouldn’t come in,” he said.
The difficulty of testing pills magnifies the importance of other harm reduction techniques, such as not using alone and having ready access to the overdose-reversing medication naloxone. Laura Fry of the suburban advocacy group Live4Lali said the organization has given away more kits than ever this year after expanding its target clientele to include weekend partyers.
“We’re really trying to push this much more into the mainstream because of the fentanyl,” she said. “The hardest thing is getting the casual substance user to realize this is a problem for them.”
Last month, Donegan helped to organize a rally on a busy street corner in New Lenox with other parents who lost children to drugs. They held signs showing their kids wearing graduation gowns and glamorous dresses, or just beaming in close-ups.
They called for more aggressive prosecution of overdose deaths as drug-induced homicides, and decried social media companies for allegedly letting their platforms serve as narcotics-peddling bazaars. Most of all, they tried to sound the alarm about fentanyl.
As cars streamed past on Schoolhouse Road, Donegan, wearing a T-shirt that featured an image of her daughter, shouted chilling statistics into a megaphone — that 2 out of every 5 fake pills tested by the DEA contain a lethal amount of fentanyl, and that a record 93,000 people died of drug overdoses last year.
Later, as other parents gathered around her for a Facebook livestream, she told the story of arriving at Saunders’ townhouse and collapsing in agony when she learned her daughter was dead.
“She did not know she was getting fentanyl,” Donegan said into the camera. “She made a mistake. She made a mistake by taking a pill that was not from a doctor, I do know that. But she didn’t deserve to die for it.”