What Are Blues? Inside the Blues Epidemic

Medically Reviewed By:

Kelly Donald, PMHNP

In recent years, the term โ€œBluesโ€ has become increasingly common in conversations around addiction, particularly among young adults and in rural communities. But what exactly are Blues, and why are they causing such devastation across the United States?

This post will explain what Blues are, how theyโ€™re fueling the opioid epidemic, the dangers associated with them, and how to seek help.

What Are โ€œBluesโ€?

โ€œBluesโ€ is a street name for counterfeit oxycodone pills, most often fake versions of Oxycodone M30, a prescription opioid painkiller. These pills are usually blue, round, and stamped with โ€œMโ€ on one side and โ€œ30โ€ on the other, hence the nickname โ€œM30sโ€ or simply โ€œBlues.โ€

The biggest danger is that these pills are rarely what they seem.

While theyโ€™re designed to look like legitimate prescription drugs, most Blues on the street today contain fentanyl, a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine.

Why Are Blues So Dangerous?

Fentanyl Contamination

The vast majority of Blues are illicitly manufactured in underground labs, not pharmaceutical facilities. Drug dealers lace them with fentanyl because itโ€™s cheap, highly addictive, and easy to press into pill form. A dose as small as 2 milligrams of fentanyl can be fatal.

Users often have no idea theyโ€™re ingesting fentanyl. What they think is a regular painkiller can lead to an instant overdose. Just one counterfeit Blue pill can contain a lethal dose of fentanyl. 

Theyโ€™re Widely Available and Cheap

Blues are easily accessible, especially on social media platforms and through street dealers. A single pill can cost as little as $5, making them affordable and appealingโ€”especially to teens and young adults.

They’re Driving the Overdose Epidemic

According to the CDC, fentanyl-laced pills now account for the majority of drug overdose deaths in the United States. In 2023 alone, over 70,000 fentanyl-related deaths were reported. Blues are a major contributor.

The Rise of the Blues Epidemic

Fast Facts

  • Blues mimic real oxycodone M30s, but are almost always fake.
  • 6 out of 10 counterfeit pills tested by the DEA contain potentially lethal doses of fentanyl.
  • Social media has made it easier than ever for dealers to market Blues to teenagers.
  • Blues are no longer a โ€œbig cityโ€ problem. Suburban and rural communities are increasingly seeing spikes in overdose deaths linked to counterfeit pills.

Parents, schools, and treatment centers are struggling to keep up with the pace of the epidemic. And because the pills look identical to real prescriptions, itโ€™s often too late by the time a problem is identified.

Signs of Blue Pill Abuse

Recognizing the signs of opioid addiction early can save lives. Hereโ€™s what to look for if you suspect someone may be using Blues:

Physical Signs:

  • Tiny or โ€œpinpointโ€ pupils
  • Drowsiness or nodding off
  • Slow or shallow breathing
  • Nausea or vomiting
  • Confusion or dizziness

Behavioral Signs:

  • Secretive behavior
  • Sudden changes in friends or activities
  • Decline in school or work performance
  • Frequent requests for money
  • Presence of pill bottles with no prescription

Paraphernalia to Watch For:

  • Small blue pills (often stamped โ€œM30โ€)
  • Burnt foil or straws (used to smoke the pills)
  • Missing prescription medication

How to Talk to a Loved One About Blues and Opioid Addiction

If you suspect someone you love is using Blues, approach them with compassion, not judgment. Here are a few steps to start the conversation:

  • Choose the Right Moment โ€“ Avoid confrontation when emotions are high. Pick a quiet, calm time.
  • Express Concern, Not Accusation โ€“ Say โ€œIโ€™m worried about you,โ€ rather than โ€œYouโ€™re ruining your life.โ€
  • Ask Open-Ended Questions โ€“ Let them talk. Avoid interrupting or lecturing.
  • Be Prepared with Resources โ€“ Have information ready about treatment options or overdose prevention tools like naloxone (Narcan).
  • Get Help โ€“ You donโ€™t have to do this alone. Addiction treatment centers, hotlines, and support groups can offer guidance.

Treatment Options for Opioid Addiction

Recovery is possible. Treatment for opioid addiction, including Blues, often involves a combination of the following:

Detox

A medically supervised detox is the safest way to manage withdrawal symptoms. Because opioid withdrawal can be intense, clinical oversight ensures safety and comfort.

Medication-Assisted Treatment (MAT)

MAT combines behavioral therapy with FDA-approved medications like:

  • Buprenorphine (Suboxone)
  • Methadone
  • Naltrexone (Vivitrol)

These help reduce cravings and stabilize recovery.

Inpatient Rehab

Inpatient or residential programs provide 24/7 support in a structured environmentโ€”ideal for individuals with severe addictions or co-occurring disorders.

Outpatient Programs

Outpatient rehab allows individuals to live at home while attending therapy several times a week. This is best suited for those with stable home environments and strong support systems.

Preventing Opioid Overdose: What You Need to Know

Naloxone (brand name Narcan) is a medication that reverses opioid overdoses. Itโ€™s available over-the-counter in most states and should be in every home where opioid use is a concern. If you suspect an overdose, administering naloxone may save a personโ€™s life.

Signs of an overdose include:

  • Unresponsiveness
  • Blue lips or fingertips
  • Gurgling or choking sounds
  • Shallow or stopped breathing

If you suspect an overdose:

  • Call 911 immediately
  • Administer naloxone
  • Perform rescue breathing if trained
  • Stay until help arrives

Get Help Today

The Blues epidemic is real, and itโ€™s deadly. But addiction doesnโ€™t have to be a life sentence. Recovery is possible, and help is available.

If you or a loved one is struggling with counterfeit pill use, donโ€™t wait. Reach out to Moving Mountains Recovery today to get started with a confidential, risk-free assessment. A single phone call can be the first step toward healing and a life free from addiction.

FAQ: Understanding and Responding to the Blues Epidemic

1. Why do people seek out Blues specifically, rather than other drugs?

Blues are often sought after because users believe they are prescription-grade opioids, which falsely creates a sense of safety or legitimacy. For many, especially teens and new users, pills seem less risky than injecting heroin or using powders. Blues also allow for precise dosing, or so users think, which leads to the dangerous misconception that they can โ€œcontrolโ€ their high. In reality, this false sense of control can be fatal due to unpredictable fentanyl content.

2. Are there non-opioid substances being marketed as Blues?

Yes, in rare cases, non-opioid fillers or research chemicals have been used to press pills resembling Blues. However, these are often still harmful. Some counterfeiters may use substances like xylazine (a veterinary sedative) or other psychoactive compounds to mimic the effects of opioids or to stretch fentanyl supplies. These drugs donโ€™t respond to naloxone and carry their own risks, like tissue damage, seizures, or prolonged unconsciousness.

3. Can drug testing kits detect fentanyl in Blues?

Yes, but with limitations. Fentanyl test strips can detect the presence of fentanyl in pills or powder before use, offering a harm reduction tool for those not yet ready to stop using. However, they donโ€™t measure how much fentanyl is present, which means the dose could still be lethal. Additionally, some counterfeit pills may contain fentanyl analogs that are harder to detect with basic strips.

While test strips are not a substitute for treatment, they play an important role in reducing accidental deaths in high-risk populations. They’re now legal to possess in many states.

References:

  1. Drug Enforcement Administration (DEA): Counterfeit Pills
  2. Centers for Disease Control and Prevention (CDC): Detection of Illegally Manufactured Fentanyls and Carfentanil in Drug Overdose Deaths โ€” United States, 2021โ€“2024
  3. Science Direct: “I don’t know how you can overdose smoking them:” Perceptions of overdose risks among persons who use illicit fentanyl-laced counterfeit pills
  4. BMC Harm Reduction Journal: โ€œThey say itโ€™s fentanyl, but they honestly look like Perc 30sโ€: Initiation and use of counterfeit fentanyl pills

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