Fake Kalma alprazolam tablets found to contain strong opioids

Source: NSW Health
Drug sold as: Alprazolam

Reason for concern: Contain etodesnitazene and O-desmethyltramadol

Warning: Strong opioids have recently been found in some fake Kalma tablets in NSW. They are white, rectangular tablets marked AL on one side, G2 on reverse.

a photo of white, rectangular tablets marked AL on one side, G2 on reverse

Know the risks

  • Testing of fake (counterfeit) ‘Kalma’ tablets found they contain a strong opioid, namely etodesnitazene. ‘Nitazenes’ can be as strong or stronger than fentanyl. Another synthetic opioid (O-desmethyltramadol) was also found in the same tablets.
  • Tablets containing strong opioids can cause unexpected and severe overdose or death, even from a single tablet.
  • Risk of harm is also higher if you:
    • Mix different sedative drugs. Alcohol, benzodiazepines (benzos) and opioids are very dangerous to combine.
    • Take a counterfeit product
    • Take a higher dose
    • Use drugs when you are alone
  • Fentanyl test strips are unable to detect these opioids.
  • Fake Kalma 2mg tablets are more likely to be rectangular in shape. Prescribed Kalma tablets purchased at pharmacies are oval.
  • Fake benzos (often called street Xanax) may contain a variety of drugs and look very similar to real pharmaceuticals.

Effects to look out for

  • Difficulty speaking or walking, drowsiness, loss of consciousness, slow breathing/snoring and skin turning blue or grey.
  • Be on the lookout for unexpected effects.

Getting help

If you see the warning signs of overdose:

  • Seek help immediately from your nearest emergency department or call Triple Zero (000).
  • Start CPR if someone is not breathing.
  • Use naloxone if you have it, repeat doses may be required. Call ‘000″ even if naloxone has been given.

Take home naloxone program​​

  • Naloxone is an easy to use, life-saving medicine that can temporarily reverse an opioid overdose. People at risk of experiencing an opioid overdose or who may witness an overdose can get naloxone for free without a prescription from some NSW community pharmacies, NSW Health needle and syringe programs, opioid treatment services and NUAA.
  • Naloxone is available in easy to use products: Nyxoid® nasal spray and Prenoxad® pre-filled syringe.
  • For participating sites and more information on take-home naloxone visit Your Room – Naloxone.

Support and advice

For free and confidential advice:

Reproduced by permission, NSW Health © 2023.