This amount of fentanyl would be enough to kill all of Southern California 0:31
Nestled among a warehouse in Dulles, Virginia, is one of the US Drug Enforcement Administration's (DEA) forensic labs.
It is one of eight across the country where scientists analyze illegal drugs and try to get ahead of the causes of deadly overdoses.
Beginning in the late 1990s with the overprescribing of prescription narcotics, the opioid epidemic has continued to plague the United States for decades.
What has changed is the type of substances that have killed more than half a million people over the last 20 years.
CNN was granted exceptional access to the secret laboratory where the DEA tests seized illicit drugs to understand what comes next.
"The market is constantly changing, so we try to do as much as we can on a scientific basis to keep up," Scott Oulton, deputy assistant administrator for the DEA's Office of Forensic Sciences, told CNN's chief medical correspondent. Dr Sanjay Gupta.
Dr. Sanjay Gupta talks with DEA Agent Scott Oulton in the drug testing lab.
Holding up a white bag of fentanyl precursor powder, one of the chemicals used to make the opioid, Oulton explained that the illicitly manufactured pain reliever remains a dominant presence in the drugs officials are finding.
“This kilogram can be converted to fentanyl to make approximately 800 grams,” he said.
"So you don't need as much material, it's pretty cheap, it's cheap to get."
Fentanyl is the deadliest drug in the United States and is often found in combination with other illicit substances, such as cocaine and heroin.
But increasingly, fentanyl appears in illicit pills disguised as common prescription drugs like oxycodone, hydrocodone and even Adderall.
Users who buy drugs on the street that look like prescription pills may end up with a highly potent and potentially deadly drug that they never intended to take.
“More than 99% of what we see is false.
They contain fentanyl,” Oulton says of the pills the agency seizes.
The 800 grams of fentanyl Oulton had could turn into 400,000 to 500,000 potentially lethal pills.
As more and more of these deadly pills circulate, the opioid epidemic reaches a larger part of the population.
Deena Loudon of Olney, Maryland is one of those living with its effects.
“I really love sharing Matthew with the world,” Loudon says as she looks at photos of her son.
One of his favorite memories is of Matthew playing hockey, something Loudon calls his happy place.
The Los Angeles division of the DEA seized enough fentanyl in 2022 to kill the entire population of Southern California.
But he also remembers his struggles with anxiety, which led him to turn to drugs.
He started dabbling in them in tenth grade.
The following year his grades began to slip and he couldn't keep them up enough to stay in hockey.
“She was using Xanax to help self-medicate and I think to help get rid of that anxiety so she could live a normal life,” Loudon said.
Matthew was always honest, almost to a fault, Loudon says.
“He told me that he tried everything.
Heroin, meth, crack, whatever, cocaine, whatever, until I guess he found what made him feel better, and it was Xanax."
And as much as a mother can worry, Loudon says, Matthew always tried to reassure her.
“I know what I'm doing,” she told him.
He had heard that fentanyl pills had appeared in his area.
"But you never think it's going to happen to you," Loudon said.
He commented that they even had a conversation about fentanyl the day before he died.
"I was a bit naive, I wanted to stick my head in the sand and think 'I bet he knows what he's doing.'"
On November 3, 2020, she found 21-year-old Matthew on his basement floor.
This is how emojis are used as code to refer to drugs 2:28
Matthew's autopsy report lists the cause of his death as fentanyl and despropionyl fentanyl poisoning.
“I am not saying that I have had an overdose.
I'm saying she died of fentanyl poisoning.
…To tell the truth, at the end of the day, for me, he was killed, right?
Because he asked for one thing.
They gave him something different.
And he took his life.
For a father, he said, the most difficult thing is to bury his son.
It's a pain he talks about in hopes of keeping other families safe.
"It's Russian roulette," he warns them.
“You never know what you are going to find”.
a pill can kill
The number of pills seized by the DEA skyrocketed in just three years, from 2.2 million in 2019 to 50.6 million in 2022.
The sheer volume of pills has been one of the biggest challenges for the DEA lab, Oulton says.
As the fentanyl threat grows, the Virginia facility is expanding to perform the necessary tests.
The lab can test for something as simple as the presence of fentanyl, but something called pill purity also offers important information.
This means how much fentanyl is actually in one of these illicit pills.
“Recently, we have seen an increase in purity over the last year, where we used to say that about four of the 10 seizures we were getting would contain a lethal dose of more than 2 milligrams.
Starting in October of last year, we started reporting that we have seen a rebound.
We now say that six out of 10 seizures we receive contain more than 2 milligrams,” Oulton said.
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He says they find an average of 2.3 milligrams of fentanyl in each pill.
Two milligrams may be the limit for what's considered lethal, but Oulton says that doesn't necessarily mean a pill with 1.99 milligrams of fentanyl can't be deadly.
"A pill can kill" is his warning.
“The message I would like to send is, don't take it,” he said.
"Don't risk it.
Your life is not worth it.
Dismantle shipment of fentanyl hidden in coconuts 0:44
More pills, new drugs
Oulton says he and his team are constantly finding new and different drugs and substances in pills, things they've never seen before.
A machine in the lab is almost the equivalent of an MRI in a doctor's office, showing the structure and details of a pill.
“We will do what we call structural elucidation to determine that this is a different version of a fentanyl that has a new compound and a molecule added to it,” Oulton explained.
They have seen "hundreds and hundreds of unique combinations," he said.
"We look at one with fentanyl, one with fentanyl and xylazine, one with fentanyl and caffeine, one with fentanyl and acetaminophen, and no one knows what they're getting."
Xylazine, a veterinary tranquilizer, poses a unique problem.
It is not an opioid, so even when mixed with fentanyl, medications designed to reverse an opioid overdose may not work.
What is wrong with the war on drugs, according to former DEA agent?
Narcan or naloxone, one of the most common overdose reversal drugs, has become increasingly necessary as the prevalence and potency of illicit drugs increases.
Retail pharmacies dispensed about 1.2 million doses of naloxone in 2021, according to data published by the American Medical Association, nearly nine times the number dispensed five years earlier.
Oulton wants to be clear: the problem isn't the pills prescribed by your doctor and dispensed by a pharmacy, it's the pills on the illicit market.
Those, Matthew's mother notes, are easy to come by.
“The first pills [Matthew] got was in high school.
And he would just go crazy, walking around, and it was easy for him to get into his hands,” he commented.
Loudon's message to parents now: keep your eyes open.
“Just keep in mind what your kids are doing.
You have to keep your eyes open.
And even sometimes, when you keep your eyes open, you can miss some of the warning signs, but I think a father knows his son better, so he keeps talking.”
CNN's Deidre McPhillips contributed to this report.
CNN's Deidre McPhillips contributed to this report.