Dear Alice,

My boyfriend received a package of unknown white pills in the mail with no return address. He doesn't know who sent them or what the pills are. To my horror he took one while out drinking one night but there was no noticeable effect. How/where can I find out what these pills are? They are round white tablets thicker than aspirin and have the numbers 54 543 imprinted on one side. I'm afraid to ask my pharmacist in case this might actually be a controlled substance. Can you help?

Dear Reader,

Though it is strange that an unknown person or company would send an unmarked package of pills for no apparent reason, what’s not strange is your concern for his safety and health. As you suggest, taking unknown medications could be harmful. Finding out more details about the meds and their origin is wise (more on that in a bit). That said, have you talked to your boyfriend about your concerns? Having a conversation with him about how this situation has you worried may also be in order.

As you figure out your next steps, consider what possible circumstances might have brought the medication into your boyfriend’s possession. Is it possible that the parcel was a practical joke from a friend? Could your boyfriend have an ailment that you don’t know about? Does he share the same name as a family member? Could your boyfriend be dabbling in illicit drug use and trying to keep it a secret? If you’re not sure about the answers to these questions, it may be time to have a talk with your beau. If you decide to go that route, it’s a good idea to try and approach the discussion with a calm, but curious tone to move the conversation along, instead of a threatening and interrogating one. That said, it’s good that you let your concerns be known; the potential risks associated with taking unknown medication, especially with alcohol are very real and are worth discussing.

Regardless of the true identity of these pills, talking with your boyfriend may help you get more information about the medication in question and a better understanding about the situation at hand. Some ideas for conversation starters are:

  • "I'm concerned that you took one of those pills. I care about you, and wouldn't want anything bad to happen to you."
  • "I'm curious about what made you decide to pop one of those pills the other night."
  • "I'm confused about this whole situation. How are you feeling about it?"
  • "When you took that pill the other night, what were you hoping would happen?"

If you find yourself without an explanation, unsatisfied with the one you were given, or not having learned more about the pills afterwards, it may be time to solicit outside help. A pharmacist may be able to help identify the pills; you could bring them in a secure container along with the original envelope. If you’re concerned about their origin and that they may be a controlled substance, you could also consider reporting them to the postal service or the police, who might be able to help track their origin.

Still, there are other resources that can help identify pills that have been separated from their labeled bottle. The series of numbers you spotted (54 543) may be a good place to start the investigation. In fact, the U.S. Food and Drug Administration (FDA) requires all solid, oral drugs intended for human consumption and sold in the United States to have a unique marker or an identifier on each pill (with some exceptions) that informs its dosage strength and active ingredient. Since you were able to take note of its shape, color, and approximate size, these descriptors can further narrow down your search, too. Here are some possible resources for identifying an unknown pill or tablet sold in the United States:

  • Pillbox, run by the National Library of Medicine, helps folks identify unknown solid dose medications (tablets and capsules) based on physical characteristics and images, as well as imprint, shape, color, size, and other information.
  • FDA Center for Drug Evaluation and Research is another resource where their Division of Drug Information (DDI) staff can identify drugs for you based on physical appearance (color, shape, size, etc.) and markings.
  • American Association of Poison Control Centers Hotline staff members provide confidential, free pill identification 24 hours a day. It’s worth noting here that the number is not for an emergency.

List adapted from the National Library of Medicine.

Keep in mind, these resources are not perfect or comprehensive. In addition, knowing what a drug is before taking it may only be a part of the story. As you alluded, mixing alcohol with unknown pills or even known prescription drugs can be risky since unexpected and potentially dangerous consequences may arise. For instance, using opioid painkillers in ways or for reasons different than they were prescribed can lead to quite serious, long-lasting, or even life-threatening effects. Combining alcohol and opioid-based painkillers could also lead to harmful effects by affecting the central nervous system. What’s more, some medications contain more than one active ingredient, which may complicate the effects even further. With such unpredictable and potentially dangerous side effects, it’s recommended that prescription drugs are only taken as directed and are not shared with other people (it’s also worth mentioning that sharing prescription medications with others is illegal).

Hopefully after some dialogue with your partner and sleuthing on your part, you’ll get some answers and actionable steps to address this situation. For more information on medication misuse, talking with a loved one about it, and potential interactions with taking medications and alcohol together, there are a number of related Q&As in the Prescription and Over-the-Counter Drugs category from the Go Ask Alice! Alcohol and Other Drugs archives. The Substance Abuse and Mental Health Services Administration (SAHMSA) is a government agency that may also be a good resource for you to learn more about these concerns and how to address them.

Good luck with your investigation,

Alice!

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