“Blues” is a street term for small round pills that look like 30 mg oxycodone, but are often dangerous counterfeits. Of late, these bright blue tablets, typically stamped “M30” or similar marks, have shifted from medical pain relievers to lethal counterfeit drugs. Health officials warn that many of these pills contain fentanyl, a powerful opioid up to 100 times stronger than morphine. In 2021, overdose deaths surged as fentanyl-laced counterfeits flooded U.S. communities. [1]
Breaking through the slang and misinformation around “blues” is essential: each pill can be a killshot.
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Blues (drug): More than just a blue pill
The ongoing spread of non-pharmaceutical fentanyl (NPF) is a major driver of the U.S. overdose crisis. One key source? Counterfeit pills known as “blues,” often made to look like oxycodone. [2] “Blues” usually refers to 30-milligram oxycodone tablets, made initially by Mallinckrodt and imprinted “M 30,” but the term has expanded. Dealers and users also call them M-30s or 30s (for the imprint), beans, roxy, perks, or even “hillbilly heroin.” [3]
In street use, any small round blue pill said to contain oxycodone might be called a “blue,” regardless of its true contents. Slang varies by region, but the risk remains constant: most “blues” are counterfeit and potentially deadly.
What's actually inside a "blue"?
Despite appearances, most “blues” don’t contain oxycodone. Instead, they’re often illicitly manufactured with fentanyl and other unknown substances. In one Texas case, investigators recovered counterfeit pills marked “M/30” in a teenager’s room who overdosed, which turned out not to be oxycodone at all but 100% fentanyl. [4] Recent DEA lab tests show that about 7 in 10 counterfeit pills contain a dose of fentanyl that could be fatal, especially for people without opioid tolerance (opioid naive). [5]
Criminal pill-pressers often cut fentanyl with additives (lactose, sugars) and may include other drugs, heroin, stimulants, or even potent fentanyl analogs like carfentanil, just to bulk up the mix. [4] Carfentanil is around 100 times more powerful than fentanyl, and 10,000 times more potent than morphine, making even tiny amounts potentially lethal. The result is a deceptively strong, tiny blue tablet—sometimes dozens of times stronger than heroin. [1] This analog, however, shows up only in isolated lab tests, not in most pills seized nationwide.
What do "blues" look like?
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Blues often appear as small, round blue tablets stamped with “M” on one side and “30” (or similar) on the other. [4][6] The Loudoun County (VA) Sheriff’s Office reported on fatal overdoses in a high school involving “a counterfeit 30 mg oxycodone pill that is blue, circular, and may be stamped ‘M30’”. [6]
How and why teens and young adults are using "blues"
Teens and college-aged users have driven much of the recent blues epidemic. Young people often assume a pill found at a party or on social media to be just a prescription painkiller – a “safer” high than street drugs. In reality, falsely treating blues like candy has been deadly.
Experts note that social media and text messaging apps are key channels where dealers advertise these pills online, and teens trust friends who “send pictures” of pills. [1] Buying pills from a social-media dealer gives a false sense of security. It is dangerous! [1] Unfortunately, that trust is misplaced. In a two-year FBI review of pills bought from social-media dealers (reported in 2023), about 90 % of the tablets tested positive for fentanyl. [7]
Why people use it
Some teens admit to chasing a euphoric “nod” or using blues to experiment in a group, where such pills are normalized. Once involved, users might swallow blues whole, crush and snort them, or even dissolve them to inject. However, when they enter the body, the goal is often the same: pain relief, escape, or euphoria, unaware of the risk.
Motivations for misuse include: [6]
- Peer pressure
- Curiosity
- Self-medicating stress or pain
What makes it dangerous: Blues effects and risks
An authentic oxycodone effect includes pain relief, relaxation, euphoria, and drowsiness. Blues give these, and more, very quickly. Because fentanyl and analogs are up to 50 times stronger than heroin and 100 times stronger than morphine, even a small amount causes intense sedation. [8] Blues users report: [2]
- Heavy nodding out
- Slurred speech
- Confusion
- Slowed heart rate
- Nausea or vomiting
- Severely slowed breathing.
Crucially, opioids depress the brain’s breathing center. Too much leads to respiratory arrest – the immediate cause of death. [8]
Chronic harms
Regular use of blues breeds dependence, addiction, and the possibility of a fatal overdose. Physically, chronic opioid use causes tolerance (needing more of the drug for the same effect) and withdrawal symptoms (agitation, aches, diarrhea, insomnia). [1][2]
Long-term misuse can cause harm to the endocrine and immune systems, cause constipation and hormonal imbalances, and weaken overall health. It may also be detrimental to mental health, with increased anxiety, depression, and the constant stress of dealing with addiction. [1]
If pills are injected and equipment is shared, there is a high risk of HIV or hepatitis transmission.
Signs and symptoms of "blues" drug use
It can be hard to spot blues use at first, but some red flags stand out. Watch for physical and behavioral changes such as: [1][8][9]
- Drowsiness or “nodding off,” even in the daytime.
- Constricted (pinpoint) pupils.
- Mood swings, irritability, or depression.
- Withdrawal symptoms between pills – flu-like aches, sweating, shaking, or nausea.
- Social/behavioral cues like isolation from friends or family, secrecy about activities, stealing money or valuables, decline in grades or work performance, and neglect of personal hygiene.
- Finding paraphernalia such as powder residue, syringes, tiny plastic bags, or pill presses/crumbles.
Blues overdose and emergency response
A blues overdose is a life-threatening emergency. The most significant signs of overdose include: [10]
- Unresponsiveness or unconsciousness. The person cannot be aroused or awakened
- Slow, irregular, or stopped breathing, possibly with choking or snoring sounds
- Lips or skin turning pale or bluish from lack of oxygen
- Very small “pinpoint” pupils that do not react to light
- Gurgling or heavy snoring (the “death rattle”)
If you think someone has overdosed on blues:
- Call 911 immediately.
- Assume the pills contain fentanyl.
- Give naloxone (Narcan) right away. Use the nasal spray or injection.
- Keep giving a dose every 2–3 minutes until they respond or help arrives.
- Start CPR immediately. If the person isn’t breathing, give rescue breaths (1 breath every 5–6 seconds for adults). If there's no pulse, start full CPR (30 compressions to 2 breaths).
- Stay with them. If you can, lay them on their side to prevent choking.
Every second counts. Remember, naloxone is safe and can buy crucial time. [10]
Importance of access to harm reduction resources
Schools and communities sometimes stock naloxone kits for this reason. As the Loudoun County Sheriff noted, in the Park View High overdose incidents, students survived only because school staff administered Narcan and called emergency services as soon as they recognized overdose symptoms. [6]
In addition, where available, use fentanyl test strips before use, distributed by many harm-reduction organizations, to detect fentanyl presence and reduce overdose risk. While fentanyl test strips can detect the presence of fentanyl, they cannot indicate how much is present, and even a trace can be lethal.
Note: In some U.S. states, fentanyl test strips are still classified as drug paraphernalia, though 36+ states and D.C. have now legalized their possession and distribution, and more are updating laws. [11]
Treatment and recovery pathways
Opioid use disorder (OUD) is treatable. Combining medication-assisted treatment (MAT) with counseling and support yields the best outcomes. Approved medications, methadone, buprenorphine (Suboxone), and naltrexone (after detox), reduce overdose risk and curb cravings. [9][11] However, fewer than 1 in 5 people with OUD get these drugs, yet they halve the chance of death from overdose. [12]
Alongside medication, behavioral therapies and counseling are important:
- Professional therapy helps replace drug-seeking habits with healthy coping skills. [9]
- Support groups (e.g., Narcotics Anonymous, youth recovery programs) offer peer encouragement and accountability. [9]
- Family therapy strengthens home support and communication. [9]
Comprehensive recovery plans also help and include:
- Medical care for health issues related to opioid use
- Social services (employment or education assistance)
- Relapse prevention training and ongoing monitoring
- Aftercare services
Inpatient or outpatient rehab programs can offer structured care. Most importantly, recovery oftentimes requires repeated effort. Relapse can happen, but it is not a failure—it signals the need to adjust treatment. With sustained support, many people recover and return to living healthy lives.
In the U.S., call SAMHSA’s National Helpline at 1-800-662-HELP for confidential referrals to evidence-based treatment; elsewhere, search for your country’s opioid or substance-use helpline and local treatment directories.
Final thoughts
The rise of “blues” is a reminder that no drug should be taken lightly. A pill bought on the street is never safe, unlike a pharmacist’s oxycodone, a blue/M30 might contain a deadly dose of fentanyl.
Parents, teachers, and the youth need to know these pills aren’t candy or medicine they can trust. Even though overdose deaths have started to decline nationwide (a nearly 24% decline), the crisis isn’t over. Overdose is still a leading cause of death among young Americans. [13]
Vigilance, open conversations, and compassion can save lives. If you or someone you know is struggling with blues or any opioid, reach out. Help from professionals and peers can turn the tide, one pill at a time.
