Rachel Blado rolled out of bed at 4:32 a.m. and sank into a chair outside her bedroom to read her Bible. Her unassuming home in the Nashville suburbs should have been quiet at this hour, but a faint chatter echoed from downstairs. Someone had left a television on overnight.

Blado, a mother of three in her late 30s, shuffled down the steps into her living room, then followed the noise to the basement, which a year ago had been converted into a bedroom for her 20-year-old son, Josh Holton. Through the door, she could hear her son's TV streaming TED Talks, which he watched every night before bed.

Blado peeked inside. Holton was sitting awkwardly on his couch, slumped forward and to the side, like he had fallen asleep while reaching to touch his toes. Blado stepped into the room to rouse her son, calling his name and shaking his shoulder. His skin was cold.

Suddenly, Holton’s head rolled to the side, revealing thick mucus draining out of his nose and mouth.

“Then I heard this horrible, horrible noise — a deep, hideous wailing — and I realized it was me,” Blado said, describing the moment she found her son. “I ran out of the room, tried to make it back up the stairs, but collapsed. My husband came down, and I just screamed ‘He’s gone. He’s gone.’ ”

Soon, the house in the suburbs was busy. Paramedics rushed into the basement bedroom, then determined that Holton was long gone, killed by some sort of drug overdose in the middle of the night. They summoned a detective from the Metro Nashville Police Department, who cordoned off the basement and began to search for clues. On Holton’s table, he found pills crushed into a line of blue-gray powder and a straw made from a tightly rolled $20 bill.

Meanwhile, Blado got on the phone and roused three of Holton’s closest friends, all of whom had known him since childhood, who hurried to the house as the sun rose. Blado met them at the door, hugged them tight and pointed toward Holton’s room.

“Go in and see him,” Blado said. “This is what drugs do.”

The three young men stood in a doorway and peered inside. Belongings were splayed across their friend's messy room, remnants of a life cut short — a dresser full of books, dangling boxing gloves and a cluster of artsy photos pinned unceremoniously to the wall. Holton was still on the couch.

The police detective turned to the young men in the doorway, speaking matter-of-factly, as if he had been here a thousand times before.

“Do you know what he might have taken?” the detective asked.

They did. Or, at least, they thought they did.

One of the friends answered.

“Xanax.”

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A fake pill | A deadly lie

No one knows exactly how Josh Holton died, but it is clear he wasn’t killed by Xanax.

His body was found a little more than two years ago, in the early morning hours of Sept. 15, 2016, at his parents’ home in southeast Nashville. Police closed all investigations into the death earlier this year and deemed it an accidental overdose involving no prosecutable crime.

But, in a state that has been ravaged by the opioid epidemic, recording more than 7,000 casualties in five years, Holton’s death was something different. He was not a surgery patient who became addicted to painkillers after being prescribed too many for too long. Nor was he a heroin addict who died while scouring the streets for the biggest high of his life. And he didn’t overdose on meth, or cocaine, or a deadly combo of opioids and benzodiazepines, all of which kill hundreds of people in Tennessee each year.

Instead, based on multiple interviews and a review of police documents, personal text messages and emails, it appears that Holton fell victim to the little-known threat of counterfeit medication, which experts say is thriving in the anonymous and unregulated corners of the internet. Holton, who was quietly mourning the death of his biological father, bought Xanax, a sedative often used to treat anxiety, on the darknet to help himself cope. Instead, Holton received pills containing only fentanyl, an opioid 50 times stronger than heroin.

Much of the research into Holton's death was done by Blado herself, who spent months probing her son's computer and squeezing answers out of his friends, some of whom were too scared to speak with police. For this story, she shared much of her research with The Tennessean in an effort to spotlight the danger of counterfeit pills.

“I think Josh was self-medicating but not explaining to his friends what was really going on,” Blado said. “He was inexperienced, and he found something he didn’t know was dangerous. And it killed him.”

Counterfeit pills have been found in 45 states and caused deaths in 27 — including as many as three others in Middle Tennessee — according to the Partnership for Safe Medicines, a California nonprofit that studies the issue.

This death toll is also certainly undercounted because overdoses from fake medications are notoriously hard to confirm, at least in part because the victim is often the only person with knowledge of what drug they intended to take.

Regardless, the cases that are confirmed span everything from fake painkillers to fake cancer drugs, said Shabbir Safdar, executive director of the nonprofit. Many victims look exactly like Holton: young men who try to buy Xanax online but instead receive fake pills made with black-market pill presses and cheap fentanyl imported from China or Mexico.

“For all practical purposes, this is happening throughout the entire country right now,” Safdar said. “If you’ve got an interstate, these pills are most certainly in your state.”

'He could never have too much knowledge'

Holton was born in southern Maryland but came to Nashville in middle school as his mother and stepfather moved to Tennessee in search of jobs during the 2008 recession. As a teen, he attended Lighthouse Christian School in Antioch, then graduated through home schooling and enrolled at Middle Tennessee State University. At the time of his death, Holton was attending classes at Nashville State Community College and working full time at the Nissan plant in Smyrna. In his free time, Holton was an avid photographer who dreamed of one day transforming his hobby into a small business.

Despite this busy life in Nashville, Holton remained close with his biological father, Doug Brown Jr., a self-made Maryland restaurateur whom he often visited over the summer. Brown and his brother Daniel, with whom Holton was also close, drowned in the Chesapeake Bay in 2015.

Friends and family say Holton never recovered from the death of his father and uncle, and his mourning worsened symptoms of insomnia that had plagued him for years. Sadness and exhaustion put a subtle damper on a young man who was otherwise ponderous, inquisitive and relentlessly ambitious.

In addition to photography, Holton dreamed of following in the footsteps of his entrepreneurial father, and showed interest in real estate, graphic design and the stock market. On the day he died, he was scheduled to attend a class on advanced Microsoft Excel, which he hoped would help get him a promotion at the Nissan plant.

“He was always learning, and I don’t think he was capable of having a surface conversation,” said Trinity Thompson, 22, who was Holton's friend since middle school. “He could never have too much knowledge, and he would ask why about everything until you were having this deep conversation and you didn’t even know how you got there.”

This same inquisitiveness is likely why Holton was so enamored by TED Talks, an online series of eclectic speeches that have become widely popular in the digital age. Thousands of TED Talks have been posted since the platform went online in the mid-2000s, and presenters include scientists, philosophers, religious leaders and former presidents.

Holton watched these talks nightly when he got home from his late shift at the Nissan plant, his mother said. And it was from one of these talks, she says, that Holton first learned how to buy narcotics online.

In the year before he died, Holton watched a 2015 TED Talk by Jamie Bartlett, a journalist who had recently published a book on the darknet, a portion of the internet that can be accessed only through anonymous browsers.

In the 14-minute speech, Bartlett focuses heavily on how illegal drugs can be bought secretly and anonymously online and at times describes the online marketplace as an achievement of innovation, capitalism and customer service. The author stresses that he is not promoting drug use, but he also says at one point that buying drugs on the darknet is a “reasonably good way of guaranteeing a certain level of purity.”

“Many of you here will be on the darknet fairly soon. Not that I’m suggesting anyone in this audience would use it to go and procure high-quality narcotics,” Bartlett said, pausing as the audience laughed.

Blado said one of her son's friends told her this TED Talk is what originally gave Holton the idea to buy drugs online. She watched it for the first time in the months after he died.

“Every time the audience laughed,” she said, “it just hit me in my gut.”

Holton’s friend declined to be interviewed by The Tennessean but confirmed that he and Holton bought the pills online after Holton got the idea from the TED Talk. The friend denied any involvement when speaking to law enforcement, police records show.

Bartlett did not respond to multiple requests for comment on this article. A TED Talks spokesperson refused an interview but issued a statement saying that Bartlett’s speech explained how the darknet worked at the time and that “neither this talk nor TED condone the purchase of illegal or non-prescribed drugs on the darknet.”

'It looked just like any other Xanax'

As far as his family knows, Holton bought drugs off the darknet only twice.

The first time was in August 2016, about a month before his death, when he and his friend ordered Xanax off AlphaBay, an anonymous marketplace that has since been shut down by the federal government. It is believed that the first shipment was really Xanax, and Holton took the pills without issue.

But then, in September, Holton and his friend ordered again.

Holton's family found out what the pills really were about two months later. Officials emailed Blado a copy of her son’s autopsy report, showing authorities tested his blood for more than 75 drugs but found just fentanyl. The blue-gray powder on his desk also tested positive for fentanyl — and only fentanyl — records show.

Now burdened with the truth, Blado knew she had to warn the others. On Thanksgiving, as her son's friends gathered in her home to play board games in the basement, Blado pulled out a copy of the autopsy report and asked them to read it.

“Some ran out the door and fell on the ground. Others just stood there. Others sat on the couch crying,” Blado said. “I realized then that they really, really, really didn’t know about counterfeit medications.”

The reveal was especially thunderous for Chris Brown, one of Holton's closest friends, who was also one of the few people to see the darknet pills before Holton died.

In an interview with the Tennessean, Brown said Holton confided in him that he was buying Xanax online and taking the pills before bed. Brown was worried about his friend but kept his concerns to himself.

Later, Holton offered Brown one of the pills, and Brown reluctantly accepted. It was marked with a trademark Xanax stamp, just like medication he had gotten from a pharmacist before. Brown said the pill put him into a deep sleep but left him unharmed.

To this day, Brown does not know for certain if he took a real pill or a fake one.

“That’s the most haunting thing — it looked just like any other Xanax,” Brown said. “This could have happened to any of us.”

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.