For the first time in Washington, D.C., an in-depth analysis of counterfeit pills has been performed as part of a larger initiative to understand the city's illicit drug supply. Over a 56-month period, 567 pills that were physically identified as a pharmaceutical were analyzed using gas chromatography mass spectrometry (GC-MS) and gas chromatography flame ionization detection (GC-FID). Out of the 567 pills submitted to our laboratory, 119 were confirmed to be counterfeit. Beginning in 2018, an increase in counterfeit pills was observed in suspected pharmaceutical submissions. By 2021, 62.5% of all pill exhibits were determined to be counterfeit. Most of the counterfeit pills submitted during this time frame had a '30M' imprint with blue coloring, consistent with the physical identification of a 30 mg Oxycodone tablet. Fentanyl was the number one identified psychoactive substance detected in counterfeit pills (75.4%), however, other opioids, precursors, and a novel benzodiazepine were also identified. This preliminary research hopes to illustrate counterfeit pill trends in Washington, D.C. and highlight the importance of analyzing pharmaceuticals in addition to suspected illicit substances. This surveillance is ongoing and collaboration with neighboring jurisdictions is anticipated in the future.