Counterfeit Prescriptions

They are everywhere

Counterfeit and substandard drugs are a problem all over the world.

In 2017, the World Health Organization (WHO) estimated that about 1 in 10 medicines in low- and middle-income countries is substandard or falsified.

♦ Those countries spend more than $30 billion a year on these products.

Studies for WHO estimate that substandard or fake antibiotics may contribute to 72,000 to 169,000 child pneumonia deaths each year. They also estimate that bad antimalarial drugs may cause between 31,000 and 116,000 deaths a year in sub-Saharan Africa. These are modeling estimates, not exact counts.

♦ Counterfeit drugs are a very serious problem in poorer nations, where they may cost more than 100,000 lives a year.

♦ Many believe fake drugs are only a threat to low- and middle-income countries. That is not true.

Counterfeit drugs have been present in developed countries, including America, for some time. They have become more available since the COVID-19 pandemic increased online purchases.

Don't panic

The drug supply in the United States is among the safest and most controlled in the world. The FDA and major pharmaceutical companies estimate that less than 1% of prescription drugs sold in the U.S. are counterfeit.

• Less than 1% is standard terminology meaning the occurrence rate is so close to 0% that it cannot be mathematically modeled as a distinct, reliable fraction.

♦ Drug shortages and high prices are an invitation for counterfeit or substandard drugs to enter a market.

Some counterfeit prescription drugs are sold to wholesalers that create false records to make the drugs look legitimate. The drugs are then passed off to pharmacies, nursing homes, hospitals and doctors' offices.

♦ Counterfeit prescription drugs are illegal and may be hazardous to your health. They are fake medicines not produced to the specifications of the drugs they claim to be.

Many counterfeit prescription drugs have been found to be contaminated or contain the wrong ingredients or no active ingredient. Some have the right active ingredient but with the wrong dosage.

Big money

Counterfeit prescription drugs are a billion-dollar industry. Generally any high priced prescription drug is a preferred target. Both brand-name and generic drugs are susceptible to counterfeiting.

• Pain medicine and antibiotics are frequently counterfeited and even medications for pets.

Lifestyle drugs like Viagra are popular counterfeits which are heavily promoted on the internet and unsolicited emails.

In addition to pharmaceuticals, medical devices and medical related products have also been counterfeited, including blood glucose test strips, contact lenses, surgical instruments and implants.

♦ In 2021, a group operating out of Texas was arrested for selling $52 million worth of counterfeit cough medicine.

Examples of counterfeit drugs

• Counterfeit Botox was found in doctor's offices and clinics.

• Counterfeit Cialis 20 mg tablets were found in the mail bound for an online consumer.

• In 2015, FDA labs confirmed a counterfeit version of a cancer drug called Altuzan was being distributed in the United States. It contained no active ingredient. The drug is licensed for use in Turkey but not in the U.S. Fake Altuzan is still being found in foreign countries.

• In 2016, the FDA sent out an alert that a counterfeit version of the cancer drug BiCNU had been detected in some foreign countries. It does not appear to have entered the U.S. market.

People are dying

Overdose deaths in the United States peaked in 2022 and have fallen for three years in a row. According to provisional data, the CDC estimates that about 70,000 people died of a drug overdose in 2025, down about 14% from 2024 and close to the level before the pandemic. That is real progress, but fentanyl is still involved in more than half of overdose deaths.

♦ Not all drug-related deaths can be blamed on fake drugs. Many are due to taking too large a dose, taking drugs in combination, or even being prescribed the wrong medicine.

• In 2016, nine people in Florida died after taking a counterfeit anxiety medication called Xanax®, which contained the opioid fentanyl.
• In the spring of 2016, twelve people in California died from taking counterfeit hydrocodone tablets.

Opioid crisis

Counterfeit pain pills remain a serious problem in the United States. Many pain medicines are opioids.

Fentanyl is an opioid used as a pain medication and, together with other drugs, for anesthesia. It is made entirely in laboratories from chemicals, unlike heroin, which comes from plants.

♦ The DEA has reported that the most common fake pills are made to look like prescription opioids such as OxyContin and Vicodin, anti-anxiety drugs such as Xanax, or stimulants such as Adderall.

Traffickers use pill presses to make pills that resemble real medicines. The color, markings and shape can match the real thing, and the fentanyl may only show up in laboratory testing. Users typically don’t realize their pills contain it.

♦ Just two milligrams of fentanyl, about what fits on the tip of a pencil, can be deadly. DEA lab testing found that about 5 in 10 fentanyl-laced fake pills tested in 2024 contained that much, down from 7 in 10 in 2023. In 2025, the DEA seized more than 47 million fentanyl-laced fake pills.

The only safe source for prescription pills is a licensed pharmacy. Never take a pill that wasn’t prescribed to you, even if it looks real or comes from a friend.

Online Pharmacies

The greatest risk of running into counterfeit drugs comes from buying from Internet pharmacies. Learn how to shop online and what to watch out for when buying prescriptions online.

Older people are targets

Older adults take far more prescription drugs than younger people. About 89% of adults 65 and older take a prescription medicine, and more than half take four or more. Because they buy more medicines and many look for lower prices, older adults have more chances to run into counterfeit drugs, especially online.

• In the past, drugs like Botox and Viagra were popular with counterfeiters. Now counterfeit lifesaving drugs, including medications for cancer, high cholesterol and mental health conditions, are common.

♦ Weight-loss and diabetes drugs are a growing target. In April 2025, the FDA warned that counterfeit Ozempic had been found in the U.S. supply chain. WHO has also received reports of fake semaglutide, the ingredient in Ozempic and Wegovy, in several regions of the world since 2022.

Drugs for erectile dysfunction have a particularly large number of counterfeit versions. Psychiatric medications, including drugs for depression, anxiety and ADHD, also have many fakes.

Tips for avoiding counterfeit drugs

• Buy prescription drugs only from a licensed U.S. pharmacy, with a prescription from your doctor. Never take a pill from a friend or any other source.
• Look closely at the packaging and lot numbers, and pay attention to any change from one refill to the next.
• Understand that a generic version will not look the same as the brand name version.
• If a generic suddenly changes color or shape, ask your pharmacist to explain. The pharmacy may have switched to a different manufacturer.
• If a prescription looks suspicious, ask your pharmacist or doctor to check it. Don’t rely on appearance alone, because fake pills can look identical to real ones.
• Alert your pharmacist and doctor right away if a medication causes unusual side effects or your condition doesn’t improve.
• Be wary of online sellers who don’t require a prescription, aren’t licensed, or offer prices that seem too good to be true.