The Dangers of Fake Drugs: Top 10 Facts on Counterfeit Meds
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 13, 2022.
What Are Counterfeit Drugs?
Simply put, counterfeit drugs are fake medicines. They are fraudulently produced or mislabeled medicines purchased by consumers who believe them to be legitimate treatments.
These drugs can cause a range of serious health concerns. Fake pills may look nearly identical to their genuine counterparts, but may be incorrectly formulated so that:
- they have the wrong amount of active ingredient (or none at all)
- may be labeled incorrectly
- contain a dangerous unapproved drug
- produced in substandard conditions.
An estimated 80% of counterfeit drugs come from overseas, and many are manufactured in India, Mexico and China.
Deadly Fentanyl Deception
Reports from The Partnership for Safey Medicines notes that the DEA considers fentanyl-containing counterfeit medications a global threat, and news releases highlight ongoing counterfeit production of these medications.
Fentanyl is an opioid 25 to 40 times stronger than heroin and used for chronic, severe pain, often in terminally ill cancer patients. Common brand names of fentanyl include Duragesic, Actiq, and Fentora.
Counterfeit fentanyl pills are showing up on the streets around the country. Their use can be deadly. DO NOT buy any drugs from street dealers or from online dealers; you have no idea what might be in the pills. Here are some examples:
- The Department of Justice (DOJ) indicted two men in northern California who distributed counterfeit oxycodone pills made with fentanyl that lead to overdoses.
- At least 2 dozen reports surfaced from Tennessee that fentanyl was being disguised as less powerful pain drugs like oxycodone or Percocet and sold on the streets.
- In California, several overdoses were caused by tablets that were labeled as "Xanax" but contained fentanyl. Norco -- bought off the streets -- has also been found to contain fentanyl.
- In Cleveland, a man was arrested with more than 900 fentanyl pills marked as oxycodone.
Fentanyl Can Be Disguised
Fentanyl is inexpensive to make illegally, so dealers can make a bigger profit on the streets by disguising it as the higher priced oxycodone.
- A letter published in the Journal of the American Medical Association (JAMA) concluded that nearly half of opioid-related deaths involved fentanyl.
- Fentanyl powder is cheap and easy to obtain from illicit web sites and can easily be "cut" into other drugs.
- Ultimately, most people die from a fentanyl overdose because they stop breathing.
These counterfeit pills are often so expertly disquised even a forensic specialist cannot tell the difference visually. But in some cases touching or accidentally inhaling certain counterfeit drugs is enough to cause an overdose, as has happened with some law enforcement officials and first responders.
Examples of "medicines" sold on the street that may contain fentanyl include U-47700 ("Pink"), alprazolam (brand name: Xanax), heroin, ketamine, hydrocodone (brand name discontinued: Vicodin) and cocaine.
In April 2016, American singer-songwriter, musician, and record producer Prince died at age 57 after accidentally overdosing on fentanyl. It was reported that a tablet that he thought was Vicodin, a common hydrocodone painkiller, was laced with fentanyl, something he probably did not know.
Cashing In On Cancer
Fueled by easy internet sales, global supply routes, and minimal punishments, counterfeit prescription drugs have become an exploding industry worth over $75 billion a year worldwide. Counterfeit pharmaceuticals is big business, and not always steered by narcotics.
Cancer medicines are often targeted because they return big profits, are a fast growing segment, and patients are often desperate.
- The FDA issued an alert that a counterfeit version of the cancer drug BiCNU (carmustine for injection) has been found in some foreign countries. The legitimate product is approved for treatment of brain cancer, multiple myeloma, and lymphoma (Hodgkin’s and non-Hodgkin’s).
- FDA also warned doctors that a phony version of Avastin (bevacizumab) for cancer called Altuzan contained no active ingredient and was being distributed in the U.S.
- The only way to ensure you are getting safe prescription drugs is to buy them from a licensed U.S. pharmacy selling FDA-approved products, or drugs you might receive that your medical doctor prescribed as part of a treatment regimen (such as with chemotherapy).
Which Drugs are Targeted?
What are the most common drugs that are involved in counterfeit transactions?
- Erectile dysfunction drugs such as Viagra (sildenafil) and Cialis (tadalafil)
- Xanax (alprazolam) and Ativan (lorazepam) used for anxiety
- Pain drugs Percocet (acetaminophen and oxycodone) and acetaminophen and hydrocodone are also commonly counterfeited.
- Generic antibiotics, tuberculosis drugs, HIV / AIDS medications, and malaria medicines are also targeted. Infectious diseases are rampant in the developing world where there is little regulatory control, and these drugs are often acquired in desperation.
Other drug targeted for fake manufacturing include:
Dangerous and Deadly Consequences
Why are counterfeit drugs so dangerous?
- Counterfeit drugs may contain the wrong amount of active ingredient -- or no active ingredient at all.
- Poisonous ingredients have been found in counterfeit medicines, as well. The risk to the user is significant.
- Typical inactive ingredients added to counterfeit medicines include chalk, gypsum, acetaminophen, flour, talcum powder and sugar.
Of course, any ingredient, including other potent pharmaceuticals, dangerous chemicals or designer drugs concocted in an illegal lab can be added, too.
And what if the amounts are not exactly calculated? For example,
- the amount of active ingredient is too high
- if the dose is too low, treatment failure can occur (assuming it's the real medication)
- possibly even death due to excessive or inadequate amounts of a product, or possible drug interactions.
How Can I Protect Myself From Counterfeits?
Counterfeit drugs can be sold through rogue Internet sites which pose as legitimate pharmacies, as well as on the streets.
These illegal online pharmacies look real, so follow these tips:
- If using an online pharmacy, make sure it has a legitimate U.S. street address, phone number, and pharmacist.
- Check with the FDA list, and National Boards of Pharmacy, which maintain lists of verified online pharmacies.
- Don’t buy drugs from sites that sell meds without a prescription.
- For more information on buying an online medicine safely from the Internet, go to this FDA website.
Deceptive Online Diazepam (Valium)
The U.S. has a comprehensive system of laws and regulations to keep the incidence of drug counterfeiting low. But in recent years the FDA has seen a growing and sophisticated network to expand counterfeit drug trafficking.
- The FDA has also warned consumers about counterfeit diazepam (brand name: Valium) being sold on the Internet.
- The World Health Organization (WHO) has previously reported 700 adverse events from patients in Central Africa taking what they thought was diazepam, but was actually the antipsychotic drug, haloperidol (Haldol).
- The patients who mistakenly took haloperidol suffered acute contractions of the muscles of the face, neck and tongue (a dangerous side effect known as dystonia).
In Scotland, as reported by the BBC in 2017, fake Valium pills containing etizolam, which mimics many of the effects of diazepam, were found on the black market, and can be fatal when combined with opioids such as heroin or methadone. These fake pills were linked with several deaths.
Get to Know Your Medicine
Any time you get a prescription refilled, check the color, texture, taste and shape of the medicine. If there is anything different, talk to your pharmacist.
- If you are getting a prescription filled for the first time, or you have been given a medicine that looks different, try the Drugs.com Pill Identifier to check.
- It can match the imprint, size, shape, or color of your tablet and lead you to the detailed description in our drug database.
- In any case where you suspect you may be in possession of a counterfeit medicine take it to your pharmacist for verification. Never take any medicine you suspect to be fraudulent or incorrect.
And remember, illicit fake drugs bought on the street can be made to look exactly like the real drugs, so this is NOT always a foolproof way to ID pills given to you or bought illegally.
FDA Cracks Down: Operation Pangea
U.S. authorities are keenly aware of the ongoing online counterfeit and illegal importation problem in the U.S., and are making efforts to combat it.
- In 2018, the U.S. Food and Drug Administration (FDA) undertook an ongoing effort called Operation Pangea X1 to combat the unlawful sale and distribution of illegal and potentially counterfeit medical products on the Internet, including opioids.
- The FDA took action against over 465 websites that illegally sold potentially dangerous, unapproved prescription drugs to U.S. consumers, including opioid (pain), oncology (cancer) and antiviral (HIV) prescription drugs.
- In the past, review of other imported drug products showed that U.S. consumers had also unknowingly purchased certain unapproved drug products from abroad to treat depression, narcolepsy, high cholesterol, glaucoma, and asthma, among other diseases.
How Else to Combat Counterfeits?
Pharmaceutical companies and the FDA dedicate resources to help contain the counterfeit problem.
Technologies such as:
- Radio Frequency Identification
- Holographic labels
- Infra-red inks
- Supply chain tracking
- Digital serial number identification
- Chemical fingerprints
are being employed as quality control and anti-counterfeiting measures.
Stronger legislation to ensure appropriate punishment and a global collaboration with foreign governments are important in order to deter counterfeiters.
Finally, as a consumer, the best thing you can do is to educate yourself about the medicines you take and purchase them responsibly from a verfied and legitimate pharmacy.
Finished: The Danger of Counterfeit Drugs: Top 10 Safety Facts
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- FDA launches global operation to crack down on websites selling illegal, potentially dangerous drugs; including opioids. U.S. Food and Drug Administration (FDA) News Release. Accessed Sep 13, 2022 at https://www.fda.gov/news-events/press-announcements/fda-launches-global-operation-crack-down-websites-selling-illegal-potentially-dangerous-drugs
- Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA. 2018 May 1;319(17):1819-1821. Accessed Sep 13, 2022 at https://www.ncbi.nlm.nih.gov/pubmed/29715347
- The Partnership for Safe Medicines. Resources For Patients. Accessed Sep 13, 2022 at https://www.safemedicines.org/patient-resources
- Drug Supply Chain Integrity. U.S. Food and Drug Administration (FDA). Accessed Sep 13, 2022 at https://www.fda.gov/drugs/drug-safety-and-availability/drug-supply-chain-integrity
- Potentially Deadly Painkiller Being Disguised as Less Powerful Drugs. Drugs.com. Accessed August 9, 2018.
- Prince death: Powerful drugs found in singer's home 'were mislabelled'. BBC. Accessed Sep 13, 2022 at https://www.bbc.com/news/world-us-canada-37151146
- Counterfeit Medicine. US Food and Drug Administration (FDA). Accessed Sep 13, 2022 at http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/CounterfeitMedicine/
- Fentanyl-Laced 'Norco' Is Lethal, Report Warns. Drugs.com. Accessed August 8, 2019.
- Illegal Online Meds Targeted in Worldwide Crackdown, FDA Says. Drugs.com. Accessed August 8, 2019.
- Fake valium 'cheaper than chips', warns drug expert. BBC News. Accessed Sep 13, 2022 at https://www.bbc.com/news/uk-scotland-38610142
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