Taking, Making, and Faking Drugs: The Danger and Prevalence of Counterfeit Medications

tth1Prescription medications, now more than ever, have become constants in many Americans’ healthcare regimens. In 2010, the US Department of Health and Human Services estimated that over 50% of Americans have taken at least one prescription medication within the past 30 days [1]. By 2015, the National Council on Alcoholism and Drug Abuse stated that the number had climbed closer to 60% [2]. While there has been much debate over the degree to which pharmaceutical companies or physicians are to blame for this trend, a still greater question looms over what happens once the prescription is filled. With the increasing size of the pharmaceutical business has come the increasing prevalence of counterfeit medication, which in turn has led to associated health risks to consumers and links to organized crime.

Around the world, individuals and illegitimate companies have taken advantage of international trade to market fake medication. The issue first started attracting attention in the 1980’s when many American women taking birth control became pregnant [3]. After an investigation, authorities discovered that the women were taking an ineffective medication of foreign origin. This event prompted Congress to pass the Prescription Drug Marketing Act, which has worked to close America’s drug supply system from foreign sources in an effort to stave off unregulated providers. However, since the 1980’s, the internet has brought major changes to the way medications are bought and sold. While the legislation prevents the sale of unverified medications in pharmacies, Americans can now buy drugs from around the world on the internet, making enforcement nearly impossible. Outside of the United States, the trend is even stronger as many countries do not have legislation to prevent the sale of foreign, unregulated medications offline.

Counterfeit drugs pose huge health risks for the simple reason that patients have no idea what they are actually taking. Counterfeit medications can be filled with any unknown contaminants. These fake drugs can contain insufficient amounts of the active ingredient, levels that are high enough to cause overdose, or no active ingredient at all. In addition to not providing the proper treatment, fake antibiotics can have levels that are low enough to prevent positive effects, but high enough to build resistance to the drug. Thus, even if a patient later receives the proper dose of medicine, they may be resistant to the treatment [4].

Fake medications have been blamed for numerous deaths around the world, including the deaths of over 300 children in Kashmir in 2012 at the state’s main pediatric hospital. Another batch of counterfeit drugs were blamed in the deaths of 15 women in Eastern India in 2014 [4]. In addition to direct deaths, many preventative drugs that aren’t regulated can kill indirectly by creating a false sense of security. Fake antimalarial drugs, for example, may not pose direct health risks but will leave people who believe themselves to be safe still vulnerable to malaria.

tth2In addition to the dangerous health complications that can result from taking counterfeit drugs, the business of selling these drugs has become a public safety concern of its own. While globalization has facilitated the buying and selling of drugs from around the globe, the process has also encouraged organized crime to infiltrate the market. As the use of prescription drugs increases worldwide, there is a growing incentive for organized crime groups to shift their focus to counterfeit medications. Because these groups have the ability to disregard safety and quality standards, licensing, taxes, and minimum wages, they face lower production costs than legitimate pharmacies and can offer appealingly low prices [5]. With the growth of online drug sales comes the growth of these illegitimate companies and, thus, of organized international crime.

Unfortunately, counterfeit drugs are as prevalent as they are dangerous. The World Health Organization estimates that 10% of drugs in circulation today, and up to 50% of those sold online, are falsified [6]. In a similarly frightening investigation, the National Association of Boards of Pharmacy analyzed over 10,000 online sites that sell prescription drugs and found that only 3% of the sites complied with pharmacy laws and practices [3]. While law enforcement has utilized tagging and thermal identification technologies to flag suspicious medications [7], the responsibility largely falls on consumers to sort out the reliable sites from the suspicious ones.

Fortunately for consumers, there are easy steps that can be taken to avoid purchasing fake medications. Because fake drugs are largely sold to individuals seeking lower prices on the internet, one of the safest ways to avoid these websites is to purchase medications from pharmacies, avoiding the internet altogether. However, for those who wish to continue buying medications online, there are markers that can help separate the legitimate from the dangerous. First, the US Food and Drug Administration recommends that shoppers make sure that the site requires a prescription and has a licensed pharmacist available to answer questions. Additionally, consumers should verify that the website sells from a licensed pharmacy located in the United States by checking their state board of pharmacy’s license database online [8]. A legitimate online pharmacy will provide a physical address and US telephone number. By taking a few simple precautions, patients can steer clear of the growing counterfeit drug market. Enforced legislation and safe, affordable alternatives will be necessary to stave off the counterfeit drug market and ensure the safety of those around the world who unknowingly buy fake medications.


  1. US Department of Health and Human Services. Health, United States, 2013: With Special Feature on Prescription Drugs. Hyattsville, MD: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2014. Accessed 6 June 2016.
  2. “Almost 60 Percent of Americans Take at Least One Prescription Drug.” NCADD in the News. November 9, 2015. Accessed June 10, 2016.
  3. “Learn About Counterfeit Drugs Around the Globe.” Counterfeit Drugs. Accessed June 1, 2016. http://www.phrma.org/counterfeit-drugs.
  4. Kalra, Aditya. “Sterilization Deaths Expose India’s Struggle with Faulty Drugs.” Reuters.November 14, 2014. Accessed May 14, 2016. http://www.reuters.com/article/us-india-health-sterilisation-drugs-idUSKCN0IY1RD20141114.
  5. Reynolds, Lucy. “Organised Crime and the Efforts to Combat It: A Concern for Public Health.” Globalization and Health Global Health 6, no. 1 (November 15, 2010). doi:10.1186/1744-8603-6-21.
  6. Ambroise-Thomas, Pierre. “The Tragedy Caused By Fake Antimalarial Drugs.” Mediterranean Journal of Hematology and Infectious Diseases Mediterr J Hematol Infect Dis 4, no. 1 (May 04, 2012). Accessed May 14, 2016. doi:10.4084/mjhid.2012.027.
  7. Wilczyński, Sławomir. “The Use of Dynamic Thermal Analysis to Distinguish Between Genuine and Counterfeit Drugs.” International Journal of Pharmaceutics 490, no. 1-2 (July 25, 2015): 16-21. Accessed May 14, 2016. doi:10.1016/j.ijpharm.2015.04.077.
  8. “Buying Medicines Over the Internet.” U.S. Food and Drug Administration. US Department of Health and Human Services, 13 June 2015. Accessed 7 June 2016.

Image References:

  1. Munoz, Claudio. Cartoon. The Economist, September 10, 2010.
  2. Global Healthcare. July 11, 2011. Accessed June 13, 2016. http://www.healthcareglobal.com/finance/66/The-financial-pull-of-counterfeit-drugs.

Sedona Rosenberg is a rising sophomore at the George Washington University hoping to major in Public Health and minor in English.

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