Dangers of Black Market Medications – More Common Than you Think

I think it’s safe to say that most of us assume the medications we get at the pharmacy or hospital are actually the drugs they are supposed to be. Most people would not even think of checking authenticity. But what if you took a medication, at home or in the hospital, that didn’t contain the active ingredient(s) you need? What if it contained dangerous chemicals? The dangers of black market medications are significant, and it’s more common than you think.

What are black market medications?

Black market medications are those sold illegally, outside of the government’s watch. These dangerous medications are either stolen, expired, contaminated, or fake.

Often referred to as counterfeit, you can find black market medications in pharmacies, hospitals, nursing homes and doctor’s offices. Fortunately, the US government regulates our medication supply chain, which is among the safest in the world. However, black market medications are on the rise. So, beware.

Experts state that “counterfeit drugs are a global problem with significant and well‐documented consequences for global health and patient safety, including drug resistance and patient deaths”.

For more information on the safety of our medication supply chain, read Are Medications Safe?

What are the dangers of counterfeit drugs?

Counterfeit drugs may contain dangerous, potentially deadly, ingredients, such as fentanyl (see below for more information on drugs with fentanyl). Additionally, counterfeit medications may contain foreign objects, such as tiny glass particles, or they may contain dangerous contaminants, such as dangerous bacteria, mold, or carcinogens. Finally, counterfeit medications might have too much or too little of the drug’s active ingredient.

What kinds of medications are counterfeit?

Unfortunately, all types of medications can be counterfeit, including drugs for cancer, AIDS, high cholesterol and mental health conditions. Therefore, you should not consider any medication immune from this issue.

A few dangerous examples.

In August, 2021, drugmaker Gilead Science announced that potentially harmful counterfeit versions of 2 of their HIV drugs are circulating in the US, including some sold at pharmacies.

Additionally, in September, 2021, the DEA (Drug Enforcement Administration) issued a warning regarding an “alarming increase in the lethality and availability of fake prescription pills containing fentanyl and methamphetamine“.

The DEA warning states that international and domestic criminal drug networks “are mass-producing fake pills, falsely marketing them as legitimate prescription pills, and killing unsuspecting Americans.” Unfortunately, these widely available, easily purchased counterfeit pills often contain deadly doses of fentanyl.

Shockingly, the DEA seized more than 9.5 million counterfeit pills between January and September of 2021. Among the most common counterfeit pills, are those that look like prescription oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®).

Criminals often sell these fake prescription pills on social media and e-commerce platforms.

How big of a problem is this?

The dangers of black market medications are widespread. Since 2010, there have been about 1,400 adverse events tied to counterfeit medications reported to the FDA, but that is likely just the tip of the iceberg.

However, it’s hard to know how prevalent this is — most patients don’t realize they have taken a fake or tampered medication. If patients don’t recover as expected, or develop side effects, doctors and patients generally don’t think that counterfeit medications are the problem. Therefore, doctors and patients often don’t report counterfeit medications to the FDA.

Unfortunately, it is estimated that the black market drug trade may account for 10% of the world’s drug supply.

How do fake medications get into the drug supply chain?

Criminals sell fake and/or stolen medications to pharmaceutical distribution companies, which then sell the medications to pharmacies, doctors, and hospitals, often at a discounted rate. Unfortunately, those purchasing the medications do not realize they are fake or stolen.

Additionally, patients can fall directly into the hands of criminals when they buy from online pharmacies. The Government Accountability Office estimated that in 2014 there were 36,000 “rogue” internet pharmacies, many selling medications that contained too little, too much or none of the active ingredients. And some of these medications contained dangerous substances like heavy metal and rat poison.

Scared yet? You should be.

What is the US Government doing about this?

In 2013 President Obama signed a law aimed at tightening the drug supply chain. In 2017, the government started to require a serial number on all prescription drug packaging; thereby making make it easier to track the path of medications from manufacturer to pharmacy, hospital, or doctor’s office.

Additionally, the law established a database of authorized wholesalers. As a result, it is easier for pharmacists, doctors, and hospitals to know they are buying from licensed sources. However, criminals can outsmart this system by creating packaging with serial numbers that are copies of authentic codes.

An FDA warning to a Canadian pharmacy.

On February 26, 2019, the FDA issued a warning letter to CanaRx regarding the sale of unapproved, misbranded and unsafe drugs. CanaRx acts as a broker between 150+ employer-sponsored health insurance plans and foreign pharmacies.

Here’s how it works: CanaRx receives a US prescription, then a foreign doctor rewrites the prescription and CanaRx sends the medications from an unknown source. Supposedly come from the UK, Canada, or Australia, but it is impossible to know the origin or quality of each pill.

FDA Commissioner Dr. Gottlieb stated that at least some of the medications received through CanaRX are “expired, mislabeled, subject to recalls or potentially counterfeit”.

What can you do about the dangers of black market medications? 

Because the dangers of black market medications are pervasive, you must be careful about where you get your medications. However, it’s hard to tell if a medication you receive at the hospital or at your local pharmacy is a fake medication because these fake medications can look exactly like the real deal.

However, there are a few things you can do to reduce your risk of taking fake medications:

• Only buy from a pharmacy located in the United States.
• If a medication looks or smells different, don’t take any of it. Contact your pharmacist and doctor right away.
• Be wary of medications that come in packaging that looks different than usual.
• Notify your doctor and pharmacist if you experience new or unusual side effect.
• Look online to see photos of medications to visually check for discrepancies. Helpful sites include pill identification sites run by WebMd and RxList. Additionally, visit the Flickr site run by the FDA that has photos of real and counterfeit medications.

Additionally, the FDA advises patients to beware of pharmacies that:

• Do not require a written prescription from your doctor.
• Offer steep discounts that seem too good to be true.
• Send you spam emails offering cheap medications.

Buying online?

If you prefer to purchase your medications on-line – beware!

The FDA’s BeSafeRx Website helps consumers understand the risks of buying medications from a fake pharmacy, and provides tips for identifying safe online pharmacies.

You can look up an online pharmacy through the state board of pharmacy (there is a link on the site for each state). If your pharmacy isn’t listed, don’t use it.

The FDA also advises that once you have identified a state-licensed online pharmacy, you should still make sure they require a prescription from your doctor, have a US street address and phone, and have a pharmacist on staff to answer questions.

Additionally, visit the FDA’s website: The Possible Dangers of Buying Medicines over the Internet.

A few more tips for online purchases:

• Do your homework before you buy anything – check the list of Verified Internet Pharmacy Practice Sites to find a pharmacy that has been accredited by the National Association of Boards of Pharmacy.
• Don’t be fooled by the sites that advertise “Canadian Pharmacy” – 85% of the time they are located in other countries, but advertise as Canadian to lure US buyers.
• Never buy from a pharmacy that doesn’t require a prescription, a sure sign that something is not right.
• And as the saying goes – “you get what you pay for”. If the price is too good to be true, it’s probably a counterfeit.
• If you find a website that you think is selling illegal drugs, contact the FDA.

What should you do if you suspect you received counterfeit medications?

If you believe you have a counterfeit medicine, talk to the pharmacist where you bought the medicine, and contact your doctor for medical advice.

Additionally, you can help the FDA protect other patients by reporting suspected counterfeit drugs.

The FDA suggests you take one of the actions below if you think a website is illegally selling human drugs, animal drugs, medical devices, biological products, or dietary supplements:

• If you purchased suspected counterfeit medication from a website, and it has led to a life-threatening situation, call 1-866-300-4374 or 301-796-8240 immediately.
• If your suspected counterfeit medication involves a serious reaction, fill out FDA’s MedWatch reporting form.
• For websites selling counterfeit medications that do not involve a life-threatening or otherwise serious reaction, fill out this form.
• To report emails promoting medical products that you think might be illegal, forward the email to webcomplaints@ora.fda.gov.

Learn more…

Since all medications, even those purchased at a pharmacy or received at a hospital, can harm patients, beware. Read these blog posts to learn how to reduce your risk of harm from medications:

• What’s an Adverse Drug Reaction?
• Reduce Your Risk of Medication Errors.
• Are Antibiotics Helpful or Harmful? What You Need to Know.
• Doctors Prescribe Too Many Medications.
• Is Off-Label Medication Safe?

Note: I updated this post on 11-28-22.