Fake medicine is a global crisis

The Growing Threat of Counterfeit Medications

The increasing demand for weight-loss medications, including injections like Wegovy and Zepbound, has led many individuals to seek out unregulated sources for their prescriptions. These drugs, which contain active compounds such as semaglutide or tirzepatide originally developed to treat type 2 diabetes, have become highly sought after due to their effectiveness in promoting significant and sustained weight loss. However, this surge in popularity has also created a vacuum that counterfeiters have exploited.

Experts warn that the rapid pace of counterfeit drug production is outstripping regulatory efforts. Saifuddin Ahmed, a public health practitioner and epidemiologist at Johns Hopkins University, emphasizes the importance of healthcare providers being actively involved in ensuring patient safety. He highlights that while prescriptions may be written by doctors, the source from which patients obtain their medication is often overlooked. “Regulators alone are not enough,” he said, stressing the need for greater collaboration between healthcare professionals and regulatory bodies.

A Global Problem with Local Consequences

Drug counterfeiting is a global issue that affects both low- and high-income countries. According to the World Health Organization (WHO), approximately 1 in 10 pharmaceutical products worldwide are counterfeit, offering no assurance of quality or efficacy. While the majority of these fake medicines are found in low- and middle-income regions, particularly in parts of Africa and Asia, the problem is not confined to those areas. In high-income nations, around 1% of people still obtain medication from unregulated sources.

The risks associated with counterfeit drugs can be severe. Some may be completely ineffective, while others could lead to adverse reactions or even new health complications. The U.S. Food and Drug Administration (FDA) has warned that purchasing medicine from unregulated online sources can expose patients to potentially unsafe products that lack proper evaluation or approval. In 2024, the WHO issued a global warning about the widespread availability of fake Ozempic on the black market, further highlighting the growing concern.

In July 2025, data from the UK National Pharmacy Association revealed that 1 in 5 Britons had attempted to obtain weight loss treatments within the previous year. This trend has raised alarms about the potential for individuals to turn to unregulated online suppliers instead of seeking care through legitimate pharmacies.

Where Are People Buying Fake Medicine?

Unregulated pharmaceuticals are increasingly being sold through online-only pharmacies, international drug shopping platforms, and organized criminal networks. These digital marketplaces often mimic legitimate pharmacies but operate without proper licensing or oversight. The drugs they offer may appear identical to genuine products online, but upon delivery, they may have errors in labeling, incorrect ingredient lists, or even entirely different contents.

Compounding, where approved medications are mixed to create non-regulated formulations, is another area of concern. In some regions, including the United States, trained pharmacists are permitted to compound medications, but this practice is less strictly regulated than the rigorous approvals required for pharmaceutical manufacturers. For example, when the FDA temporarily allowed the compounding of weight loss drugs to address shortages, some pharmacists used unapproved semaglutide salts instead of the approved form, leading to reports of side effects.

Ahmed noted that compounding was not limited to licensed pharmacies. “This is done in places like gyms and spas,” he said. Although the FDA has since stopped allowing compounded versions of these weight loss drugs, concerns remain about the continued availability of substandard products through unregulated online pharmacies.

Efforts to Combat the Issue

To help consumers avoid counterfeit medications, the FDA runs a campaign called BeSafeRx, which provides guidance on identifying genuine pharmaceuticals. In the European Union, safety features on medicines are mandated, including standardized labeling practices. The European Medicines Agency has advised patients to use only online retailers registered with national authorities to reduce the risk of purchasing substandard or falsified medicines.

Europol, the EU’s law enforcement agency, has coordinated operations across member states in partnership with U.S. and Colombian authorities. In a 2023 operation, over 1,284 individuals were charged for offenses related to the trafficking of counterfeit and misused medicines.

Ahmed, who leads the BESAFE initiative at Johns Hopkins University, emphasizes that raising awareness among patients and healthcare practitioners is critical. Surveys conducted by BESAFE have shown that awareness of safe prescription purchasing and reporting mechanisms is low in the U.S. and South Africa. He believes that building trust between consumers, medical professionals, and regulators can help prevent the risks associated with counterfeit and unregulated drug purchases.