Fake Medicine in the US: The Rising Threat of Counterfeit Viagra, Ozempic, and More

Within the last few years, online pharmacies have rapidly grown in popularity. For many people, they can offer convenience, lower costs, and better product availability. But along with these perceived benefits, online pharmacies also pose a significant risk for counterfeit medications.

Even though the U.S. drug supply chain is strictly regulated, counterfeit medications can find their way to consumers. Buying medications from online pharmacies is one of the most common ways this happens. And within recent years, social media has emerged as another source for fake drugs. In rare cases, they may end up in a retail pharmacy or medical office.

So, what exactly is a counterfeit medication, and how do you protect yourself from being exposed to one?

What constitutes a counterfeit medication?

Simply put, counterfeit medications are fake drugs that are fraudulently produced and sold. They often mimic legitimate medications in appearance. But they may contain incorrect ingredients, improper dosages, or harmful substances.

What are the dangers of fake medicines?

There are many dangers associated with taking fake or counterfeit medicines. A few examples of potential risks include:

• Ineffective treatment due to containing the wrong dose, missing or wrong active ingredient(s), or misleading dosage information on the label

• Unexpected side effects or adverse reactions due to unknown or harmful ingredients

• Severe health complications, including poisoning or death

• Increased resistance to medications, such as antibiotics, due to improper dosing

What drugs are commonly counterfeited?

The vast majority of medications sold through retail pharmacies in the U.S. are the real thing. But if you purchase medications through online pharmacies or social media, there’s a higher risk that you’ll receive a counterfeit product.

Any medication could have counterfeit versions on the market. But some may be at higher risk than others. For example, medications that are in high demand due to shortages, such as weight-loss injections, may have an increased risk of fakes. This is also the case for more costly medications, since counterfeits can attract customers with steep discounts. Here are a few examples.

Erectile dysfunction medications like Viagra

One of the most commonly counterfeited medications in the U.S. are erectile dysfunction (ED) pills, such as Viagra (sildenafil). Their high demand and popularity make them prime targets for counterfeits. And they’re often sold online, sometimes without a prescription, making it difficult to verify their authenticity.

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• Fake Ozempic: A shortage of Ozempic (semaglutide) has resulted in counterfeit Ozempic products on the market. Here’s what real Ozempic looks like, plus how to spot fakes.

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• Taking Viagra if you don’t have ED: Online pharmacies make it easy to buy medications like Viagra (sildenafil), even if you don’t have erectile dysfunction. Here are the potential risks of taking Viagra if you don’t actually need it.

According to Viagra’s manufacturer, the company has found blue printer ink, amphetamines, and even drywall in counterfeit Viagra products. What’s more, you’re likely not actually getting the dose listed on the label. These pills contain either too much or too little, or in some cases, the product may not contain Viagra at all.

Taking counterfeit ED pills puts you at risk for serious side effects. Plus, medications like Viagra aren’t safe for everyone. Buying ED pills without a prescription skips an important step of talking to a healthcare professional that can determine if they’re OK for you to take.

Opioid pain medications like oxycodone

Opioid pain medications are another common target for counterfeits. Fake opioids are a growing problem in the U.S., with record numbers of counterfeit pills being seized every year.

Fake opioids are particularly risky. They’re often easy to buy and look like the real thing. And they sometimes contain substances such as fentanyl, which can be deadly. In fact, just one fake opioid pill can contain a lethal dose of fentanyl.

Opioids are controlled substances, meaning that they have a risk of dependency and misuse. Because of this, they have strict prescribing and dispensing requirements. If you’re able to purchase opioids without a prescription, there’s a good chance they’re fake.

HIV medications

For people living with HIV, starting and staying on antiretroviral therapy helps them live longer, healthier lives. And preventative medications (called pre-exposure prophylaxis or PrEP) are also available for people at high risk of HIV exposure.

There have been several counterfeit HIV medications found on the market, including Symtuza, Biktarvy, and Descovy. In these cases, fake HIV drugs were purchased from unauthorized distributors and dispensed by pharmacies. Noted issues included false documentation and bottles containing other medications, such as the pain reliever Tylenol (acetaminophen), instead of the HIV medication.

Counterfeit HIV medications may not have the same potency as the authentic products. They may even contain a different drug. This can put people at risk of contracting HIV (if they’re taking PrEP) or having their HIV management compromised.

Cancer medications

Cancer medications are another common target for counterfeit drugs. Many cancer therapies are given by a trained healthcare professional in a medical setting. Others may be taken at home.

There have been several instances of counterfeit cancer drugs in the U.S. Examples include chemotherapy like Abraxane (paclitaxel) and targeted therapies like Avastin (bevacizumab) and Adcetris (brentuximab vedotin). Counterfeit versions of immunotherapies, such as Keytruda (pembrolizumab) and Opdivo (nivolumab), have also been found.

In some cases, fake cancer medications have been found to contain no active ingredient at all. This means that someone receiving this product wouldn’t actually have their cancer treated, unknowingly allowing it to grow and spread.

Ozempic and similar medications used for weight loss

Ozempic (semaglutide) belongs to a medication class called glucagon-like peptide-1 (GLP-1) receptor agonists. Due to their popularity for weight loss, most injectable GLP-1 agonists are currently in shortage. Because of this, counterfeit versions have flooded the market.

Fake Ozempic is commonly sold online and through other unverified sources. But there has been at least one instance where a counterfeit product found its way into a retail pharmacy. In this case, the product was actually an insulin pen that was labeled as Ozempic. So it’s a good idea to inspect your medication closely, no matter where you purchase it from.

It may be tempting to purchase weight-loss medications online. They’re often sold at a significant discount and advertise the same benefits as the FDA-approved products. But there’s a higher likelihood that the product you receive is fake.

Botox injections

For fine lines and wrinkles, Botox (onabotulinumtoxinA) injections are widely available through med spas, dermatologist offices, and even “house parties.” But counterfeit Botox is a very real concern, especially if you receive Botox in a nonmedical setting or from an unlicensed person.

In April 2024, counterfeit Botox products were found in multiple states. These products were linked to serious side effects, including symptoms of botulism. While rare, botulism is a life-threatening illness that can happen when the toxin in Botox spreads to other areas of the body. According to the CDC, 13 people were hospitalized as a result of counterfeit Botox.

There are several risks of receiving Botox outside of a medical setting. Along with potential exposure to fake Botox, improper technique from an inexperienced or unlicensed person can also increase the likelihood of side effects.

ADHD medications like Adderall

Stimulants like Adderall (mixed amphetamine salts) are commonly used to treat attention deficit-hyperactivity disorder (ADHD). These medications are in high demand but difficult to access due to shortages. This may be partly due to expanded access to medications like Adderall via telehealth during COVID-19.

Today, counterfeit versions of ADHD medications are being sold through online pharmacies and social media. And like counterfeit opioids, they may also contain substances such as fentanyl or methamphetamine. What’s more, some pills don’t contain any Adderall, but pain relievers like Tylenol and tramadol instead.

Stimulant ADHD medications are also controlled substances with strict prescribing requirements. If you’re able to get them without a prescription, think twice before taking them.

How to spot counterfeit medication

It isn’t always easy to tell counterfeit medications apart from the genuine product. But there are several red flags you can look for

• Packaging: Look for any discrepancies in the medication’s packaging, such as poor print quality, misspelled words, or differences in the color or design.

• Appearance: Oral medications, such as pills, often have specific markings, colors, and shapes. Online pill identifiers can be a helpful tool. Counterfeit injection pens may look or work differently from the real thing. If you notice any differences in how your medication looks from one refill to the next, check with your pharmacist if you’re unsure.

• Price: If the price seems too good to be true, it probably is. Very low prices can be a red flag for counterfeit medications. If you need a reference point, GoodRx can be a good resource to see how much your medication usually costs.

• Source: Most counterfeit medications are purchased through online pharmacies. Be sure to purchase medications only from reputable pharmacies. Avoid buying them from unverified online sources or street vendors. You can verify if an online pharmacy is safe by using NABP’s Safe Site Search Tool.

What to do if you suspect you’ve received fake medication

There are several steps you should take if you think you’ve received a fake or counterfeit medication.

• Stop using the medication: Counterfeit medications can contain a different drug, wrong dose, or harmful contaminants. Discontinue use to avoid potential health risks. Seek emergency medical care if you’re experiencing symptoms that feel severe or life-threatening.

• Contact your healthcare team: Speak with your prescriber for guidance on what to do next. And if you received the medication from a pharmacy, notify them about the counterfeit product.

• Report it: Report counterfeit medications purchased online to the FDA. This can help them track and stop counterfeit drug operations. You can also report suspicious online pharmacy sites to NABP. And if you experienced a serious adverse event from taking the product, you can report it to the FDA’s MedWatch program.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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