The Food and Drug Administration took 130 enforcement actions against counterfeit medication rings from 2016 through 2021, according to my new study.

Arrests, confimation of products, or the dissolution of counterfeit rings are some of the actions that might be taken.

The counterfeiting operations involved tens of millions of pills, more than 1,000 kilograms of active ingredient powder that could be turned into pills in the US, and hundreds of millions of dollars in sales.

These actions barely scratch the surface, with over 11,000 rogue pharmacy sites selling drugs on the internet.

The Office of Criminal Investigations is part of the FDA. The agency has a database with links to press releases.

The counterfeit products were sold over the internet at a rate of 64.6% and the products were obtained without a prescription at a rate of 84.6%.

Many of the counterfeit drugs were for controlled substances such as oxycodone and hydromorphone, which are used to treat attention-deficit/hyperactivity disorder, as well as benzodiazepines, which are used for anxiety and sleep.

China, India, Turkey, Pakistan, and Russia were some of the countries that supplied counterfeit drugs to the US.

According to the World Health Organization, approximately 11 percent of medications sold in developing countries are counterfeit, resulting in 144,000 deaths annually from imitation antibiotics and anti-malarial drugs alone.

500 children died because of diethylene glycol being added to cough suppressants as a sweetener.

There are counterfeit versions of drugs used for chronic conditions, such as the transplant medication tacrolimus, sold under the brand name Limustin.

The Drug Quality and Security Act of 2013 in the US allows a specific medication to be followed from the manufacturer to the pharmacy through a national electronic track-and-trace system.

According to a survey by the Kaiser Family Foundation, 19 million people in America obtained prescription medications that are likely counterfeit through non-US licensed internet pharmacies or while traveling abroad.

According to the National Association of Boards of Pharmacy, 96 percent of the internet pharmacies they analyzed did not comply with US federal or state laws. Of these, 62 percent did not reveal their location and 87 percent were affiliated with internet drug outlets.

The FDA can help consumers determine if an online product is legit.

Opioids, benzodiazepines, and stimulants are addictive and dangerous when used together.

The active ingredients that are supposed to be in these controlled substances are often replaced with more dangerous alternatives. There are four in 10 counterfeit pills with a lethal dose.

The US seized more counterfeit pills from April 2020 to April 2021 than the previous two years combined. The 100,306 drug overdose deaths in the US over that time are likely the result of this.

Social media platforms are used by online pharmacies to reach potential customers. It suggests that more needs to be done by online platforms like social media, online forums and search engines to identify and stop illegitimate sellers of prescription drugs.

People buying controlled substances over the internet are usually trying to circumvent physician control over the medication or the quantities they can receive. Most people trying to get counterfeit drugs are trying to buy them at an affordable price.

The US needs a long-term strategy to lower the cost of prescription medications to diminish demand for counterfeit medications, though there are some money-saving strategies that can be used in the short term.

C. Michael White is a professor at the University of Connecticut.

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