Growing Threat of Fake and Bad-Quality Medicines Sold Online

Published July 8, 2024

Fake and bad quality (substandard and falsified, or SF) medicines are a serious danger to people’s health. These SF medicines are fake copies made to look like the real thing. Now that more and more people are buying medicines online; people are setting up fake websites that pretend to be real pharmacies. In truth, about 95% of these websites that sell prescription drugs are illegal. Some may look like they are a Canadian pharmacy with low prices, making it hard to know if they are real or fake.

SF medicines can contain very dangerous substances, like fentanyl, a powerful pain medicine which can cause deadly overdoses. While some people think SF medicines are only a problem for illegal drug use, these SF medicines can hurt anyone looking for medicine that is not expensive. Sometimes SF medicines have things like rat poison, cement, or heavy metals (such as arsenic or mercury), and contain no real medicine at all.

Here is a recent case reported to us. As you read about it, try to notice signs that the medicine was not real.

Error Reported to ISMP

A person went to a hospital’s emergency department because they could not stop vomiting after taking what they thought was a 10 mg dose of semaglutide, instead of the recommended smaller dose of 0.5 mg. They were treated at the hospital emergency department and after 24 hours they were able to go home.

Before this incident, the person’s doctor had given them a prescription for Wegovy (semaglutide) to help them lose weight. However, they could not afford the copay. So, they bought the medicine from an online pharmacy.

When the package arrived, the shipping label showed it came from someone's house, not a company. The medicine was in a cardboard box, and there were no instructions on how to mix or use the medicine. Inside, there were glass ampules of “sterile water” with no labels (Figure 1) and only insulin syringes to prepare and give the medicine. The box also had ten vials, each saying it had 10 mg of semaglutide powder (Figure 2). Although the vials had a lot number (ZPHC768) and an expiration date (March 2027), they did not have a national drug code (NDC) or any other drug identification (ID) number that is required.

The carton label said the product was “Made by SecureSemaglutide Labs,” had a “SWISS MADE” logo, and had a “GMP” seal, which means it should have been made in a good manufacturing practice facility (Figure 3). Semaglutide is supposed to be injected under the skin (subcutaneously), but the caron also said it could be given into a muscle (intramuscularly).

The side of the carton had instructions to mix 1 mL of “sterile water” into the “vail” (which should bespelled “vial”). It also said what the first dose should be in milligrams (mg) and how to increase the dose. But the instructions did not say how to measure a dose using the insulin syringe (Figure 4).

Warning Signs that Something Is Wrong

• The medicine was bought online without a prescription and claimed to be from Switzerland.
• The patient did not get any instructions, and they were not able to talk/chat with a pharmacist.
• The medicine was shipped from a home address in the United States.
• There was no phone number or contact information to ask questions.
• There were no labels with the person’s name or clear instructions about how much to take.
• They were given insulin syringes without instructions on how to measure a dose.
• The word “vial” was spelled wrong on the labels (“via” and “vail”).
• The “sterile water” glass ampules had no labels.
• The medicine did not have an NDC or any other ID number.
• The carton stated the medicine should be refrigerated but it was not shipped with cold packs or in an insulated box.

Here’s what you can do: Talk to your doctor or pharmacist about how to safely order medicines online. Use resources such as the US Food and Drug Administration’s (FDA) BeSafeRx campaign. Use the National Association of Boards of Pharmacy's (NABP) searchable list of accredited digital pharmacies to look up pharmacies to see if they comply with quality assurance criteria. Check to see if a licensed pharmacist is available at any online pharmacy you are considering, which can help determine the pharmacy's legitimacy. If a pharmacy does not require a doctor’s prescription to purchase medicine, the site is likely illegal and unsafe.

Look at the medicine package when it arrives. Check the package and labels for spelling errors, which is one of the most noticeable mistakes on SF products.¹ Make sure there are specific instructions and information about how to prepare and take a dose. Be suspicious if vials are not labeled, if an appropriate measuring device is not provided, or if the drug is not shipped according to the storage requirements on the label (e.g., states to refrigerate but does not arrive with cold packs). If anything does not look right, check with a doctor or pharmacist before taking the medicine.

Reference

1. ‍‍ How to identify fake medicines. Pfizer. Accessed April 2, 2025.

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