Amid rising demand for popular medications, experts and industry groups are concerned regulators may not be able to keep pace with the speed of counterfeiters.

"A doctor simply writes down the prescription. They don't care where the patient buys the drug," said Saifuddin Ahmed, a public health practitioner and epidemiologist at Johns Hopkins University in the US. 

"It is critically important that a health care provider should be engaged. The [regulators are] not enough," Ahmed told DW.

Nowhere else is the challenge more obvious than with the huge demand for products like Wegovy and Zepbound.

They contain active compounds called semaglutide or tirzepatide, which were originally designed to treat type 2 diabetes. But these drugs were found to have a side effect that triggered substantial, sustained weight loss.

Demand rose from people wanting to lose weight, and that caused a shortage. Fakes have filled the gap.

Fake drugs are a global problem

Drug counterfeiting is a major global problem. The World Health Organization (WHO) estimates that one in 10 pharmaceuticals are fakes that carry no guarantee of any health benefits. 

While this is mainly a problem in low-and-middle income countries, especially parts of Africa and Asia, around 1% of people in high-income nations also obtain medication from unregulated sources.

In some cases, these drugs may have no effect. In other cases, however, ingredients in the fake medication may lead to adverse reactions or create new health problems.

"Purchasing medicine online from unregulated, unlicensed sources can expose patients to potentially unsafe products that have not undergone appropriate evaluation or approval, or do not meet quality standards," said the US regulator, the Food and Drug Administration (FDA) in 2023, when it issued its first warnings about the problem.

In 2024, the WHO issued a global warning that batches of fake Ozempic were flooding the black market.

More recently, in July 2025, data from the UK National Pharmacy Association found one in five Britons had attempted to obtain weight loss treatments in the previous year.

It warned that the high demand for these medicines carried the risk that people would "resort to unregulated online suppliers instead of regulated pharmacies."

Where are people buying counterfeit medicine?

Unregulated pharmaceuticals are being sold via online-only pharmacies, international drug shopping and organized criminal distributors.

These digital marketplaces are not online stores for established pharmacies, but sites that seemingly offer medicine at a fraction of the usual cost.

The drugs may look identical to genuine medicines online, but when delivered often have spelling errors on the packet or incorrect ingredient listings.

But it's not only fake drugs or placebos. Regulators have raised concern about compounding, where medicines that have been approved individually can be formulated to produce non-regulated "compounds" for individual patients.

In some regions of the world, including the US, trained pharmacists are allowed to compound medicines, but even then, the practice is less regulated than the stringent approvals that drug manufacturers must meet to bring their products to market.

For example, when the FDA temporarily allowed the compounding of weight loss drugs to address a product shortage, some pharmacists used semaglutide salts — which are not approved by regulators — instead of semaglutide itself. This led to reports of side effects.

And it wasn't just trained compounding pharmacies that were formulating these products in the US. Ahmed said, "this is done in [places] like gymnasiums and spas."

The FDA has now stopped allowing compounded versions of these weight loss drugs, but it is concerned that unregulated online pharmacies are still making substandard products available.

Raising awareness about fake drugs

To address concerns that consumers may seek unsafe products from unregulated sources, the FDA operates a campaign called BeSafeRx that provides guidance for consumers to identify genuine pharmaceuticals.

In the European Union, safety features on medicines are mandated, and include standardized labeling practices. In a statement provided to DW, the European Medicines Agency said "patients should only use online retailers registered with the national competent authorities in the EU Member States, to reduce the risk of buying substandard or falsified medicines."

Europol, which is responsible for law enforcement for pharmaceutical crime across member states, has coordinated regular actions across the bloc in collaboration with US and Colombian partners. In a 2023 operation, more than 1,284 people were charged for offenses related to the trafficking of counterfeit and misused medicines and doping substances.

As well as local awareness campaigns and enforcement initiatives, the key measure, Ahmed said, was to help improve awareness between patients and their health practitioners.

Ahmed heads the Johns Hopkins University's BESAFE initiative, which investigates risks and interventions to prevent the uptake of substandard and counterfeit medication. 

Surveys undertaken by BESAFE have found that within the US and South Africa, awareness of where to safely buy prescriptions and report fakes or adverse events is low. He said building trust between consumers, medical practitioners and regulators may help avoid the risks of counterfeit and unregulated drug purchases.

Edited by: Zulfikar Abbany