The United States is home to one of the most secure drug supply chains in the world, but criminals still find pathways to buy and sell prescription drugs—including controlled substances—often using websites and social media platforms to do so. We compiled information from experts about how criminals use online platforms to sell these drugs illegally and information to help you educate patients on protecting themselves and their loved ones. 

What are Illegal Online Pharmacies?  

For decades, illegal online pharmacies have sold unsafe drugs to patients, and their methods have adapted with the development of new technologies. Based on a 2021 ASOP Global survey, nearly half of Americans have purchased prescription medications online. Of the 42% of Americans who reported buying prescription drugs online, 59% erroneously believe all websites offering prescription drugs have been approved by Food and Drug Administration (FDA). Large global criminal organizations have taken advantage of the public’s trust and are operating illegal online pharmacy websites, often segmenting their operations between countries to avoid prosecution. These illegal operations claim to sell FDA-approved prescription drugs online at a deep discount, but the drugs they are selling are often substandard or falsified. The drugs may contain too much or too little of the active ingredient, poisonous fillers, or active ingredients, like fentanyl, that could cause deadly overdoses. At any given time, more than 40,000 illegal online pharmacies are active online, selling harmful drugs to unsuspecting patients.  

How to Spot an Illegal Online Pharmacy 

There are many clues that an online pharmacy is not legitimate. For example, if a website selling prescription drugs does not require a prescription, that is a sure sign that it is acting illegally. Also, many illegal online pharmacies create false “FDA Approved” watermarks to target customers in the US. Although the “logo” appears on just about everything you see, many of the drugs being offered have not been approved by FDA. Oftentimes, the website’s homepage will prominently feature popular drugs like erectile dysfunction pills, hair loss medication, and trending drugs. For example, many illegal online pharmacies featured hydroxychloroquine during the COVID-19 pandemic. Although the homepage may focus on drugs like these, the websites usually sell a wide variety of prescription-only drugs.  

Many illegal sites also offer “bonus pills”: buy-one-get-one offers that would not be offered by legitimate pharmacies. They also use the term “generic” to explain why certain drugs are so heavily discounted, but these drugs are not actually FDA-approved generic drugs. Instead, they are unapproved drugs that have not gone through the FDA-regulated supply chain. 

Illegal Pharmacies on Social Media 

Over the past decade, many illegal online pharmacies began utilizing social media platforms to expand their customer reach. Along with creating thousands of domain names to avoid the forced removal of their websites by authorities, criminal organizations will create many different social media accounts, switching from platform to platform to avoid being reported. These criminals use social media accounts not only as a method to sell drugs but to advertise their illegal businesses as well. Some social media pages do not have any posts and simply link to an external site, or their bio prompts the buyer to send a direct message (DM) for more information. After a buyer has DM’d, the seller frequently directs them to an encrypted messaging app. Once on the encrypted platform, they typically accept payment using peer-to-peer apps or cryptocurrency. Similar to how these criminal enterprises separate various aspects of their operation between different countries, illegal online drug sellers will often break up social media sales over various apps to avoid enforcement. 

In the 2019 article Internet Pharmacies: Trends, Opportunities, and Risks, Niamh Lewis and Libby Baney write, “Government officials are additionally calling on internet search engines and social media platforms to do more to protect consumers from illegal online drug sellers.” They add, “By disabling the ability to search for illegal online drug sellers, internet search engines and social media platforms would deny these criminal actors the visibility they need to be successful.” 

Illegal Online Pharmacies Threaten Public Health 

Illegal online pharmacies pose a significant threat to the general population. Many patients that have purchased drugs from dubious online sources have experienced “adverse effects” – meaning any effect from taking the drug that was not intended, including death. All demographics are susceptible to the harm of online pharmacies. In 2022, Charlie Ternan, a 22-year-old college student, took a pill purchased on social media that he believed was Percocet. It turned out to be laced with a deadly amount of fentanyl, and Charlie died within 30 minutes of taking it. Charlie’s family, one of many who have lost children to illegal drug poisoning, started the organization Song for Charlie to raise awareness about the dangers of buying drugs online.  

Protecting the Public from Illegal Online Pharmacies 

Alongside organizations like Song for Charlie, NABP and federal regulators like FDA and DEA are committed to protecting the public from illegal online pharmacies. Using our Safe Site Search Tool, patients can make sure that they are buying drugs from legitimate sources online. Our annual RogueRx Activity Reports highlight new or developing illegal activity threats. NABP will continue to bring awareness to this issue and maintain our efforts that support our mission to protect public health. 

If you, a loved one, or a patient has taken drugs purchased from an illegal pharmacy website or on social media and experienced an adverse effect, report it to NABP, your state board of pharmacy, FDA Office of Criminal Investigation (OCI), and your state attorney general. Victims have the unique opportunity to help others by sharing their firsthand experiences, but often feel too ashamed or afraid to report. Instead, it’s important for that person to realize they have the power to help stop illegal online pharmacy criminal enterprises by reporting their experience.