The idea of counterfeit goods might initially bring to mind fake designer handbags or knockoff high-end shoes. But some counterfeit products are much more dangerous than a bag you thought was from a luxury brand or shoes that turned out not to be collectible sneakers.

Fake pharmaceuticals, especially those bought online, pose great risks to consumers.

“The rise of counterfeit pharmaceuticals represents one of the most urgent and complex threats to brands and consumer safety today,” said Kari Kammel, director of the Michigan State University Center for Anti-Counterfeiting and Product Protection, or A-CAPP Center. “From the proliferation of illegal online pharmacies to the staggering number of counterfeit products circulating through online marketplaces, the risks facing patients and medical systems are expanding faster than most systems can respond.”

Jennifer Frink became connected with A‑CAPP through her advocacy work following the loss of her 21‑year‑old son, Tasman, to an accidental overdose from drugs purchased on the dark web in 2024. By sharing her family’s story, she is committed to raising awareness and helping prevent similar tragedies for other families.

“Our children and young adults now have unprecedented access to electronic devices and direct exposure to illegal online drug markets,” said Frink. We can’t erase these dangers, but we can refuse to ignore them by advocating for better protections, pushing for accountability and staying engaged with the digital spaces our kids, friends and relatives navigate.”

A growing global threat

A-CAPP Center researchers Saleem Alhabash, Subhalakshmi Bezbaruah, Patricia T. Huddleston and Anastasia Kononova recently surveyed nearly 5,000 participants from eight nations — the U.S., China, India, Australia, Brazil, Italy, Nigeria and the United Arab Emirates — to examine consumer behaviors and perceptions on the online purchase of legitimate and counterfeit medications.

The researchers found one in five consumers have been deceived into buying counterfeit medicines, while one in four knowingly purchased them. These counterfeit pharmaceuticals — including prescription medicines, over-the-counter medicines and supplements — were most frequently bought from online pharmacies and e-commerce and social media platforms and for personal use.

“Our survey highlights a troubling gap in consumer awareness and safety — many people are either unknowingly putting their health at risk or feel they have no other affordable or accessible option for obtaining needed medications,” said Alhabash, professor of advertising and public relations and associate director of research for A-CAPP.

The report also revealed that consumers don’t have a clear idea of what to do when they are deceived into buying counterfeit medication. They mostly dispose of it, but some keep counterfeit drugs. For respondents who decided to keep the medications, a slightly higher percentage of them used the medications rather than refraining from use.

“Coordinated efforts across multiple stakeholder groups, including brands and law enforcement, can enhance consumer knowledge about the dangers of using counterfeit medications and also boost their confidence in making decisions that protect them against health risks,” said Alhabash.

According to the A-CAPP Center survey, more than one in 10 participants who bought medications online experienced direct health or financial harm from using them.

“There are real-world consequences of counterfeit medications — what might seem like a convenient or affordable option online can quickly turn into a serious health risk or unexpected financial burden,” said Bezbaruah, a doctoral candidate in the Department of Advertising and Public Relations.

Demographics, education and motivation

Individuals who reported purchasing counterfeit pharmaceuticals were more likely to be male, younger (millennial and Gen Z), married, highly educated, high-income earners and frequent online shoppers. They were also likely to report lower levels of health literacy.

The A-CAPP Center researchers recommend that anti-counterfeiting campaigns target the segments noted above. They also emphasize the need to consider health literacy levels in developing outreach to consumers.

“Efforts to educate people about the dangers of counterfeit medications should consider the health literacy of those most at risk. Anti-counterfeiting strategies should focus on improving overall health literacy so people can better understand these risks,” said Huddleston, a professor of retailing in the Department of Advertising and Public Relations.

Convenience and accessibility motivate many consumers to shop for medications online. However, necessity — driven by factors such as lack of prescription access, high prices or limited availability of legitimate medications — is the strongest predictor of counterfeit medication purchasing.

“To effectively encourage attitude and behavior changes in consumers, brand protection professionals should focus on reducing the ‘I had no choice’ scenario by expanding legitimate access, fixing access barriers and optimizing production and distribution of pharmaceuticals to circumvent the replacement of authentic medications by fake ones,” said Huddleston.

Ad exposure, behavior predictions and risk

Nearly 60% of survey participants were exposed to medication-related advertising within the previous year. Globally, exposure to television ads reduced the likelihood of counterfeit purchasing, while exposure to radio ads or messages posted by illicit sellers on social media increased the likelihood by more than 12%.

“Not all advertising exposure is equal. While traditional media may help steer consumers toward legitimate sources, unregulated messaging on social media can actively increase the risk of people encountering and purchasing counterfeit medications,” said Bezbaruah. “Coordinated actions are needed to limit illicit sellers’ presence on social platforms and strengthen counter‑messaging.”

Although participants expressed strong negative views of counterfeit medications, such attitudes did not reliably predict if they would actually buy them. Instead, positive associations and perceptions of social acceptance — if people they knew thought it was OK to purchase counterfeit medicines — were significant predictors. Participants believed that about one‑third of people in their social networks have bought counterfeit medications.

“Social norms had a considerable association with counterfeit purchase behavior. Specifically, thinking that close family and friends are accepting of counterfeit purchase behavior increased the chances of buying counterfeit medications — both intentionally and unintentionally,” said Kononova, an associate professor of advertising and public relations. “Anti-counterfeit awareness-raising campaigns should leverage close relationships and influence of social norms among close reference groups as a means of influencing consumer attitudes and behaviors.”

Participants reported high awareness of counterfeit medication risks and strong confidence in their ability to detect them — yet this confidence paradoxically increased purchasing likelihood.

Anti-counterfeiting messaging is typically rooted in fear-based language, rather than language empowering consumers to make informed choices. A recent report from the A-CAPP Center outlined how anti-counterfeiting messages can backfire when consumers feel their freedom to choose is threatened, a response known as psychological reactance.

“People who feel more at risk are also more likely to buy counterfeit medications. For those who feel especially vulnerable, it’s important to avoid fear-based messages that can make them feel helpless. Instead, messages should focus on what people can do to protect themselves,” said Kononova.