Nearly all of the world’s 35,000 online pharmacies are being run illegally, risking consumers getting ineffective or dangerous drugs, according to the U.S. Trade Representative’s annual report on notorious markets. The report stated that 96% of online pharmacies violate the law, many selling medicines without prescriptions and safety warnings.

A network of illegal drug sellers packaged potentially deadly synthetic opioids into pills disguised as common prescription drugs, leading to at least nine deaths from narcotics poisoning between August 2023 and June 2024.

The report highlighted ongoing issues with counterfeit goods and piracy, naming various online platforms and real-world locations notorious for selling such products.