Illicit Latin American labs are producing huge quantities of knockoff pharmaceuticals. There are several varieties:
Less common than other fakes, these are made with the same ingredients, formulation, and packaging as the originals.
The packaging and appearance are high-quality, but there may be little or no active ingredient. Some lookalikes may even contain harmful substances such as boric acid, glass, or fungus.
Drugs that have been rejected by the manufacturer for quality reasons are illegally obtained by counterfeiters from incinerators, repackaged, and sold.
Bottles of authentic drugs that have expired are soaked in hot water, relabeled with a much later expiration date, and sold.