As more pharmacies close across the U.S., a growing number of people are going online for their prescription medications — but some experts are warning that fake pills pose a very real risk.

Earlier this month, Rite Aid declared bankruptcy and announced the closure of more than 150 stores nationwide. 

Walgreens and CVS have also shuttered some locations, creating so-called “pharmacy deserts” where people can’t physically buy their essential medicines. This has created a “breeding ground” for counterfeit pills, expired prescriptions and laced medicine, according to Roei Ganzarski, CEO of the Washington-based company Alitheon, which provides technology for counterfeit identification and traceability.  

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The problem is most extreme in rural areas, he noted.

“In general, a company would start cutting costs where there’s less demand,” he told Fox News Digital in a phone interview. 

“If there’s a pharmacy in the middle of a condensed neighborhood, it’s probably making more money than a pharmacy in a rural area, small town or farmland, and so those will probably be the first to go.”

Why are pharmacies closing?

Irene Brako, PharmD, a pharmacy manager at Walgreens in Washington, D.C., noted that retail pharmacy chains face challenges that include fierce competition, low-profit margins on prescription drugs and changing consumer behaviors. 

“Retail crime, staffing shortages and a lack of adequate store investment have further strained operations,” she told Fox News Digital.

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Also, fewer people are pursuing pharmacy technician jobs due to low salaries and the availability of alternatives, Brako noted.

“These challenges have led to the closure of numerous pharmacies, which is impacting access to essential health care services in various communities,” she said.

A store closing notice is seen at the entrance to the Walmart Supercenter in North Portland, Oregon. Retail pharmacy chains face challenges that include fierce competition, low-profit margins on prescription drugs and changing consumer behaviors, a pharmacy manager told Fox News Digital. (iStock)

Viraj Ghandi, the founder of Medivant Healthcare in Scottsdale, Arizona, confirmed to Fox News Digital that pharmacies have been closing down — especially independent stores — for the last two decades. 

“There were 55,000 independent pharmacies in the early 2000s, and this number is down to 25,000 this year,” said Ghandi, who has 25 years of pharmaceutical manufacturing experience. 

One of the main reasons is that reimbursement rates from pharmacy benefit managers have come down substantially, he said. 

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“A pharmacy earns a margin of between 25% to 30% on generic medications,” Gandhi told Fox News Digital. 

“The prices of most of these generics have come down significantly — thereby squeezing the money earned by the pharmacy.”

Gandhi calls the low margins and the increasing cost of labor a “deadly combination” for pharmacies.

Options in ‘pharmacy deserts’

When people no longer have physical pharmacies nearby, they have three options, according to Ganzarski.

“And that is happening with elderly people with disabilities who can’t go online, or maybe it’s too expensive or too complex, or they can’t drive for hours to get it,” he said.

“When you go digital, you just don’t know who you’re ordering from or what it is you’re actually getting — and yet you’re putting it in your body.”

The second alternative is that someone will drive to the nearest pharmacy, which is inconvenient, costly and time-consuming.

Then there’s the easiest solution, said Ganzarski — which is to go online, type in the name of the medicine and order it.

The challenge with purchasing pills online, an expert said, is that you often don’t know what you’re getting. (iStock)

This may work out fine if people are buying from the actual company’s legitimate website — but there’s danger when they find themselves on a third-party site.

“They might think, ‘Oh, look, I can buy it from this company in Canada or Taiwan and it’s cheaper,’” said Ganzarski. “They may not even know who it is, but hey, it says the name of their medicine and it’s much cheaper.”

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“When you go digital, you just don’t know who you’re ordering from or what it is you’re actually getting — and yet you’re putting it in your body,” he added.

Risks of the unknown

There are a few different levels of counterfeit medicine, Ganzarski noted. 

For some people, it might mean getting a medicine that has some trace amounts of the actual chemicals in it, but not enough to actually fight whatever condition they might be treating.

Fewer people are pursuing pharmacy technician jobs due to low salaries and the availability of alternatives, a pharmacy manager told Fox News Digital. (Getty Images)

“The second type of counterfeit is when literally there’s nothing there,” Ganzarski said. “You’re just taking a pill that is a placebo, and then you don’t understand why you’re not getting better.”

There is also the potential that a consumer will receive real pills — but the medicine is already expired.

“Bad actors can get their hands on a surplus of old pills that were supposed to be destroyed or thrown away, then change the date and ship them,” Ganzarski warned.

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And the most dangerous possibility is for pills to be laced with life-threatening substances.

Deaths from counterfeit pills are rising. The Centers for Disease Control and Prevention (CDC) says the percentage of recent overdoses caused by fake pills increased from 2% in Q3 2019 to 4.7% in Q4 2021.  

A consumer could receive real pills — but that medicine could have expired, an expert warned. (iStock)

While Ganzarski noted that the government does a great job of trying to find and remove these fraudulent websites, it’s all too easy for criminals to have a new one up and running within minutes.

“These fake pills can pose significant health risks, as they may lack proper quality control, contain incorrect ingredients or have incorrect dosages,” Brako told Fox News Digital. 

“Patients who unknowingly receive counterfeit medications could experience adverse effects, treatment failure or harm to their health,” she added.

Safety tips for buying online medication

The main problem with ordering medications online, Gandhi said, is that most people end up buying from offshore online pharmacies that dispense drugs that are not approved by the U.S. Food and Drug Administration (FDA). 

“This is always risky, and is something the FDA has made a lot of efforts to educate the public about,” he noted.

“Fake pills can pose significant health risks, as they may lack proper quality control, contain incorrect ingredients or have incorrect dosages.”

When buying online, people should only order from licensed pharmacies within the U.S., said Gandhi.

“Almost all insurance companies offer an option of shipping drugs to your home based on your insurance plan,” he said. 

“There have also been other initiatives, like Pillpack and now Mark Cuban’s Cost Plus Drugs, that offer U.S. FDA-approved low-cost generics.”

When buying online, people should only order from licensed pharmacies within the United States, said an expert. (iStock)

Brako emphasized that patients should only purchase medications from reputable, licensed online pharmacies with a verified internet pharmacy practice site (VIPPS) seal or other regulatory certifications. 

“Always have a prescription from a licensed health care provider for prescription medications,” she added. “Verify the pharmacy’s authenticity, check for customer reviews and ensure secure payment methods.”

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Shoppers should also report any suspicious websites or products to health authorities to protect others from potential harm, Brako advised.

A good rule of thumb, according to Ganzarski, is that if it’s too good to be true, it probably is.

If a medicine is suddenly much less expensive than usual, that should be a red flag — for example, if it’s usually $100 and is priced at $40.

“Patients who unknowingly receive counterfeit medications could experience adverse effects, treatment failure or harm to their health,” an expert warned. (iStock)

“No website should have to advertise medicine with super-cheap prices,” Ganzarski said. 

If they do that — “there’s probably a reason.”

People should also steer clear of medicine sellers that don’t publish their phone number, address or clear statements about how they ensure quality control, he added.

Even well-known online marketplaces such as Amazon and eBay can fall victim to unscrupulous sellers, Ganzarski warned.

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Another tip is to call a local hospital or family doctor and ask which pharmacies they recommend as trustworthy. 

“Doctors will have a list that they usually prescribe from in their system,” Ganzarski said.

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Since her Alzheimer’s diagnosis in 2019, a Colorado woman has refused to give in to the disease — and after 4½ years, she is still mentally sharp and virtually symptom-free.

Dr. Rebecca Chopp, who is married with three sons, was 67 when she was diagnosed with mild cognitive impairment (MCI) due to Alzheimer’s disease.

At the time, Chopp thought everything was normal — other than the fact that she’d been sleeping more than usual. 

Then, at her annual physician’s visit, she mentioned that she’d gotten lost on the way to her appointment, which prompted her doctor to run some tests.

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Ultimately, an MRI and a PET scan led to Chopp’s diagnosis.

“Now, I look back, and I realize there were signs that I wasn’t educated about, and I wasn’t paying attention until my very smart primary care physician put two and two together,” she told Fox News Digital in an interview via Zoom.

Among those missed signs was withdrawal from social activities, Chopp said.

“All of a sudden, I stopped wanting to go to all the galas and parties and dinners that came with my job,” she said, referring to her position as chancellor of the University of Denver. “I just kind of wanted to withdraw into myself.”

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She also had a little more trouble with work tasks, but initially chalked it up to getting older or being tired.

“About six out of 10 Americans, even when they see the signs, just don’t want to get that diagnosis because they think it will immediately lead to the last stage of the disease,” Chopp said.

At first, Chopp was devastated at the idea of leaving her distinguished academic career — and at the prospect of missing out on all the retirement activities she’d planned with her husband.

Chopp (pictured) follows the MIND diet, which is a hybrid of the Mediterranean and DASH diets. (Rebecca Chopp)

Chopp also had a mental picture of her mother and both grandmothers — all of whom died with Alzheimer’s after receiving late-stage diagnoses.

“So when she told me, my husband and I were devastated — it was just an abyss for us,” she recalled.

After Chopp’s initial shock and sadness, she said she faced another challenge when a neurologist provided little information or guidance. 

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“She told me that in three years, I would not be able to button my own shirts or feed myself,” Chopp recalled. 

Then a second neurologist painted a brighter outlook. This neurologist told Chopp that in light of new research and lifestyle treatments, people with Alzheimer’s could live up to 20 years — and could slow down the progress of their symptoms.

That gave her the encouragement to take control of her disease and reclaim her life.

Chopp is pictured hiking on a mountain in Colorado with her husband, Fred Thibodeau. Physical activity is a regular part of Chopp’s routine. (Rebecca Chopp)

Lakelyn Hogan Eichenberger, PhD, a gerontologist and care advocate for Home Instead in Omaha, Nebraska, agreed that lifestyle choices are important for health in later life.

“While there is no one food that can reduce the risk, eating a well-balanced diet is important for reducing the risk of cognitive decline in later life,” she told Fox News Digital. “The DASH and Mediterranean diets have been shown to be most effective.”

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“In addition to diet, other important lifestyle factors include regular exercise, quality sleep, stress management, keeping your brain engaged, and maintaining social connections.”

Chopp shared with Fox News Digital what she calls the “four pillars” of her fight against Alzheimer’s.

1. Feeding the brain with optimal nutrition

Chopp follows the MIND diet, which is a hybrid of the Mediterranean and DASH diets.

Exercise has also proven to be a great way to stimulate her creativity, said Chopp, who just finished writing a book about her Alzheimer’s journey. (Rebecca Chopp)

Dr. Martha Clare Morris and colleagues at the Harvard Chan School of Public Health and Rush University Medical Center first introduced the diet in 2015 as a means of promoting brain health in older adults. 

“It also includes additional blueberries, walnuts, lots of salmon, sardines, avocados — foods that we know are good for the brain,” Chopp told Fox News Digital. 

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She also cut out processed foods, as they have been shown to trigger the inflammation in the brain that contributes to Alzheimer’s symptoms.

“I wish I’d known about the importance of diet when I was 40,” she said.

2. Moving to benefit the mind

Exercise has been proven to help prevent cognitive decline and slow the related symptoms.

“Exercise flushes the brain with good chemicals and literally creates a kind of protein that may grow that section of the brain where your memories are,” Chopp said.

“I began to realize that I could live with joy, that I could live well, that I could live in a state of abiding awe and have a great quality of life.”

Physical activity is a regular part of Chopp’s routine. It also provided the perfect excuse for her to get a puppy — which she’d wanted for 25 years.

“I walk with my dog, maybe an hour and a half a day, and I also do strength training,” she said.

Chopp also does kickboxing, ballet and yoga — activities that engage the brain and the body.

Exercise has been proven to help prevent cognitive decline and slow the related symptoms. Chopp is pictured here with her dog.  (Rebecca Chopp)

Exercise has also proven to be a great way to stimulate her creativity, said Chopp, who just finished writing a book about her Alzheimer’s journey.

“The only way I was able to write that with Alzheimer’s over the course of 11 months was to work on it for two hours each day after walking with my dog in the morning,” she said. “It was amazing how much better my concentration was.”

3. Living with joy and awe

One piece of advice from the second neurologist stuck with Chopp: It was to “live with joy.”

“Attitude is key in life,” she told Fox News Digital. “When you’re faced with this sort of devastating news, you kind of go into a dark underworld at first — but when I began to realize that I could live with joy, that I could live well, that I could live in a state of abiding awe and have a great quality of life, my attitude got a lot better.”

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For many Alzheimer’s patients, Chopp said, the diagnosis leads them to “get grumpy” and withdraw socially.

Chopp urges them to follow her lead in refusing to surrender.

“For the most part, I live with joy,” she said. “I now have time to spend with my husband, who patiently put up with me working 14- to 16-hour days. I spend time with my family and friends.”

Since her diagnosis, Chopp has sought out ways to pursue creative endeavors to keep her brain sharp, including painting. (Rebecca Chopp)

Chopp has also embraced advocacy efforts to support Alzheimer’s research and treatment, which has allowed her to meet many other people who are traveling the same journey.

As a member of the National Early-Stage Advisory Group, she works to help others live their best lives after an Alzheimer’s or dementia diagnosis.

“It has given me a tremendous sense of purpose,” Chopp said. “And I think we all know how comforting that is, to be encouraged, to cry with one another, to know you’re not alone.”

4. Embracing creativity

Since her diagnosis, Chopp has looked for ways to pursue creative endeavors to keep her brain sharp.

In addition to writing, she’s begun painting — something she never considered before.

“For a brain-healthy lifestyle, whether you worry about Alzheimer’s or not, you’ve got to tap into that creative side.”

“One of the things the second neurologist told me is that I needed to engage the other side of my brain, that I could form new neural pathways through creativity,” Chopp told Fox News Digital.

An artist friend took Chopp to the mountains and taught her to paint. Now, several years later, she is painting professional portraits. 

“Still Me” by Rebecca Chopp, PhD, will be available in early 2024, with pre-orders beginning in November. “Everybody and every brain is unique,” she said. (Rebecca Chopp)

“But it doesn’t matter how good you are — you can doodle, you can dance, you can garden, you can woodwork,” she said. 

“For a brain-healthy lifestyle, whether you worry about Alzheimer’s or not, you’ve got to tap into that creative side.”

These days, Chopp’s doctors are “very pleased” with how her lifestyle interventions have slowed the progression of her disease.

“It’s really important to educate yourself about the disease and its progression. Get help and support from others and refuse to surrender.”

“The last time I was in the office, which was three weeks ago, the neurologists told me that I was pretty much the same as I was three or four years ago,” she said.

Chopp realizes that won’t always be the case — but what she’s doing is working, and she said she’s not the only one.

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“I have learned there is so much you can still do,” she said. “It’s really important to educate yourself about the disease and its progression. Get help and support from others and refuse to surrender.”

“Everybody and every brain is unique,” she told Fox News Digital. “But I think almost everyone will be able to delay the rapid progress of these symptoms through lifestyle and medical treatments.”

Chopp’s book, titled “Still Me: Accepting Alzheimer’s Without Losing Yourself,” from MFF Publishing (Morgridge Family Foundation), will be available via Amazon and other outlets in February, with pre-orders starting in November.

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Before Chopp’s diagnosis, she was a widely published author and editor, an ordained minister and a well-known academic in the fields of education, philosophy, religion and feminism, according to the foundation. 

Prior to her role as 18th chancellor of the University of Denver, she served in leadership positions at Swarthmore College, Colgate University, Emory University and Yale University. 

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