Counterfeit drugs are a scourge known throughout the world, and patients have been harmed and killed because of their presence. Regulation and penalties are weak against purveyors of fake medicines, yet entering and profiting from this illicit business is low cost with high returns. The Internet has fueled the sale of these counterfeits, while the current state of technology is inadequate to secure the safety of the drug supply. A multi-disciplinary effort across public and private actors focusing on technological investment, increased legal penalties, professional and public education, and international cooperation is essential to address the harm associated with counterfeit drugs.