Since as early as 2015, drug traffickers have been selling North Americans counterfeit medications made from fentanyl, a dangerous painkiller 25-40 times stronger than heroin, and even stronger synthetic opioids like carfentanil.  More recently, pill counterfeiters are using the same equipment to manufacture fake medicines made with new, dangerous ingredients such as methamphetamine, isotonitazene, clonazolam and etizolam.

The problem has spread to all 50 states, and many Americans have suffered overdoses and death because the drugs they were taking were counterfeit.