Most of the 35,000 online pharmacies around the world are operating illegally and could be selling dangerous or ineffective drugs, according to the U.S. Trade Representative's annual "notorious markets" report.

Ninety-six percent of online pharmacies were found to be in violation of the law, meaning they were operating without a license and selling medications without prescriptions. An estimated 20 new illegal pharmacy websites are created every day around the world, according to the 2024 report released Wednesday.

"The health and safety concerns posed by counterfeit medicines are particularly troubling," Trade Representative Katherine Tai said in a statement.

Over 30 online retailers were identified in the report identified as engaged in selling counterfeit products. The websites often mimic legitimate e-commerce platforms, with false claims that they are approved by the Food and Drug Administration. The report compiled also singled out 19 countries over concerns about counterfeit or pirated products.

Online pharmacies gained traction during the COVID-19 pandemic when the demand for prescription medications was high and many patients may have been confined to their homes. Meanwhile, physical pharmacies are shutting their doors and across the U.S., at least 7,000 pharmacies have closed since 2019, The Associated Press reported, citing data from the University of Pittsburgh.

In October, the U.S. Drug Enforcement Administration and the Center for Disease Control and Prevention both issued a public safety warning about illegal pharmacy websites selling and shipping counterfeit pills to patients who believe they are purchasing real pharmaceutical drugs.

Last year, the FDA issued warnings to multiple online pharmacies selling suspected counterfeit products, demanding that the websites stop selling the products.

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