The boom in online marketplaces for illicit pharmaceuticals poses a severe risk to public health and criminal dynamics across Europe. Behind the slick, emoji-laden online storefronts is a developing form of transnational organized crime that operates entirely through digital supply chains, bypassing traditional controls. These marketplaces blur the line between street drugs and genuine pharmaceutical products to dupe buyers, with life-threatening consequences.

A few clicks to the danger zone

In October 2025, police in Berlin issued an urgent public warning that counterfeit oxycodone was circulating on the illicit market. The genuine product is a synthetic opioid whose potency is comparable to heroin; the counterfeit variants identified in Germany contained nitazenes, a synthetic opioid that can be several hundred times stronger. Despite bearing the familiar ‘OC’ stamp and packaging designed to closely resemble the original product, the pills were potentially lethal. That same month, counterfeit Xanax tablets were also reported in the city. Rather than containing the active ingredient benzodiazepine, these pills contained cychlorphine, a synthetic opioid linked to fatalities in the United Kingdom in late 2025.

These are just a few examples of a trend that GI-TOC research has highlighted for some time: that the surging illicit market for prescription drugs on the continent combined with the influx of highly potent synthetic opioids could become an overseen element within a potential European opioid crisis. Counterfeit drugs enter the market not through pharmacies, but through user-friendly online marketplaces with low barriers to entry, offering anonymous payment and delivery options. The vendors, some of which can be found on the surface web but mostly lurk on Telegram and the dark web, have become distribution hubs for pharmaceuticals in the region. As synthetic opioids are frequently disguised as other substances, this is especially worrying.

As documented in the 2025 Organized Crime Index, the trade in counterfeit goods in Europe has expanded in recent years. However, the dynamics of trafficking medical products are poorly understood. Pharmaceutical products, whether genuine or counterfeit, reach the illicit market in several ways. Legitimate pharmaceutical-grade medicines are diverted from pharmacies and other legal supply chains to be sold on the black market.

In the case of counterfeit medicines, some replicate legitimate drugs and contain the declared active ingredient, although often with an altered dosage, increasing the danger of overdose. Others are falsified, with producers substituting the declared ingredient for entirely different substances, such as synthetic opioids or other novel psychoactive compounds. Being counterfeit, there is no regulatory compliance or quality control. These fake products may be visually indistinguishable from licensed medicines, yet carry a dramatically increased risk of overdose and poisoning.

Blurring the lines between the pharmacy and street markets

When it comes to the physical drug trade, there is generally a distinction between street drugs, such as heroin, cocaine or MDMA, and pharmaceutical drugs, such as tranquillizers and painkillers. The demand for prescription drugs sold by street dealers is usually met by authentic products diverted from pharmacies through over-prescription, or falsified or stolen prescriptions. In Hamburg, for example, street dealers sell painkillers such as Tilidine and pharmaceutical-grade fentanyl patches, but counterfeit pharmaceuticals are uncommon.

On online marketplaces, however, the picture is rather different. Illegal drugs are sold alongside fake pharmaceuticals and diverted medicines. On Telegram channels, listings offer cocaine, MDMA and amphetamines alongside Xanax, Ozempic, ketamine, Viagra and tramadol. These products are often advertised as legitimate, although users have few means of verifying their composition or origin.

In addition, online retailers on the surface web often exploit legal grey areas by marketing substances as ‘research chemicals’. These products are usually minor chemical variants of controlled drugs, and are sold with disclaimers such as ‘not for human consumption’ in order to skirt regulations. In November 2025, Funcaps, an online retailer, was investigated for its links to almost 50 deaths in the Netherlands. Although the website was taken down, evidence suggests that other similar surface‑web vendors are still operating within Europe.

Behind the boom

Users turn to unregulated online platforms for a variety of reasons. Above all, they do so either to access cheap prescription drugs without seeking medical advice or because access to certain products is severely limited, such as with ketamine or weight-loss medicines. In this uncontrolled market, self-medication goes hand in hand with recreational motivations. Organized crime networks have learned to exploit this dual demand, creating an illicit ecosystem that thrives on changing consumption patterns.

On both fronts, this growing trade poses a serious health risk in Europe. While authorities and services responsible for harm reduction, treatment and prevention can reach drug users in traditional settings, doing so in online markets is challenging. Consequently, those who purchase drugs in these online spaces are essentially on their own, with limited access to support networks. Even more critically, the consequences of taking synthetic opioids can be devastating, as indicated by overdose and death rates.

Forward-looking organized crime and outdated legal structures

The shifting illicit pharmaceutical market has given rise to a new form of transnational organized crime. Digitized supply chains connect countries such as China, India and Pakistan – repeatedly identified by European authorities as key source markets – with mid-level sellers in Europe through the dark web. Perhaps surprisingly, transcontinental postal and private courier companies form the almost uncontrollable backbone of this market, as the sheer size of this industry makes detection extremely difficult.

Law enforcement has yet to catch up with these digital developments. European legislation differentiates between illicit drugs, which fall under traditional drug laws, and medicines, which are subject to pharmaceutical regulations. At the same time, the mandates of law enforcement agencies to counter drug supply and of customs agencies to control transborder trade overlap and are not always clearly defined. Hybrid online markets selling both street drugs and pharmaceutical products operate within different legal and operational systems, and these gaps are ripe for exploitation by organized crime.

Furthermore, many European countries lack the expertise and resources to control the illicit market for medicines, in contrast to their substantial capacity for traditional drug control. The transnational criminal actors behind this new trade are not conventional cartels or mafias, but low-profile, digital networks that evade traditional anti-trafficking approaches. These groups are capitalizing on the fact that the division between street and pharmacy no longer reflects market realities. Europe has yet to define its response to this new form of organized crime, which poses a significant threat to public health.