A survey of emergency contraceptives in Lima, Peru, turned up worrying results: More than a quarter were either counterfeit or defective.
Some of the morning-after pills tested contained too little of the active ingredient, or none at all. Other pills contained another drug altogether, researchers reported Friday in the journal PLOS ONE.
Swallowing these fakes can result in dangerous side effects, not to mention unwanted pregnancies.
"The biggest implication is the quality of emergency contraceptives in developing countries cannot be taken for granted," says Facundo Fernandez, a chemist at the Georgia Institute of Technology, who contributed to the study.
Fake and shoddy drugs of all kinds are a growing problem around the world. But developing countries, with limited resources to regulate medications, are especially vulnerable to counterfeiters.
Malaria medications are among the most popular drugs to fake. Counterfeit abortion pills are also a rising issue in poor countries.
"But developed countries are not immune," Fernandez tells Shots. Phony cancer medications have turned up in the U.S. And last year the federal government cracked down on websites peddling counterfeit medications.
Reports of faulty emergency contraceptives are common globally. The World Health Organization has found fakes circulating in Nigeria, Kenya, Angola and Ghana. And in 2011, the Food and Drug Administration warned Americans about counterfeit morning-after pills marketed under the brand name Evital.
"It is very worrying," Fernandez says, especially because health officials don't know how widespread the problem is.
To start figuring that out, Fernandez and his colleagues examined pills from 20 different brands, which they collected from 15 pharmacies across Lima.
Most of the shoddy contraceptives didn't have enough of the active ingredient, levonorgestrel. Others didn't dissolve properly.
But the pills with the wrong active ingredient were especially dangerous, Fernandez says. They found that one type of fake contained an antibiotic that could cause bad reactions, like a rash or other skin condition, in some people.
"In my ideal world, the consumer would have a cellphone app that they can use to check the medicine," he says. But that sort of technology doesn't exist yet — at least not for the general public.
The FDA has developed a hand-held device that uses ultraviolet light to scan for counterfeit drugs. Fernandez is developing a similar device to scan batches of pills and ensure they contain the right chemicals.
Many counterfeits are sophisticated, Fernandez says. So consumers can't easily distinguish the fakes from the real deal. But they should be wary of discounted medicines and drugs sold online.
"If you travel to countries where you can't know the quality of the drugs," he says, "take your medicines with you."