The tag on her white lab coat read “professional pharmacist,” and the framed health and safety certificates lining the walls behind her gave the drugstore an air of legitimacy.
That pretense faded seconds later, when she was asked for controlled medications — and got on her hands and knees to pop open a hidden panel under the counter. She rooted around for a minute and emerged with two sealed bottles.
“These are from licensed laboratories,” she said. “The problem is when you’re buying from a laboratory that’s not certified.”
One of those bottles — sold as Adderall — tested positive for methamphetamine.
In pharmacy after pharmacy in this Mexican resort city, workers offered similar assurances, but time and again the pills proved to be fakes. There were oxycodone pills that tested positive for heroin and over-the-counter cough medicine, and Vicodin tablets that turned out to be fentanyl. Pills sold as Adderall were sometimes methamphetamine or caffeine, and sometimes simply an appetite suppressant.
The image that emerged is one of a troubling practice that seems remarkably resistant to change.
Despite pharmacy raids by Mexican authorities and a warning from the U.S. State Department, the latest round of testing found that fake medications appear even more plentiful at independent drugstores and regional chains in tourist hot spots and border towns now than earlier this year.
Some of the counterfeits are now more sophisticated, and lab testing found a wider array of substances in them than previously documented. And the latest reporting in Puerto Vallarta and Cabo San Lucas found that workers at small chains and individual pharmacies alike often went to great lengths to convince potential customers of the safety and efficacy of their counterfeit wares.
The Times is not naming independent pharmacies or workers due to safety concerns, including the threat of violence.
Dr. David Goodman-Meza, a UCLA assistant professor who studies drug use, said the results of The Times’ investigation show a much larger problem than was initially apparent.
“This is a systematic effort to taint the supply,” he said. “It involves many levels, and the endpoint is the pharmacy. There’s likely other players making and distributing these counterfeit products — we just don’t know who those players are.”
After visiting 10 vacation spots and border towns across Mexico this year, reporters used drug-testing strips and later lab testing to show that travelers who shop at pharmacies there risk unwittingly buying pills tainted with powerful drugs, including fentanyl, heroin, meth and MDMA — also known as ecstasy.
In February, The Times reported that some drugstores in Tijuana and the Los Cabos area were selling loose pills over the counter, passing off tablets containing fentanyl and meth as expensive brand-name medications, including Percocet and Adderall.
A team of UCLA researchers, including Goodman-Meza, reported similar findings in four unnamed cities in northwestern Mexico around the same time.
But U.S. authorities didn’t take public steps to address the issue until March, after The Times reported that both the Drug Enforcement Administration and the State Department had known for years that U.S. travelers were dying after purchasing counterfeit pills containing fentanyl from Mexican pharmacies.
The State Department issued a travel advisory later that month, warning Americans to “exercise caution” when buying medications from pharmacies south of the border.
After several more trips to Mexico, The Times published an investigation in June that documented the presence of counterfeit medications at drugstores in cities from the Yucatán Peninsula in southeastern Mexico to the Pacific coast to the country’s northern border.
Later, reporters showed that several stores and at least a few regional chains had begun selling tainted medications by the bottle, in elaborate packaging that was sometimes indistinguishable from the real thing.
Of the 114 narcotic medications purchased over the course of the year, 62% were fake. Just over 71% of the stimulant medications used to treat attention deficit/hyperactivity disorder — such as Adderall and Vyvanse — were counterfeit, as were nearly 61% of the supposed opioid painkillers.
A few medications were consistently legitimate, including the opioid painkiller tramadol and the ADHD pill methylphenidate, best known as Ritalin. But some medications were almost always counterfeit.
Testing showed that 9 in 10 pills sold as Adderall, six in 10 pills sold as oxycodone, and 7 in 10 pills sold as hydrocodone were fake. Overall, 26 samples contained methamphetamine and 29 contained fentanyl.
In March, authorities in Mexico inspected more than 100 pharmacies in Los Cabos and nearby La Paz, closing nine in Los Cabos for a variety of violations. In June, another series of pharmacy raids in Los Cabos resulted in four arrests and the seizure of cash and nearly 25,000 pills.
One worker said that during the second round of sweeps, authorities came to his Cabo pharmacy “looking for loose pills.” The officials also reviewed financial records, and ultimately decided the store passed inspection.
“Everything we have, we have permission and invoices from where we bought them,” the worker said in November. “Everything comes from a laboratory. Everything is safe here; that’s why we’re still operating.”
But less than 24 hours earlier, the same store had sold three loose pills — purported to be Percocet, Vicodin and Adderall — and one bottle labeled as Adderall. Laboratory testing showed both painkillers were fentanyl, the tablet sold as Adderall was methamphetamine, and the bottle of supposed Adderall contained capsules of an appetite suppressant called clobenzorex.
The news reports and resulting law enforcement activity “caused a lot of problems” for the families of closed drugstores’ owners and employees, according to one worker at another Cabo pharmacy.
“All you’re doing is affecting tourism,” she said the day after selling reporters one bottle that was labeled “oxycodone and acetaminophen” but contained guaifenesin — a cold medication — and another that was labeled as Adderall but contained clobenzorex.
Two months after the Los Cabos arrests, federal health officials in Mexico announced that authorities had closed 23 pharmacies in the Yucatán Peninsula after finding potential counterfeit medications and other irregularities during a series of raids.
Finally, authorities shut down 31 pharmacies and seized more than 4,681 boxes of medication during recent raids in Ensenada, where officials said some of the pills probably contained fentanyl.
At a Puerto Vallarta pharmacy near bustling Playa de los Muertos last month, a clerk said she had no controlled substances for sale before offering a warning.
“In no place in Puerto Vallarta are they going to sell you actual Adderall,” she said. “Be very careful in what you buy.”
It’s unclear why raids have failed to curb these illicit activities. But several pharmacy workers said authorities didn’t confiscate any of their pills or take away samples for testing. Others said they stopped offering controlled medications immediately after the sweeps, but soon resumed sales.
Workers at two chain drugstores in Cabo San Lucas that sold reporters counterfeit pills said authorities hadn’t inspected them at all in 2023.
At several drugstores in Puerto Vallarta’s lively tourist districts, employees said in November that pharmacies there had been raided a few months earlier. The Times could not independently verify their claims, and officials did not respond to requests for comment.
At a small drugstore on one of the city’s main streets, an employee working the register said drug regulators had searched the store — even inspecting the bathroom and going through employees’ bags. But they didn’t find anything worth confiscating.
There were no opioid painkillers in stock, but reporters bought a bottle of supposed Adderall. The drug had been unavailable for about two months after the raids “all because of fentanyl,” the worker said.
“We weren’t selling any medication like this because they were checking,” she said, referring to the authorities who carried out the raids. “They don’t want us selling fentanyl or oxycodone or things like that.”
The alleged Adderall tested positive for methamphetamine.
Aside from the glut of willing sellers and suppliers, another roadblock to reining in the sale of counterfeit pills in Mexico is the constant demand — often from Americans looking for medications that may be cheaper or easier to get than in the U.S., where opioid painkillers are tightly controlled and ADHD medications are scarce due to a years-long shortage. In recent months, several people prescribed ADHD drugs told The Times they’d purchased or considered purchasing their medications in Mexico.
One of those was Andrés Muñoz. Earlier this year, he took a few days off from his consulting job in Chicago for a family trip to Cancún. Muñoz was 30 and in Mexico for the first time, and he decided to stop in at a drugstore for ibuprofen.
He had recently been prescribed Adderall in the U.S., and was surprised to see that the drug was available without a prescription. He said he almost bought at least one $200 bottle of the pills, even though he knew that fentanyl-tainted counterfeits were a concern in Mexico.
“Honestly, I didn’t even consider the dangers of it,” Muñoz said, adding that uneven access to affordable, quality health insurance leaves many Americans with few good options. “So of course you’re gonna go try to find a solution. The system we have in place doesn’t offer a solution.”
Shopping for narcotic medications in pharmacies in Mexico often means listening to workers explain that bottles stashed in hidden compartments and loose pills kept in unlabeled plastic bags contain legitimate medications.
At one pharmacy in Cabo San Lucas, a worker warned that “a lot of people sell fake medication” — and even offered reporters advice on how to spot it.
“Those are real,” she said, pointing to a box of medication with a code on the side. “If they don’t have that number, they’re not.”
But the painkillers purchased from that pharmacy tested positive for fentanyl, and the supposed ADHD medications were made of methamphetamine.
At a Puerto Vallarta outpost of a drugstore chain that sold reporters fake medications, Ed Sheeran was crooning through tinny speakers about having faith in what he sees.
The clerk claimed the pharmacy did not stock counterfeit pills. But the worker said some stores in another regional pharmacy chain had been “making irregular medications that had fentanyl” and selling them to unsuspecting travelers.
On two separate trips to Puerto Vallarta, reporters visited several stores in that same regional chain, and repeatedly purchased pills sold as Adderall that tested positive for methamphetamine.
One of those purchases was the bottle the “professional pharmacist” had pulled out of a secret panel behind the counter. Another was a bottle that a young worker pulled from a locked hiding spot.
She said the medication was hidden from view for safekeeping because it was pricey — $300 per bottle.
“We can’t have expensive medications out like that,” she said. “We mostly sell sunblock.”
The chain did not respond to requests for comment.
In addition to concealing illicit wares and offering empty assurances about safety, pharmacy workers seemed choosy about their customers.
Several residents said the stores would sell narcotic medications over the counter only to foreign tourists. At one drugstore, when a reporter started speaking Spanish, the clerk grew suspicious.
At a Puerto Vallarta location of the prominent national chain Farmacias Similares, a worker said only customers with prescriptions could buy controlled medications. Other pharmacies, she said, would sell them without a prescription — depending on who you are.
“If I go, as a Mexican, and I ask them, they’re not going to tell me” whether they have the medications, she said. “Because it’s not something they’re supposed to [sell]. Only to foreigners.”
Organized crime experts say that Mexican drug cartels are almost certainly involved in making the sophisticated counterfeit medications. But it is unclear exactly how the pills end up on pharmacy shelves or in hidden compartments behind the counter.
Vanda Felbab-Brown, a senior fellow at the Brookings Institution who studies criminal organizations, told The Times earlier this year that the tainted pills “must be coming from the Mexican criminal groups.” But she said it was unclear whether the pharmacy owners were seeking out the fake medications or selling them under threat of violence.
“It would be fascinating to know whether they have any clue what they’re selling,” she said.
The Times’ recent reporting found that many store workers know there are fentanyl-tainted fakes on the market, and that some drugstores sell them. As one worker at a pharmacy that would not sell controlled medication without a prescription put it: “Where else are you going to get that medication that easily?”
When asked about the source of their medications, some workers shifted blame to the stores’ owners.
“Our boss gives them to us,” said a clerk at a pharmacy in Cabo. “They come from laboratories — you should focus on them.”
But when asked for contact information for the store’s distributor, the worker said that was “private.”
At another drugstore, an employee said she couldn’t remember the name of the store’s supplier, but that it was a big distributor in Guadalajara. Workers at other stores suggested their pills came from California, but also could not name a supplier.
This month, after getting back results from lab testing, reporters called and messaged more than a dozen pharmacies they’d visited in November. Most did not respond to repeated messages inquiring about the counterfeit goods or the suppliers who provided them.
One worker who did respond said he knew the Cabo pharmacy where he worked did not sell opioid painkillers because he was one of only two people who worked there. When a reporter explained that the store had sold fentanyl-tainted pills weeks earlier, his tone shifted.
“Perhaps you have the pharmacy confused,” he said.
Instead of denial, some responded with fear. A few weeks after selling reporters fentanyl- and methamphetamine-laced pills, a worker at a different pharmacy in Cabo refused to answer questions about such a “delicate topic.”
He said he was embarrassed and wouldn’t disclose where the drugs came from.
“I can’t give you any information,” he said in a telephone interview. “It’s scary to even talk about these kinds of things.”
When asked what he was scared of, he hung up.
