PUERTO VALLARTA, Mexico — 

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.

When confronted about the counterfeits, pharmacy workers often blamed suppliers, whose names they said they didn’t know or couldn’t remember. Others denied ever selling medications they had in fact sold just minutes or hours earlier.

Last month, reporters visited dozens of drugstores in Mexico to interview pharmacy workers and piece together a fuller picture of the counterfeit medication problem The Times has been investigating for nearly a year.

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.”

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After visiting 10 vacation spots and border towns across Mexico this year, reporters used drug-testing strips and later lab testingto 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.

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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.”

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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.”

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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.”

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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.

PUERTO VALLARTA, Mexico — 

As a shortage of Adderall stretches into its second year, millions of patients are still struggling to fill their prescriptions in U.S. pharmacies. But in Mexico, some pharmacies are selling the pricey orange pills over the counter, in sealed bottles bearing the names and logos of well-known pharmaceutical companies.

One problem: They’re not real. Some are counterfeits made of methamphetamine, while others contain appetite suppressants, acetaminophen or caffeine.

Ten months after the Los Angeles Times sounded the alarm about methamphetamine-tainted Adderall appearing in Mexican pharmacies, a follow-up investigation shows the problem is more sophisticated than previously known.

A new round of testing in Cabo San Lucas and Puerto Vallarta found that counterfeiters in both beachfront cities are now passing off a wider array of substances as attention deficit/hyperactivity disorder medications and selling the pills not only as Adderall but sometimes as a similar medication called Vyvanse.

And, instead of just selling loose tablets one at a time, dozens of drug stores are offering painstakingly counterfeited bottles, complete with drug identification codes, lot numbers and sometimes even holographic anti-tamper seals. In some cases, identical bottles were found in multiple stores or regional chains.

“It’s really bad to find out that pharmacies are selling whole bottles of fake medication, and clearly an effort has been made to make them look legitimate,” said Chelsea Shover, a UCLA researcher who published a study on counterfeit medications in Mexico earlier this year.

“There was some sense before that maybe the problem was largely confined to single pills, but clearly that’s not the case,” Shover said. “It sounds like the problem of counterfeit medications is a lot more widespread than we would have thought.”

Healthcare providers called the shift “very concerning,” and drug market experts said the sophistication of the faux bottles points to the involvement of large criminal organizations.

“This is clearly escalating, increasing the quality of the fakes,” said Vanda Felbab-Brown, a senior fellow at the Brookings Institution who studies organized crime. “That also suggests a systematic component — like the cartels. You wouldn’t have this consistency in the packaging if you didn’t have a big actor behind it.”

Drug regulators in Mexico did not respond to requests for comment, although in recent months officials have cracked down with raids and seizures in multiple cities.

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Pharmacies in Mexico have long been known for selling a wide range of medications over the counter, many of which, in the United States, either require a prescription or are simply not available. But the official list of substances that can be legally prescribed in Mexico does not include Adderall — which makes it a prime target for counterfeiters catering to American travelers who can no longer get their medication at home.

The Times first began investigating counterfeit medications in January, when reporters traveled to Tijuana and Los Cabos and purchased loose pills over the counter from several brick-and-mortar drugstores.

They found some of the pills sold as opioid painkillers were actually fentanyl, and all of the pills sold as Adderall were actually methamphetamine. Overall, the Times investigation found that 71% of the 17 pills tested came up positive for more powerful drugs. So reporters expanded the investigation to other border towns and tourist destinations, using at-home testing strips followed by confirmatory lab tests to determine the pills’ contents.

By June, the Times team had bought and tested more than 50 pills from 29 pharmacies in eight cities, finding counterfeits for sale in stores from coast to coast, mostly in areas that attract travelers. While more than a third of the painkillers tested were fake, an even higher fraction — roughly 80% — of the pills sold as Adderall were counterfeit.

During initial rounds of testing in the first half of the year, most of the 15 Adderall samples purchased were sold over the counter as single pills. Many bore a strong resemblance to the orange, circular tablets commonly sold as Adderall in U.S. pharmacies, though a few came in large capsules typically used for antibiotics.

Twelve of the pills tested positive for substances that are not found in legitimate Adderall, including methamphetamine, caffeine, acetaminophen and MDMA — more commonly known as ecstasy.

Following the investigation, authorities in Mexico raided pharmacies in several areas where reporters and researchers had documented the problem. Government agents shut down dozens of pharmacies in the Yucatán Peninsula and Los Cabos over the spring and summer. Then in late November, authorities shuttered 31 stores in Ensenada, a Baja California port city roughly 50 miles south of Tijuana.

But this fall, a follow-up investigation by The Times at two of the tourist hotspots reporters visited previously found that pharmacies were still selling counterfeit medications. In Puerto Vallarta and Cabo San Lucas, none of the 15 pills sold as Adderall in November contained either of the medication’s active ingredients, dextroamphetamine and amphetamine.

Instead, 13 contained methamphetamine — a drug that is closely related, but stronger. Some of the orange pills also contained other drugs such as acetaminophen or caffeine. In two cases, the alleged Adderall instead came in green capsules that contained clobenzorex, a weaker stimulant sold in Mexico as an appetite suppressant.

Though some stores offered the pills individually, most sold them in sealed bottles. In Cabo San Lucas, the bottles varied in appearance from one store to the next. They all bore the names of major pharmaceutical companies — though often there were spelling, printing or translation errors, telltale signs of counterfeiting.

In Puerto Vallarta, several stores and at least two regional chains offered identical bottles: wider ones bearing a Teva Pharmaceutical Industries label, and taller ones with a Sun Pharmaceutical Industries label. The bottles typically had expiration dates, lot numbers, bar codes and drug identification numbers.

But the most elaborate counterfeit was a bottle of fake Vyvanse sold in Puerto Vallarta. Unlike Adderall, the medication has been legally available by prescription in Mexico — and last year health officials there put out a vague warning about counterfeit versions appearing on the market. Crucially, the warning did not say what the counterfeit pills actually contained.

When reporters visited a small chain called Súper Farmacias del Pueblo, one worker offered up a bottle of Vyvanse bearing the brand name Shire Pharmaceuticals for a little over $200. There were no obvious mistakes on the sealed bottle or the Spanish-language informational material that came with it.

And both items were enclosed in a neatly printed box with tamper-proof holographic stickers at the edges. The only red flag was the capsules themselves. Like regular 50-milligram Vyvanse, they were half-blue and half-white — but they didn’t have the “S489” and “50mg” imprints that appear on the legitimate medication.

Takeda Pharmaceutical Company, which acquired Shire in 2019, said it has not sold Vyvanse in Mexico since 2021 and confirmed the lot number on the box was “not one associated” with the legitimate Takeda medication. The company said it could not comment on the rest of the packaging.

In response to questions from The Times, a Súper Farmacias del Pueblo representative said the chain planned to do an audit of its stores to make sure none of them were selling products not included in its catalog. In a follow-up message, the representative went on to accuse two other chains of selling unapproved medications.

Of the other drugmakers whose products were counterfeited, one — Sun Pharmaceuticals — did not offer comment. Teva confirmed that the company does not sell Adderall in Mexico and said it reported the suspicious pill bottles to health authorities there.

“Based on our review of these images, we believe that the pictured bottles are counterfeit and not produced by or on behalf of Teva,” spokesperson Yonatan Beker wrote in an email to The Times. “Teva takes counterfeiting of its products very seriously.”

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Tucked between massage parlors and bars on the curvy, sun-speckled roads of Cabo San Lucas and dotted along the hilly, bougainvillea-lined streets of Puerto Vallarta are dozens of drug stores that also take counterfeiting very seriously — or at least that’s what their workers say.

When reporters visited in November, clerks at several pharmacies stressed that their medications came from legitimate suppliers whose names they had forgotten. One said the pills came directly from a laboratory.

Pharmacies in both cities sold Adderall to one reporter and then denied carrying the illegal product just minutes later when a second set of reporters showed up with questions. At one drug store steps from the yacht-filled marina in Cabo San Lucas, a woman working behind the counter warned two reporters about fake ADHD pills at other stores in the area.

“In Mexico, they don’t make Adderall,” said the woman, who did not give her name. American buyers, she continued, should “be careful” when purchasing narcotics, even in bottles.

“You can tell from the presentation of the box or the bottle, you can tell that it’s not real,” she said. “Or we can tell, because they’re Mexican brands. But you all [tourists] — how are you going to tell?”

That warning came hours after another reporter purchased Adderall from that same pharmacy, where a different worker had asserted the pill was safe because it had come directly from California. Lab testing later showed it contained acetaminophen and methamphetamine.

Though unwittingly taking a methamphetamine pill may not necessarily carry the same immediate risk of death as accidentally consuming fentanyl, drug experts say there are still significant concerns — such as failing a drug test, accidentally running afoul of the law or having unanticipated effects.

“Meth is a stronger stimulant than Adderall, and that can mean it lasts longer or has more pronounced effects than what some would be expecting,” said Shover, the UCLA researcher. “Crucially, with the chronic use of meth there are long-term cardiovascular issues.”

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It is difficult to know how much the recent scarcity of ADHD medication in the U.S. has pushed people toward methamphetamine-tainted prescriptions in Mexico, although drug experts say it’s a foreseeable outcome.

“Cutting off prescriptions gets more people using meth,” said Dr. Ryan Marino, a toxicology expert at Case Western Reserve University School of Medicine. “Making more things inaccessible increases the revenue to cartels. It’s predictable.”

When the FDA acknowledged an Adderall shortage in October 2022, federal officials blamed it on “manufacturing delays” at Teva, one of the major suppliers of the drug. Eventually, the shortage spread to other companies and to other stimulant medications, including Ritalin and Vyvanse.

The U.S. Drug Enforcement Administration sets annual quotas limiting the amount of raw materials each company can have to make certain controlled drugs. According to the agency, pharmaceutical companies weren’t making as many doses of ADHD medications as they could. But several drugmakers said they were — and that they’d even asked the DEA for permission to make more.

“At the end of the day, the fact that this shortage lasted so long without any intervention, that falls on the DEA,” Marino said. “They’re the ones that had the power to change that — especially when other companies were offering to step up and increase their manufacturing.”

The DEA did not respond to a request for comment.

This year, at least one company — Ascent Pharmaceuticals — took the matter to court, filing a motion accusing the DEA of slow-walking and then denying its request to get the raw materials for making a variety of ADHD medications. The agency responded with filings accusing Ascent of major record-keeping violations that officials said justified denying the application altogether. The case is ongoing.

After nearly a year of complaints from increasingly desperate patients and the elected officials who represent them, in August the FDA and DEA addressed the shortage publicly by releasing an open letter to pharmaceutical companies, asking them to increase their production of stimulant ADHD medications.

A few months later, federal officials announced changes that could prevent similar medication shortages in the future and said 17 of the drug companies that produce ADHD medications have agreed to increase their output.

Now, several drug experts and healthcare providers said, the shortage appears to be waning.

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Despite the concerning presence of fake medication in Mexico, not all stimulants appear to be affected. In several Mexican cities, about half a dozen samples of methylphenidate — commonly known in the U.S. by the brand names Ritalin and Concerta — did not reveal abnormalities.

That could be because the medication is readily available in Mexico through legal means, or simply because it comes in harder-to-fake blister packs.

And over the summer, lab testing on a small number of Adderall samples reporters collected from pharmacies in Tijuana found the pills contained the same ingredients as legitimate Adderall. Drug experts said that could mean the medications were smuggled from the U.S., where they are legally available by prescription.

Still, to healthcare providers, the specter of drug stores selling methamphetamine-tainted medications is deeply concerning. Millions of children and adults are prescribed stimulants for either ADHD or narcolepsy, and shortages can derail their academic and professional careers.

“ADHD can also coexist with depression and anxiety, and the more severe cases can cause depression and anxiety,” said Linda Yoon, a licensed clinical social worker in Los Angeles who helps people manage ADHD. “I have definitely had clients who cannot get out of bed without their ADHD medication.”

If the shortage continues to ebb in the coming months, there may be less incentive for desperate patients to buy pills abroad — but some cartel and drug market experts are still concerned about what the future holds.

“One of the things that worries me is at what point criminal organizations will start putting pressure on legitimate industries,” said Felbab-Brown, pointing to her prior work examining the infiltration of criminal organizations into Mexico’s fishing industry.

“Are we going to have systematic pressure on the pharmaceutical industry and the packaging industry? It’s extraordinary what they’re doing now, and the public health dangers are clearly enormous.”