Experts at a regional meeting this week said Eastern Europe is a key route in a multi-billion-dollar trade in dangerous counterfeit medicines that has grown exponentially on the Internet.
More than 120 anti-counterfeit specialists from six Eastern European countries met in Romania on Wednesday and Thursday to step up the fight against a risky business estimated to be 75 billion dollars (54 billion euros) worldwide in 2010.
"There is an important Balkan route for fake medicines, which is the same as for heroin and other narcotics," Hungarian customs officer Karolyi Szep told AFP at the meeting called by the world's leading pharmaceutical company Pfizer.
Such drugs can contain no active ingredients at all or 8,000 times the required amount, or heavy metals such as arsenic, lead-based paint, brick dust or floor wax -- content that poses major health risks and can lead to death.
Today most of the sales are done via the Internet, which has multiplied the trade -- and the risks -- exponentially.
According to the World Health Organisation, one in two medicines sold online are fake.
"People who buy medicines on the Internet are playing Russian roulette with their own lives," Steve Allen, senior director of Pfizer Global Security, told AFP.
Allen said 63 million fake Pfizer tablets, vials and capsules as well as enough active ingredient to manufacture an additional 64 million have been seized worldwide since 2004.
"But this is just the tip of the iceberg," he warned.
"Fighting back counterfeiters can't be done by one country or by one organisation, it calls for a synergy of efforts," he said. "We are dealing with organised crime gangs, there is no doubt about it."
Considered a low-risk and high-reward business, counterfeit medicines have become increasingly alluring to narcotics smugglers.
"Supply techniques are identical, but the punishment is not," Allen said, stressing that in certain countries manufacturing or selling fake medicines is not considered a crime.
In one case of narcotics and fake medicines going hand in hand, Turkish police seized 6,000 counterfeit Viagra pills smuggled with 378,000 ecstasy tablets and enough ingredients to manufacture 51 kilogrammes (110 pounds) of heroin.
The Bucharest meeting brought together representatives of Romania, the Czech Republic, Hungary, Poland, Slovakia and Ukraine.
The former Soviet bloc has made important progress in recent years in fighting counterfeit medicines, said Gabriel Turcu, a senior partner in leading European anti-counterfeiting network REACT.
Most countries in the region have toughened legislation and some are even setting an example for their Western neighbours. In Romania, fake drugs smugglers have for the first time been sentenced to prison this year.
"Years ago, judges would deem counterfeiting T-shirts or medicines was the same. Now their perception has changed," Turcu said.
But he stressed that "the countries lying on the European Union's Eastern border are facing major challenges when it comes to fake goods smuggling."
The developed countries are hardly safer.
"What is most alarming is that counterfeit medicines have been detected in the legitimate supply chains in 45 countries, including the US, the United Kingdom and Canada," Pfizer Global Security strategy director Rubie Mages said.
Calling for increased public awareness, experts and law enforcement authorities stressed that deaths caused by fake medicines are often attributed to natural causes.
"This scourge cannot be fought pill by pill," Turcu said, adding that medicines can be smuggled quite easily and often go unnoticed in a bag.
After 25 years in the field, Karolyi Szep, the customs officer, has developed a knack for spotting counterfeiting and is training younger customs officers in "human and car behaviour", giving them tips as to what makes a person, or a vehicle, look suspicious.
He cites the case of a smuggler who was uncovered when he could not bend to pick up his passport, which had been purposefully dropped by an officer: he was wearing a belt filled with counterfeit medicines.