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As a shortage of Adderall stretches into its second year, millions of patients are still struggling to fill their prescriptions in U. 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. 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. 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. 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. 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. New testing by Times reporters has revealed that some pharmacies in cities across Mexico sell counterfeit medication tainted with fentanyl and methamphetamine. 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. 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. 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. 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. 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. Mexican authorities raided pharmacies in tourism hot spots, seizing medications and shuttering drug stores. The operation comes on the heels of a sweeping Times investigation. 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. 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. The company said it could not comment on the rest of the packaging. 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. 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. The drugstore closures in Ensenada come on the heels of a months-long investigation by The Times. 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. 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. Eventually, the shortage spread to other companies and to other stimulant medications, including Ritalin and Vyvanse. The U. Drug Enforcement Administration sets annual quotas limiting the amount of raw materials each company can have to make certain controlled drugs. 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. 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. 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. 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. 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. Before joining the Los Angeles Times in , she spent nearly seven years in Texas, first covering criminal justice for the Houston Chronicle and then covering prisons for the Marshall Project. Connor Sheets is an investigative and enterprise reporter at the Los Angeles Times. Previously, she wrote narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L. She joined The Times in De Los. Times Everywhere. For Subscribers. All Sections. About Us. B2B Publishing. Hot Property. Times Events. Times Store. Special Supplements. In November , some pharmacies in Puerto Vallarta were selling bottles of fake Adderall containing methamphetamine that were identical to this one that Times reporters purchased from a drug store in the coastal city in May Share via Close extra sharing options. Men stand in front of a mural in the tourist-friendly Zona Romantica district of Puerto Vallarta, Mexico. A woman walks past a pharmacy in Cabo San Lucas, Mexico. More to Read. Old newspaper boxes are being used to distribute the overdose reversal drug naxolone. Seedy discovery at U. Keri Blakinger. Connor Sheets. Brittny Mejia. More From the Los Angeles Times. California Navy identifies two aviators killed in crash near Mt. Rainier as California natives.

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