The U.S. Trade Representative's annual report highlights that nearly all of the world's 35,000 online pharmacies are illegal, with 96% violating laws. Consumers face serious risks, including counterfeit or dangerous drugs. The report identifies specific countries and online retailers engaged in such illicit activities, referring to a startling survey indicating that almost one in four Americans using online pharmacies encounter substandard products. Authorities are taking steps to combat online piracy and counterfeit goods globally, but significant challenges remain, particularly with foreign pharmacy operations and the sourcing of illegal substances.