A network of illegal drug sellers based in the U.S., the Dominican Republic and India packaged potentially deadly synthetic opioids into pills disguised as common prescription drugs and sold millions of them through fake online drugstores, federal prosecutors said Monday.

At least nine people died of narcotics poisoning between August 2023 and June 2024 after consuming the counterfeit pills, according to an indictment unsealed in federal court in Manhattan.

The indictment charges that the leader of the enterprise, Francisco Alberto Lopez Reyes, orchestrated the scheme from the Dominican Republic, directing co-conspirators to set up dozens of online pharmacies that mimicked legitimate e-commerce sites. The sites lured customers into buying synthetic opioids — in some cases methamphetamine — disguised as prescription drugs such as Adderall, Xanax and oxycodone.

The counterfeit pills were sold to tens of thousands of Americans in all 50 states and to customers in Puerto Rico, Germany and Slovenia, U.S. Attorney Damian Williams said at a news conference announcing the indictment.

”The websites the defendants made and the pills they distributed looked very real,” he said. “But they were not.”

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Williams said 18 people including Lopez Reyes have been charged with crimes including participating in a narcotics trafficking conspiracy resulting in death. It was not clear whether Lopez Reyes had a lawyer who could comment. No attorney was listed in online court records.

Authorities said the fake pills were manufactured in New York using fentanyl smuggled from Mexico.

Members of the enterprise ran basement pill mills in the Bronx and Manhattan, where they used custom molds to press powdered narcotics into pills at rates of up to 100,000 pills every 12 hours, prosecutors said.

Law enforcement officers raided one pill mill in Manhattan on May 31, 2023, and seized more than 200,000 pills as well as bricks, bags and buckets filled with powdered narcotics, according to the indictment.

Prosecutors said that after the orders were delivered, the conspirators bombarded customers with calls and texts urging them to buy more drugs. One customer had to block 30 phone numbers to stop the aggressive marketing.

One victim, a 45-year-old Army National Guard veteran identified as Holly Holderbaum, purchased what she thought were oxycodone pills in February 2024, according to the indictment.

Holderbaum received the pills in the mail on Feb. 20 and died five days later with 46 of the counterfeit pills by her bedside, prosecutors said.

The pills were made of fentanyl and para-fluorofentanyl, an analog of fentanyl, and Holderman’s cause of death was acute fentanyl intoxication, prosecutors said.

Recent years have seen a surge in fentanyl deaths, including among children, across the U.S. The most recent figures from the federal Centers for Disease Control and Prevention estimate that more than 78,000 people died from overdoses involving synthetic opioids between June 2022 and June 2023, accounting for 92% of all opioid overdose deaths during that period.

Anne Milgram, the administrator of the federal Drug Enforcement Administration, who joined Williams at Monday’s news conference, called fentanyl “the most addictive and deadly drug threat that we have ever faced as a nation.”

“Fentanyl is cheap,” Milgram said. “It is easy to make, and even tiny amounts can be highly addictive and deadly.”

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