Think of it this way: If you have a small pill fab facility, how can you make extra cash? Would you buy expensive raw ingredients and make legit stuff with regulated distribution, or just use filler and copy the most expensive meds that are in high demand?
Bottles, cotton, labels and boxes are EASY to obtain. Any printer can create 'original' quality packaging. Some is so good that it can be placed in the commercial distribution channel and go undetected. <Anybody remember the GH fiasco? How about Viagra fakes? Both are common in NY, NJ, and IL right now.>
Occasionally the fakes are mixed with the real thing so that you get SOME reaction. But history tells us that the most expensive and difficult to get meds are usually all fakes or substituted with cheaper alternatives.
Same thing happens with injectables, and some sources will dilute them further for their own purposes.
Ya just NEVER know......