Nearly all of the world’s 35,000 online pharmacies are being run illegally and consumers who use them risk getting ineffective or dangerous drugs, according to the U.S. Trade Representative’s annual report on “ notorious markets.

The U.S. Trade Representative’s annual report on “ notorious markets” also singled out 19 countries over concerns about counterfeit or pirated products.

Ninety-six percent of online pharmacies were found to violate the law, meaning they were operating without a license and selling medications without prescriptions.