Fake pills, such as Xanax and painkillers, pose a deadly threat in Arizona, a group of law enforcement and pharmaceutical experts said on Thursday during a meeting with U.S. Sen. Martha McSally (R-AZ).

The experts included Maricopa County Sheriff Paul Penzone, Phoenix pharmacist Randle House and Arizona’s U.S. Drug Enforcement Administration special agent in charge Doug Coleman. They asked McSally for help controlling the drug supply chain in the state, the Arizona Republic reports

The prevalence of counterfeit pills has surged in recent years as more and more people have responded to surging drug costs by turning to foreign sources to get medication. Doctors’ increasing reluctance to prescribe painkillers in the wake of the opioid epidemic has also contributed to the scourge of fake medication, creating a void that drug cartels stepped into fill. The cartels traffic fake pain pills made with fentanyl, a cheaper, but deadlier synthetic opioid that has played a key role in rising overdose rates nationwide.

Counterfeit pills have been found in 48 states and killed people in 33, Shabbir Imber Safdar, executive director of The Partnership for Safe Medicines, told the Arizona Republic.

Other attendees of the meeting noted they’d encountered fake birth control, fake cancer drugs and fake Adderall, underscoring the sheer scope of the problem.

Among the possible fixes suggested by meeting attendees were the creation of a medical opioid card, similar to a medical marijuana card.

The U.S. Department of Health and Human Services has also announced that it is considering importing cheaper drugs from Canada, though that has also raised concerns that some of those drugs might not actually be from Canada and may prove to be counterfeit. 

McSally said that Congress is working to combat rising drug costs, and the Democratic-led House passed a bill in May to do just that, but McSally’s colleague, Senate Majority Leader Mitch McConnell (R-Ky) has refused to hold a vote on the bill.

McSally says she wants to lower drug and other healthcare costs, but she also voted to repeal the Affordable Care Act in 2017, infamously telling her colleagues that they needed to get the “fucking thing” done.

Her vote came despite the fact that people who get insurance through the ACA are “significantly more likely to get prescription medications than they were before,” and generally end up spending less of their own money for those drugs, according to a 2016 study from Health Affairs. 

Beyond her and her fellow Republicans’ attempts to undermine the ACA, they’ve taken no substantive action to address drug costs on the federal level. Meanwhile, drug makers kicked off 2019 by raising the prices on more than 1,000 medications by an average of 6.3%, meaning that the epidemic of fake pills is unlikely to go away anytime soon.