It has been widely suggested that the global market in counterfeit, falsified and illegally traded medicines has expanded at a tremendous rate in recent years, offering lucrative opportunities for criminal entrepreneurs with little legal risk. However, with a few exceptions, there has been little criminological research conducted on the trade’s actors and organisation. Of the few studies that are available, most position the supply of these products in the context of ‘transnational organised crime’, often presupposing the overwhelming presence of large-scale, hierarchical structures in the trade. This article, based on two extensive research projects in the United Kingdom and the Netherlands, offers an account of the illicit supply of medicines in two European jurisdictions. The research outlines the nature and dynamics of the trade including the roles played by each national context as nodes in the global supply chain. The focus then shifts to the modus operandi, actors, online trade and social organisation in both countries. In contradistinction to the ‘transnational organised crime’ narrative, the empirical data outlined in this paper demonstrates that actors and networks involved in the trade are highly flexible and complex structures that straddle the categories of licit and illicit, online and offline, and global and local. This suggests that operations supplying illicit medicines vary largely in terms of size, reach, organisation and legality.