How's That Canadian Drug Thing Working Out?

About two decades ago, "common wisdom" dictated that the way to control drug prices in the US was to import the same drugs from Canada for a fraction of the price. The only problem with this strategy was... everything (1):

1) Most of the time, it is illegal.

2) You never know what you're getting. For example, although Canadian pharmacies "require" a prescription, some of them employ a "rent-a doc," who will ask you a few questions online, and then OK the prescription.(See Figure 1)

3) Canada has one-tenth the population of the US. If we imported every single drug from the entire country, it would make little difference in drug prices here.

4) There are serious questions about the quality of the re-imported drugs. For example:

Following is a recent press release from the Justice Department's, Western District of Pennsylvania, which announced the filing of criminal charges against Quantum Solutions, SRL (Canada), and three pharmacies in Western Pennsylvania that could reasonably be called "ethically challenged." It ain't pretty. 

"Three Canadian residents and their company have been charged by Information in Pittsburgh with conspiring to distribute wholesale quantities of misbranded prescription drugs made for the foreign market and money laundering, Acting United States Attorney Soo C. Song announced today."

Source: "Anatomy of a Fake Canadian Online Pharmacy." PharmacyChecker Blog

And, some details from the release include:

• "Quantum Solutions, SRL (hereafter, Quantum), [is] a company registered in Barbados with offices in the Vancouver, British Columbia area. Quantum purchased prescription drugs made for foreign markets and sold wholesale quantities to three pharmacists in Western Pennsylvania."
• "Quantum purchased the drugs from suppliers located in Turkey, Great Britain and other countries... [and] arranged for these misbranded drugs to be sent to a re-shipper in the United Kingdom."
• "The UK re-shipper was instructed to unpack the drugs, repack them in several small packages, put misleading labeling and shipping documentation on them ...in order to create the appearance to U.S. Customs and Border Protection that the drugs were health care products for the personal use ..."
• "Wholesale quantities of these misbranded drugs intended for use in foreign markets were purchased by three pharmacists in Western Pennsylvania. The wire transfers, checks and credit card payments from the pharmacists traveled from Western Pennsylvania to Canada and Barbados. None of the re-shippers were licensed in the United States to conduct this business. None of the prescription drugs met FDA approval because they were made and labeled for use outside of the United States. The information against Quantum seeks forfeiture of $4,235,000."
• "None of the prescription drugs met FDA approval because they were made and labeled for use outside of the United States."

Well, that doesn't sound so marvelous, does it? But the actual indictment is far worse.

But let's assume that you still want to take your chances to save some money. How do know which place to trust. It's slim picking. When you take a look at Canadian pharmacies that sell products in the US, some are OK, but most are not. The table below will at least give you a fighting chance should you decide to go North for your meds. 

Figure 1: How to spot phony Canadian pharmacies. Source: Pharmacy Check Blog. (3)

Even knowing this, it's not so easy. There a far more bad eggs than good ones up there (emphasis mine):

Of the more than 8,300 online pharmacies reviewed in July 2011 by the National Association of Boards of Pharmacy (NABP), which accredits online drugstores in addition to representing state pharmacy boards across the U.S., just over 3 percent appear to be sound. It considers the rest to be “rogue” operations.

Source: Consumer Reports, 2011. 

The FDA agrees:

"In recent years, however, FDA has seen growing evidence of efforts by increasingly well-organized counterfeiters, backed by increasingly sophisticated technologies and criminal operations, intent on profiting from drug counterfeiting at the expense of American patients."

Some particularly egregious examples of fraud, which resulted in harm to patients include:

• Samples of the life-saving drug cancer drug Avastin didn't even contain the drug. 
• Rat poison has been found in imported drugs. (Source: Interpol)
• Chemicals synthesized in China can be combined with fillers in India and then packaged in Mexico before arriving at a pharmacy in Canada. Source: Newsweek

Of course, there are the dissenters— those who are convinced that this is no more than propaganda that is being put out there by the pharmaceutical industry. 

"It is evident that Canadian prescription medications are safe based on the actions of the very government that won’t legalize them." (huh???) 

Source: "Why the FDA is against Canadian imports — separating myth from reality" -  eDrugSearch

"In other words, the research doesn’t suggest that Canada’s drug supply is particularly problematic.

Source: Julia Belluz, writing in Vox

"For almost 15 years big drug companies have vigorously lobbied Congress and the federal government to stop Americans from buying foreign medicines. As part of that lobbying, they have made it seem as if all medications purchased from Canada and other international sources are the same as those that come from websites that sell counterfeit drugs."

Gabrial Levitt (Vice president of PharmacyChecker.com) writing in the New York Times. 

I guess they are all entitled to their opinion. Which may very well change if they end up with a vial of phony Avastin.

Note:

(1) If you're going to comment that I'm a shill for the pharmaceutical industry because I wrote this, save your breath. Not only does this display an appalling lack of originality, but it's also dead wrong, and I will just make you look stupid. 

(2) It would be really nice if the Ottawa Senators stopped beating up on the Rangers.

(3) Thanks for Stephen Barrett of Quackwatch  for pointing out that I had not made it obvious that Pharmacy Check Blog is the place to go to separate the good eggs from the bad.