Fighting Fake Online Pharmacies & Counterfeit Medicines

By: Shabbir J. Safdar, Executive Director of the Partnership for Safe Medicines

If law enforcement knows that criminals in another country are shipping illegal drugs to patients in the United States, how long should we let them traffic poison while we fight the problems of prosecuting foreign nationals? How long do we let them harm Americans while they sit outside our borders and refuse to come to the U.S.? Three weeks? Six weeks?

Right now, we’re operating at delays measured in years, and the cost to Americans in medical harm and fraud is not acceptable. New bipartisan legislation would help disrupt these criminals: the DRUGS Act (S.3399 / H.R. 6352)

Let me tell you a story about a “Canadian” pharmacy: A web pharmacy named CanadaDrugCenter.com shipped an anti-inflammatory and a blood thinner to the U.S. in 2014. Their website had Canada in its name, but the medicines they sold came from Mauritius and Turkey. They didn’t even pretend. The packages were drop shipped straight from Mauritius and Turkey to the buyer in Portland, Maine.

The recipient was a professor of pharmacy with access to a lab, so he tested them. The anti-inflammatory was sub-therapeutic (not enough active ingredient) and the blood thinner had a contaminant. (Cancer-causing agent, anyone?)

What do you think happened to the company, CanadaDrugCenter.com? 

Extradition, even from a friendly neighbor like Canada, is challenging. The criminals that ran
CanadaDrugCenter had an enormous network of over 200 fake pharmacy websites, but still
could not be easily extradited. It’s hard to negotiate a plea deal with someone who knows you
can’t force them into court to face charges.

Nothing. For years.

As the Maine Board of Pharmacy and the Maine Attorney General wondered how they might be able to protect their patients from Canada Drug Center’s predatory business, CanadaDrugCenter continued selling to Maine patients. The Internet Archive shows they ran the website for at least two more years. They also ran full page ads in the local Maine newspaper. And they continued selling their counterfeit medicines to Mainers.

Eventually, the feds finally got involved. They had to conduct a long investigation, convince a U.S. attorney to bring charges, and then deal with the fact that the executives from Canada Drug Center had no interest in showing up in U.S. courts. Eventually they pleaded guilty and settled the case. Nobody went to jail but they paid a fine of over four million dollars.

Why do we let these operations continue when law enforcement knows they are selling drugs illegally online? These criminals sell fake versions of therapeutics like blood thinners, but also controlled substances like the ones driving the current opioid crisis. They do it from outside U.S. borders because they know it’s really hard to extradite them. These aren’t the first counterfeiters to simply decline to show up in U.S. court.

There is a better way: When we have clear evidence that someone is running a business selling drugs illegally online without a state pharmacy license, we should suspend their website domain name. The Food and Drug Administration and the Department of Justice could have suspended CanadaDrugCenter.com once they had proof of the crime. And the “Canadian pharmacy” could have reclaimed the domain when they cleared themselves of the charge.

This isn’t a new concept: if the police discover you’ve turned your home into an open air heroin store and shooting gallery, you don’t get to keep the supply of drugs until you’ve won your trial. You’re lucky if you even get let out of jail. If you’re caught with a pill press with an illegal mold for opioids in it, you don’t get to keep using the pill press until the trial is over.

Photo Source: Money Logue

A new law that would take these website domains away from criminals is called the DRUGS Act (HR 6352 / S 3399). It’s bipartisan, introduced by both Republicans and Democrats in the House and Senate, and would go a long way to protecting Americans from criminals who refuse to play by the rules while we go through the long process of adjudicating their cases.

To learn more about how you can support it, watch our video about this legislation and use this link to send a letter to your elected officials.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Drug Importation Policy is a Hard Pill to Swallow

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

When I first heard the news that Congress was considering legislation that would allow prescription drugs to be imported from abroad, I was honestly quite shocked. I know firsthand how such policy can negatively impact consumers who decide to purchase drugs from abroad. The potential consequences are quite daunting.

In 2002 (just shy of my 30th birthday), I was diagnosed with HIV. When my doctor told me the news, a hundred questions came to mind all at once. What was my long-term prognosis? What types of medications would I have to take? Who could I turn to with my questions about life with HIV?

(Editor's Note: The photo of me was taken in 2002 on Easter Sunday during the time that I was importing my HIV medications. At the time, I was still quite sick after experiencing my acute seroconversion. In fact, in this photo my two best friends are literally helping me stand up, and they made me look "presentable" with some make-up. The benefits of rooming with two wonderful women who took care of me.)

What happened next directly shaped my viewpoint of the dangers associated with importation.

I ordered medications from an online Canadian pharmacy. To this day, I have no way of knowing where the drugs were made or if they contained the active ingredients I needed to effectively treat my condition.

At the time, I opted not to consult my physician in the process. Due to my insurance coverage, my out-of-pocket cost was $1,300 during the second month of treatment. For two months, I received medications via mail from Canada. Honestly, I didn’t even entertain the idea of whether the medicines were real or fake.

Fortunately, my doctor intervened and advised me of the reality of what I was doing. She told me that drugs purchased through online channels are often counterfeit and most likely do not contain any ingredients that help patients. In many cases, the ingredients can be deadly. Without even knowing it, I was rolling the dice with my health and safety. It was an eye opening intervention and one that too few patients ever experience before irreparable damage has been done.

Without question, we need to address the issue of rising health care costs in the United States, which greatly contributes to patients buying medicines online. However, legalizing importation isn’t the solution we need. It will undoubtedly lead more patients to risk their health and, ultimately, their lives through online drug purchases.

Consider the following: The World Health Organization estimates that 10 percent of medicines across the world are fake. In some parts of the world, this number is as high as 30 percent. In 2015, Interpol confiscated nearly 21 million fake medicines, a significant increase over the previous year.

As a society, why would we take our guard down when the threat is so high? As someone who is informed on health care issues (even at the time of my diagnosis), my search for Canadian pharmacies did little to warn me against the dangers. I had little knowledge or available information when I ordered medications from Canada.

Rather than open the floodgates to unregulated medicines, we should be doing more to ensure the safety and integrity of our drug supply. Last month, former FBI Director Louis Freeh released a report highlighting the incentives that drug importation would create for criminals who are actively marketing to consumers in the U.S. and the burden it would place on law enforcement who protect our drug supply.

Among his recommendations to be proactive on the issue, Mr. Freeh urges policymakers to conduct a detailed assessment of law enforcement’s readiness and ability to get in front of the threat that exists. I completely agree with Mr. Freeh - this should be our focus.

As we strengthen our defenses, we must also prioritize patient education and engagement initiatives to ensure that we’re deterring importation from the moment of diagnosis. The reality is that a number of online pharmacies with a Canadian flag attached to them are merely front doors for smugglers operating in countries across the globe.

There are viable ideas to combat the rising cost of healthcare – including prescription medications – but importation is not one of them.

Over the past two decades, we’ve made significant progress against HIV/AIDS. Today, there are medications available that we didn’t have just a few years ago. In fact, recent studies have shown that people in North America and Europe who are infected with HIV and who begin treatment with a triple-drug cocktail can expect to live nearly as long as people who aren’t infected by the virus.

Having lived with HIV for nearly 15 years, I know how important medicine is in achieving a sense of normalcy again. If we embrace drug importation, we’re sending a signal to patients across the country that their health and safety don’t matter. Lawmakers should not be playing a game of chance when patient lives hang in the balance.

This opinion piece was also published in the August 11th edition of the Washington Blade.