Consumer Reports Canada

The most prevalent financial problem Americans face month in month out is the inability to afford their medicines. That’s according to a monthly national poll by Consumer Reports National Research Center. Indeed, medication in the U.S. can cost up to twice as much as it does in other parts of the world, so many bargain hunters turn to the Web seeking discounted, name-brand prescription drugs from Canada or other countries. But recent analysis has found that buyers should beware: Only a fraction of online pharmacies are legitimate. Our medical consultants say that given such risks, ordering from foreign websites should be avoided altogether.

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.

More specifically, the NABP found:
• 6, 812 (nearly 85%) don’t require a valid prescription from the customer’s doctor
• 3, 687 offer foreign drugs or ones not approved by the FDA
• 2, 100 have a physical address outside of the U.S.
• 2, 878 have servers located in foreign countries

The problem with websites selling medication from other countries is that there’s no way to ensure their safety or legitimacy. The FDA doesn’t have the authority to regulate foreign versions of medicine purchased by people over the Internet, so their ingredients might be unknown. Also, the drugs may not have been approved by the FDA (as in the case of generic versions of drugs not yet approved in the U.S.), or foreign regulatory agencies might not have approved the medication, either.

And for those seeking safety by ordering specifically from Canadian websites, there’s something else to consider. “Many of the Canadian sites aren’t Canadian at all, ” says Carmen Catizone, NABP’s executive director.

While there are legitimate online Canadian pharmacies regulated by Health Canada, a government agency similar to the FDA, Canadian pharmacies that ship prescription medication to the U.S. aren’t subject to Canadian regulatory authority, according to the U.S. Department of Justice.

Ilisa Bernstein, the FDA’s deputy director at the Office of Compliance, also urges caution. “I think it is safe to say that when you buy over the Internet there is a chance that you are going to get a substandard or counterfeit drug, ” she says. “There is little oversight of the global online drug marketplace. There are some pharmacies that are legitimately doing business online in the U.S. These pharmacies abide by federal and state laws in the U.S.”

In one recent study published in the online journal PLoS One, researchers ordered several brand-name medications through various pharmacies, some they thought were legitimate and others they suspected were not. Of the 152 drugs received, they found that three orders of Viagra (sildenafil) failed in testing and were probably counterfeit. And another 31 orders (20 percent) weren’t filled with the drug written on the prescription. Some online pharmacy websites replaced brand-name medication, such as Nexium and Lipitor, with other drugs that the researchers reported were probably generics. We’re usually a big fan of generics but only when they’ve been officially approved by the FDA. (Nexium and Lipitor don’t have approved generics in the U.S. market yet.) Since the researchers determined that the generics couldn’t be compared with the brand-name drugs, they weren’t tested to determine if they were counterfeit.