Drug Diversion and Abuse: Ordering Rx Drugs from Outside the United States

Thousands of criminal Internet pharmacies dispense millions of dosage units of pharmaceuticals.

One of the significant problems in the area of pharmaceutical diversion in this country lies in the millions of dosage units of prescription drugs that are shipped into the United States to our citizens. Some are consumed directly by the person who orders the drug, and others are trafficked in America’s streets to contribute to the abuse and diversion issues we face.

Maine recently passed a state law, effective in October 2013, allowing its citizens to order pharmaceuticals from Canada and a few other countries, in violation of federal law. This is similar to the actions of states that have passed medical and now recreational marijuana laws in direct violation of federal statutes. Both instances are not only illegal but also, in my opinion, a very bad idea. Plenty of examples of abuse already exist in the legal marijuana arena; these kinds of legal maneuvers can only worsen prescription drug problems.

Ordering pharmaceuticals illegally over the Internet is not difficult or new. Depending on the drug, many are counterfeit and contain only a small portion of the active ingredient needed; erectile dysfunction medications are most notably affected. There is also no guarantee of what fillers are present in these drugs; fillers such as drywall and cattle dung have been detected. I have seen many photos of so-called “labs” in foreign countries that are producing look-alike pharmaceuticals, and the conditions are deplorable.

What drives many people to do this? Money, of course, as many of these drugs can be ordered cheaper from Canada or Mexico. I am well aware that the savings are significant in certain cases. Other Internet orders, such as those for controlled substances, fuel addiction issues that customers can’t satisfy through doctor shopping or illicit prescribers here in the United States.

A case in my jurisdiction involved a person in charge of a day care service who was ordering carisoprodol over the Internet with a credit card. She found that the drugs kept coming whether she ordered them or not, as long as the credit card was valid. She ended up canceling 3 credit cards, as she would stop for a while and then start up again with a new card. She was arrested, and there are plans to pursue the violators.

In 2011, the National Association of Boards of Pharmacy (NABP) conducted a study on the legitimacy of Internet pharmacies. The NABP found that 7234 of the websites were not recommended, with 6018 (83%) not requiring a valid prescription, not requiring consultation with a pharmacist, or not taking insurance. Only 3.4% of the sites that NABP reviewed appeared to be potentially legitimate. This is not a good “track record” to support straying from American pharmacies and, in some cases, even US manufacturers.

In 2006, the Office of National Drug Control Policy identified 34 rogue Internet pharmacies and found that they had dispensed over 98 million dosage units of hydrocodone to citizens in our country. It is estimated that in that year, it would have taken 1118 average American pharmacies to match the output of hydrocodone by these Internet pharmacies.

Could we all agree that thousands of criminal Internet pharmacies dispensing hundreds of millions of dosage units of pharmaceuticals, some of them counterfeit, in the United States significantly adds to abuse and diversion issues?

Like the so-called medical marijuana issue, there is no indication that the federal government will pursue those in Maine who will soon be illegally ordering pharmaceuticals from outside the country. As with the marijuana issue, other states will likely follow with similar legislation once they find that there are no federal consequences and as some interest groups apply pressure on legislators.

This is not just an Obama issue; the Bush administration also turned a blind eye to this type of disregard of federal statutes. This not only creates new problems of abuse, it is a slippery slope as administrations decide what laws they will or will not enforce on the federal level. The unenforced federal statutes discussed here were passed by Congress for a reason, and that reason still exists.

John Burke is commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad.