Being sick is bad enough even without the question of whether the prescription drugs you’re taking are legitimate.
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But with the proliferation of counterfeit medicine, a growing number of Americans who use online pharmacies may be at risk for taking fake pills that can result in serious health problems or even death.
According to the Federal Drug Administration, drugs sold on bogus websites may contain the wrong ingredients, incorrect quantities of ingredients, or may be composed of materials like drywall and eggshells.
And the trend shows no signs of slowing.
Last October, FDA Commissioner Margaret Hamburg said in a speech that "in some parts of the world, somewhere between 30% and 50% of drugs to treat serious diseases are actually counterfeit. And even still, it’s hard to really know the full extent of the problem." She pointed to the pharmaceutical industry’s shift in moving manufacturing operations and supply sourcing overseas as a main driver of the increase in fake drugs.
Adding to the troubling scenario is that there are currently more than 200 drugs on the FDA’s shortage list, a number that has steadily grown over the last five years, and could lead to more counterfeit production.
Drug prices in the U.S. tend to be significantly higher than other parts of the world, forcing cash-strapped patients to turn to the Internet to fill prescriptions. But according to the National Association of Boards of Pharmacy (NABP), the agency that certifies reputable online pharmacies operating in the U.S., of the more than 8,300 online pharmacies reviewed in July, a tad more than 3% appear to be legitimate.
We checked in with experts in the pharmaceutical industry to get answers to the most commonly asked questions about counterfeit prescription drugs and how you can protect yourself.
Which drugs are most commonly counterfeited?
The first counterfeit prescription drugs to hit the market were the kind people had a hard time getting prescriptions for, or were too embarrassed to ask their doctors for, according Roger Bate, author of Making a Killing: The Deadly Implications of the Counterfeit Drug Trade.
“Drugs like Viagra and pain killers were the prime focus for counterfeiters until the last 10 years or so, but now people are involved in faking a variety of drugs, including cancer drugs, blood pressure medicines and cholesterol medicines,” he says.
According to the FDA, drugs like Ambien, Xanax, Lexapro, and Ativan are also being faked. In the last year, the agency said some individuals who ordered these drugs online received drugs made of Haldol, a powerful anti-psychotic drug that can be deadly.
The most commonly-counterfeited drug continues to be Viagra, which is manufactured by drugmaker behemoth Pfizer. Pfizer Vice President and Chief Security Officer John Clark says the erectile dysfunction drug accounted for 57% of global seizures of counterfeit drugs in 2010, and that many online pharmacies claim to sell “generic” versions of Viagra, which doesn’t even exist in the U.S.
According to Clark, in the last decade there have been counterfeit versions of 22 Pfizer medicines discovered for sale online including Celebrex, Lipitor and Zithromax.
And although the focus is typically on counterfeit pills, Bate says that it’s not impossible for things like inhalers and cough syrups to be faked as well.
“Of course the most important thing to a counterfeiter is to be able to fake packaging, so for inhalers, having the box look right would be the most important piece of the puzzle.”
What are some indications my drugs are counterfeit?
For some pills, it’s almost impossible to tell what’s real and what’s fake, says Carmen Catizone, executive director of the National Association of Boards of Pharmacy (NABP).
“The best indication would be if it tastes different, appears different in color, or reacts differently in the way it dissolves or breaks,” says Catizone. “If anything appears abnormal, people should call their pharmacy or doctor immediately.”
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Pfizer’s Clark says that any indication of abnormality in a drug should be a red flag, and that the size and shape of the pill should always be examined before consumed.
“If you have a chronic condition that requires treatment every day, you can more readily spot change in the pill,” says Bate.
Am I in danger of buying counterfeit drugs when I get a prescription filled at my local pharmacy?
“The odds are very low,” says Bate. “The U.S., generally speaking, has a very secure supply chain, and over last decade there have been very few breeches.”
Who is the most at risk for getting counterfeit drugs?
NABP’s Catizone says the people most at risk are those who think they know everything about buying drugs online.
“There are some people who think they are great at getting good deals and finding legitimate drugs online and half the price, and they think they are going to outsmart the criminals,” says Catizone. “It doesn’t work that way.”
Senior citizens are also at risk, particularly those looking for a bargain on multiple types of medication, says Catizone.
“Thankfully, we haven’t seen as many seniors being taken advantage of since Medicare Part D began offering more subsidies for prescription drugs, but because they know less about the internet and are less experienced with online scams, seniors are still a high-risk group,” he says.
Terri Mock, vice president of Global Marketing for OpSec Security, an anti-counterfeiting technology company that works with the major U.S. pharmaceutical companies, says that unfortunately bargain-hunters are also in the at-risk category.
“If you think a deal sounds too good to be true, it probably is. When it comes to medicine, too many people are willing to ignore that inner flag that gets raised,” she says. “With the economy the way it is, consumers are trying to save money. They may be more willing to try an online pharmacy because they can avoid the process of seeing a doctor.”
How can you protect yourself?
If you must buy pharmaceuticals online, Bate says the odds for getting a counterfeit drug falls rapidly if you take a few steps. The National Association of Boards of Pharmacy issues reputable Internet pharmacies a seal indicating it has met state licensure requirements called the Verified Internet Pharmacy Practice Sites Seal, or VIPPS Seal.
“The seal tells consumers this is a safe, legal pharmacy,” says Catizone. “If someone tries to copy the seal, we have programs that detect that. Also, any site bearing the seal has a security feature that when you click on the seal, it links back to the NABP site.”
People looking to buy drugs online shouldn’t make a sudden decision to do so, says Bate.
“If you do 20 extra minutes of research, you can find a credentialed site to get what you need. But there are huge dangers if you just pick one at random.”
What should you do if you think you got a fake prescription drug?
“If you receive a suspect drug from your local pharmacy, definitely take the drug back to your pharmacist,” advises OpSec’s Mock. “If you purchase your drug from an online pharmacy, call the number listed on the site.”
Consumers can also contact the FDA’s Division of Drug Information at 888- 463-6332 or firstname.lastname@example.org.