Heard the one about the chap claiming to be a professional counterfeiter? He had the documents to prove it! Counterfeit derives from Old French—contre (“counter or against”) and faire (“to make”), the combined meaning “to make an imitation.”
We pilots are a funny lot; our passion demands adherence to rules, some without question, like Bernoulli’s Principle or that an annual always costs more than expected. Rule compliance prevents taxiway landings, flight when inebriated, or embarking on a four-hour flight with three hours of fuel. But we rail against some rules, especially those relating to our health and freedom to fly. I receive numerous emails starting with “Why does my AME…” or “Why does FAA…,” all expressing understandable frustration. But beneath burdensome bureaucracy lies a rationale, preserving safety. However, protecting the many comes at a cost, inevitably and unfortunately inconveniencing some pilots.
The same philosophy applies to pharmaceutical products with their multiple layers of regulations and safeguards, but the internet, and those who seek to profit, have found ways to circumvent regulations with potentially profound consequences from selling inappropriate and counterfeit medicines.
Drugs require a long and arduous development process (https://pilot-protection-services.aopa.org/news/2024/april/01/do-parachutes-prevent-injury) and contain active ingredients that do the biological work, combined with excipients, substances that are preservatives, coloring agents, or means to ensure the drug reaches the right place at the right time. Once approved by regulators such as the FDA, doctors prescribe medications and a reporting system follows every batch from factory to pharmacy to patient, also recording adverse side effects to better inform when the drug may, or may not, have a positive risk-to-benefit ratio. Doctors writing prescriptions know each patient’s medical history, additional medications they may be taking, and other factors like diet that might impact how a drug behaves. For instance, drugs to lower cholesterol (statins) can cause liver damage, so alcohol consumption history is relevant.
Once a drug’s patent expires, a generic version may be marketed. The companies making these pills and potions are also highly regulated, and the active compound(s) are the same as the branded drug that gave them birth, although they tend to be less expensive as the company does not have to invest billions to develop the initial drug.
Normally, one requires a doctor’s appointment, a prescription for either branded or generic drug, and then collecting the therapy from a local pharmacist. This professional also knows your medication history, thereby adding another level of safety. Think of it as looking in the fuel tanks as well as at the gauges. With internet access one can self-diagnose (with varying accuracy) and self-prescribe for far lower cost. A quick check showed that one Canadian pharmacy (more of that below) offers a well-known cholesterol-lowering drug for $167. For the same medication, the lowest cost option from a U.S. online pharmacy was $276, and at a local pharmacy, well over $300.
However, many people now buy medications from websites with no certainty as to whom they are dealing with. The big chain pharmacists can supply medications with the same level of safety and many online suppliers are high quality, utterly legitimate, and the drugs they sell are—and do—exactly what they are supposed to. Some suppliers require an online medical consultation, but their physician may not understand your detailed medical history, is possibly not licensed to practice where you live, and VPNs (virtual private networks) mean that someone “in Columbus” might actually be in Calcutta.
In the example above I reference statins; buying online might bypass the doctor asking key questions that could mitigate medical risk. Another example is purchasing drugs to treat erectile dysfunction (https://pilot-protection-services.aopa.org/news/2022/april/01/dont-come-crying-to-me-when-youre-the-lonely-one), which has many causes, including emotional stressors, low testosterone and serious cardiovascular disease. Men who develop ED should see their doctor and not just buy a solution online; it is dangerous!
Additionally, internet suppliers may have no verifiable supply chain from manufacturer to your mailbox; their drugs may be produced in unsanitary or suspect locations and may contain incorrect quantities of the active ingredients, unsuitable excipients, and could conceivably contain other, potentially dangerous, ingredients. Teenagers are much more computer-savvy and are purchasing stimulants like amphetamines and “recreational” drugs from the dark web at epidemic levels.
In America, the National Association of Boards of Pharmacy (NABP) estimates that 95% of internet pharmacies don’t comply with U.S. pharmacy laws or professional standards. Not uncommonly, and quite astonishingly, these rogue sites put the name “Canada” in their website domain because Americans identify their northern neighbor as a clean, nice, and trustworthy place. (By the way, I think it is and love visiting Canada!) One study (full disclosure, published by the Pharmaceutical Research Manufacturers Association, PhRMA) showed how a US consumer, ordering from an online “Canadian” pharmacy, was buying drugs made in China, shipped to Hong Kong, Dubai, or the Bahamas, then to the UK and thence to the buyer (https://www.phrma.org/-/media/Project/PhRMA/PhRMA-Org/PhRMA-Org/PDF/D-F/DrugImportation_InlineGraphic.pdf), and while these drugs may be safe, and sold without ill intent, do you want to take a chance? There is a risk that one may not be buying what it says on the label and such counterfeit medicines are potentially risky.
Counterfeit drug investigations have uncovered all sorts of harmful substances, from lead paint to boric acid. The threat to human health from antimicrobial resistance is clear; counterfeit antibiotics may contain insufficient active ingredients thereby not eradicating an infection totally and allowing resistant bugs to flourish.
Another aspect of this is even more worrying. Hundreds of deaths have been ascribed to common medications purchased online, including insomnia tablets, antihistamines and the relaxant diazepam (Valium), all found to contain instead synthetic opioids called nitazenes, which are stronger than heroin or fentanyl. There are several drivers at play here, including organized terrorist threats where malign(ant?) groups posing as online pharmacies sell actual poisons masquerading as common medications. Or acting as money laundering schemes. Or tied to organized crime. Or identity theft scams. Scary stuff.
Warning signs that an online vendor is dodgy? They publish wildly appealing price deals—if it looks too good to be true, it probably is! Other red flags? The site is not in a country one normally associates with pharmaceutical manufacturing, has no address, and seems willing to sell all sorts of dangerous medications without a prescription. In response to these threats, many healthcare entities, governments, regulators, policing, and Customs officials around the world are working together to raise awareness of counterfeit medicines and disrupt illegal activities.
Online merchants are becoming smarter at disguising counterfeit medications and passing them off as legitimate. While buying books and vacations is common online, we all employ caution with financial transactions, so please use the same care with your health.
Maybe find other ways to save a few bucks and get your prescriptions from your trusty neighborhood pharmacist, and if you do use an internet site, ensure that they are properly licensed; the FDA, the National Association of Boards of Pharmacy (NABP), and the Center for Safe Internet Pharmacies provide ways to find legal and safe providers. Ideally, the company will have a physical American address and contact number and if it has a “.pharmacy” domain name or Verified Internet Pharmacy Practice Sites logo, it is accredited by NAPB. And if anything you buy does not look, taste, or smell right, go and see your pharmacist to protect yourself and others. Also, do not be misled because a website is really professional looking—view everything online with caution. For drugs that require a prescription, no supplier should sell to you without one, preferably from your own doctor, and if you can talk to their pharmacist, check their credentials. Also, one of the latest scams is that after buying online you will be contacted by the FDA or DEA asking for information about the transaction; be alert, this is probably a set-up as our beloved Feds do not contact folks like that!
I hope I haven’t induced a headache or given you a headache, but if I have, and you need to take something for it, make sure the pills look legitimate!
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