Is My Canadian Online Pharmacy Really in Canada?

Maybe Not.

I practice in Washington State, and have a number of patients who travel to Canada to purchase their medications.  Why drugs are so much less expensive in Canada than in the US is primarily related to the single payer system in Canada, where drug companies have to negotiate prices with the Canadian health plan.

In the US with so many different insurers none have the where-with-all to negotiate steeply discounted prices because to remain competitive they have to offer all the popular drugs or risk losing patients to plans that do offer those drugs.  This leads to a situation where many patients simply cannot afford some of the expensive branded drugs that they are prescribed.  Admittedly we have a nice variety of inexpensive generic medications for most conditions, but in some situations there is no good alternative to expensive drugs.  Don’t think the Discount Drug Coupons are going to save you in the long run.

Of my patients who get drugs from Canada, many of them see a physician there who does a brief evaluation and re-prescribes the medications prescribed for them by me or other US physicians.  Others find pharmacists who will fill prescriptions written by US doctors.  At the border crossing coming home rarely patients  are searched and have their prescriptions confiscated, but the prices in Canada are enough less than US drug prices that it is worth the trip and risk of confiscation that patients using expensive branded meds find the trip worthwhile.   I don’t have a big concern for these patients.  I have no reason to believe that the drugs dispensed in Canada by pharmacists to visiting Americans are not the same medications they get in the US.

Unfortunately I don’t have the same confidence for my patients who get their medications from online pharmacies representing themselves as Canadian pharmacies. One FDA investigation where 4000 parcels suspected of containing prescription drugs sent from India, Israel, Costa Rica and Vanuatu were inspected.  About 43% of these were ordered from an internet site claiming to be a Canadian pharmacy, and only 15% of the drugs found actually originated in Canada.  85% of the drugs originated from 27 different countries.   It is difficult to impossible to know if an online pharmacy stating it is a Canadian pharmacy is actually Canadian or not.  Many of the drugs found were not labeled in English, and some were found to be counterfeit, i.e. not the drug ordered at all.   There is little reason to believe that if a company will falsify the origin of the drugs it is sending that it may not also falsify the composition of the drugs themselves.

For a detailed discussion by the FDA see: Buying Medicines on the Internet and Congressional Testimony

I have much less experience with Mexican pharmaceuticals.  Mexican pharmacies can dispense many drugs without a prescription that require a physician’s prescription in the US.  In addition many providers other than physicians can prescribe controlled drugs in Mexico.  In 1996 the top two drugs found on border crossing checks were valium and rohypnul (the date rape drug), and the age and gender most commonly found to have drugs was young men and second young women.  I suspect Oxycontin is a big favorite too.   The explanation for this was that these drugs were destined for blank market resale in the US.  I cannot find any study on the likelihood of counterfeit drugs at Mexican pharmacies, or on internet drugs ordered at pharmacies claiming to be Mexican.

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news and policy from a primary care physician’s perspective at his blog, DrPullen.com.

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