Canadians go to Canadian pharmacies to get their prescriptions; they do not go online to a Canadian Internet Pharmacy. Canada has specific regulations that put a cap on the price of their prescription medications for Canadian Citizens, which is considered part of the Canadian Health Care System.

I am not here to debate health care systems, rather, I want to discuss for a moment the wide spread practice of ordering prescription medications over the internet from a so-called Canadian Internet Pharmacy.

The Food & Drug Administration (FDA) in the United States assures all medications approved for use in the United States meet specific requirements. These requirements are numerous and include things like quality, manufacturing, labeling, and storage. The facility where the medications are manufactured are certified and monitored, as well as the tracking of all of the ingredients to each medication.

"Chain of Custody," in this situation, refers to the tracking of the ingredients of a medication from their point of origin to the manufacturer, followed by the tracking of the produced medication all the way to the pharmacy where the medication is dispensed. During this process, there are specific storage and handling requirements that need to followed and documented the entire process. At every point there is a United States, either federal or state, licensed entity that takes responsibility for this process.

When a medication is manufactured in another country for use in the United States, the FDA provides the same level of monitoring, following the "chain of custody" of the medication from the point that it was manufactured all the way to the pharmacy where the medication is dispensed to the patient.

When a medication is sold for use in another country, the FDA's "chain of custody" is broken and the other country takes over with whatever laws they have. If a medication is manufactured by a United States FDA approved drug company, and is then exported to another country, that country then takes over the ownership of the medication. It is then illegal to import that medication back into the United States. The "chain of custody" has been broken and there is no guarantee that the medication has been stored and handled 100% appropriately.

The law states that there are certain situations where a patient may take a prescription to Canada and purchase up to a 90 days' supply of medication and bring it back into the United States for personal use. These particular situations are limited to medications that are not currently available in the United States yet still necessary for specific illness. They do not include purchasing medications available in the United States just because they are cheaper from another country. No where does it state that it is legal to order these medications over the internet and have them mailed to you. That said, it is done all the time by regular people who do not realize that they are "trafficking prescription medications across a federal border".

Joe McCallion, a consumer safety officer in the FDA's Office of Regulatory Affairs, sums it up this way: "If you buy drugs that come from outside the US, the FDA doesn't know what you're getting, which means safety can't be assured."

Just do a Google search and see how many Canadian Internet Pharmacies you find. These folks set up an internet store front in Canada and then market great deals on prescription medications. The actual warehouse may be in India or Malaysia or anywhere. There is absolutely zero FDA regulation on the "chain of custody" for these medications.

Not only may the manufacturing, storage and handling of these medications be inappropriate, the medication themselves may be counterfeit. If a medication costs $120 for 30 days' worth at your local pharmacy, and it costs $29.95 over the internet for the same medication, what's the deal. If they do not need to worry about storage and handling or concern about the manufacturing plant being licensed and monitored, or even if the correct ingredients are being used, well then, we can cut corners and charge less money.

There have been multiple documented cases of medications being imported through Canadian Internet Pharmacies where the patient has gotten severe side effects or the medication has not worked. Upon evaluation the medication was a counterfeit. There is no recourse if this happens; only the consumer who purchased it over the internet is to blame.

Please, do not order your medications from Canadian Internet Pharmacies. You do not know what you will be getting. If you are having trouble paying for your medications, talk with your pharmacist. They may have some ideas on a cheaper generic, or perhaps connect you with the manufacturer of the medication so you can use their "Patient Assistance Program".

For more information read this How to Review an Online Pharmacy and FDA publication.

About the Author

Dr. Steve Leuck owns and operates an online Medication Specific Counseling program called AudibleRx which is dedicated to increasing medication education and understanding at the patient level.

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