When legislators think they have found an easy way to remedy the high cost of prescription drugs, their solutions often fall short. That is particularly true for the latest silver bullet: importing drugs from Canada. My research on the consequences of drug importation show it poses an acute threat to patient safety — and the practice could worsen Utah’s deadly opioid crisis.
After more than two decades of studying the economic and health impacts of drug importation, the verdict on bringing drugs in from Canada is clear and consistent: It’s a risky gamble and one too dangerous to take. Experts know that preventing the introduction of dangerous counterfeit medicines cannot be guaranteed.
Moreover, the depth and breadth of the counterfeit drug industry is large and growing. An Organization of Economic Co-Operation and Development study showed that counterfeit drugs accounted for 2.5 percent — $461 billion in misappropriated revenues — of the world drug market in 2013. And the World Health Organization estimates that 10 percent of the global pharmaceutical market is counterfeit.
Further evidence may be found in the number of investigative cases opened by the federal Food and Drug Administration, which has increased more than ten-fold over the past two decades.
Researchers estimate that given the sharp rise in the opioid epidemic, fueled by counterfeit, clandestine drug labs, as well as the increase in warnings by the FDA about other counterfeit drugs, the share of the drug market that is counterfeit has surely risen.
Utah is facing this threat on a daily basis.
In recent years, law enforcement in Utah and around the country has been targeting fentanyl, a deadly ingredient that is frequently used by criminals in the manufacture of counterfeit oxycodone. Fentanyl, known as “heroin’s synthetic cousin,” is the source of thousands of overdoses and deaths.
Reports on counterfeit drug operations are becoming a daily fixture in Utah media. The first week of February saw a raid on a massive counterfeit oxycodone and Xanax operation capable of producing 1,000 pills per day. This comes on the heels of a raid in June 2017 in a Utah suburb, an operation capable of producing several thousand pills an hour in which federal agents seized more than 70,000 pills.
But counterfeiters do not limit themselves to the illicit drug market.
Counterfeiters falsify name brand drugs, generic drugs, over-the-counter drugs and even herbal remedies. Counterfeit medicines may contain no active ingredient, harmful ingredients, the wrong drug, the wrong concentration, or drugs past their expiration dates. Moreover, counterfeit pharmaceuticals containing a greatly reduced dose of the active constituent have contributed to antibiotic-resistant forms of shigella, cholera, salmonella and tuberculosis.
For example, the FDA warned Utah health care providers about the prevalence of counterfeit cancer drugs in the marketplace — spurious medicines that undermine treatment regimens and devastate the ability of patients to fight their diseases.
Our nation has the safest drug supply in the world, the result of safeguards and regulations that protect all of us. While many perceive Canada to be a safe alternative source for prescription drugs, numerous investigational studies establish that many drugs shipped from (or through) Canada actually originate in other countries. Their origins are falsified and their ingredients are unknown, which deepens the threat to the supply chain.
While importation can seem to be an attractive target to provide ready access to less-expensive alternatives to approved prescription drugs, the research is crystal clear that importation poses deadly risks to patients and should be resisted.
Dr. Kristina M. L. Acri, née Lybecker, is an associate professor of economics and chair of the Department of Economics & Business at Colorado College.