The Dangerous World of Counterfeit Prescription Drugs

In this case, the active ingredient in Heparin was replaced with a cheaper counterfeit substitute, causing a range of adverse reactions and a nationwide series of recalls. Eventually, the counterfeits were suspected in as many as 81 deaths. Baxter, the company that sold the drug in the U.S., maintains that the number is far lower. As a result of the contamination, Baxter faced 740 lawsuits and eventually sold the division that produced the drug.

The Heparin situation is one of the rare examples of counterfeit substances making it into the legitimate U.S. pharmaceuticals system; most cases happen overseas. In 2005 and 2006, U.K. authorities discovered that thousands of packs of counterfeit Lipitor, a cholesterol drug, had entered the legitimate supply chain or had already been consumed by patients.

In 2009, anti-diabetic medicine that contained six times the normal dose of its active ingredient was found in China and cited in the deaths of two people, according to the WHO. In 2006, the agency also reported that more than 100 patients were killed in Panama by counterfeit glycerin contained in cough medicine. In parts of Africa, where counterfeits are estimated to account for 70 percent of the market, it is difficult to measure counterfeit-related deaths, although some estimate the number to be in the hundreds of thousands per year, mostly related to malaria and tuberculosis drugs.

Online pharmacies: Drugs without a prescription are likely too good to be true

Where Are They Purchased?

Protecting against counterfeit pharmaceuticals is relatively easy: Just avoid certain types of merchants. The major makers of fake medical products are unregulated online pharmacies, the most common method for these drugs to get into the hands of American consumers, according to drug companies, international organizations, and the FDA.

Most of these pharmacies offer lower-than-market-priced, physician-prescribed drugs, without

a prescription, for importation to the U.S. — a practice that is “almost always unlawful,” according to the U.S. Justice Department. “Google ‘without prescription’ and you’ll find hundreds, if not thousands, of Internet pharmacies,” says Andrew Jackson, head of corporate security at Novartis. “And the vast majority are not approved by the FDA, but appear to be Canadian in origin… They feature smiling medical professionals offering prescription-free pharmaceuticals... but you don’t have to dig too far to discover that the sites are not based in Canada at all.”

More illegal online pharmacies that sell to Americans give the appearance of being Canadian firms, because Canada is known for its safe and inexpensive pharmaceutical supply. Howard Zucker, former assistant director general of the World Health Organization and head of the International Medical Products Anti-Counterfeiting Taskforce (IMPACT), offers a rule of thumb: “If there’s no mailing address on the site, 50 percent of all those are fake companies and, odds are, their medicine is also fake.”

Are All Online Pharmacies Bad?

CNBC.com contacted several online pharmacies that offered to ship prescription drugs at low prices, many without a prescription or after simply filling out an online medical questionnaire. Although most wouldn’t comment, a representative from one U.K. and Canadian-based online pharmacy, BestCDS.info, maintained its products were legitimate, and said it required faxed prescriptions from consumers. The manager, who said his name was Carl, said customers were mainly concerned about whether they would receive their order and not whether the order was counterfeit. He noted that the controversy over counterfeit drugs was overhyped and was intended to “spoil” his business.

Carl also derided online pharmacies for selling “sugar pills” to consumers, a practice his website had been accused of, although he said that these accusations were without merit and his company had not sold any fake medications. According to Patrick Ford from Pfizer, however, genuine Viagra is sold to distributors for around $18 per tablet and “you’re not going to get it at a better price than that.” BestCDS sells 25mg tablets for between $1.09 to $2.49, and others such as TabsFast.com list 130mg tablets from 99 cents to $1.31 per pill. Sometimes online pharmacies list these tablets as “generic,” but in neither of these examples is that true. When contacted, both websites maintained their drugs are authentic.

The scope of the business behind these online pharmacies is difficult to measure, but rare insight into online pharmacies was recently brought to the public’s attention. In August 2011, the U.S. Department of Justice required Google to forfeit $500 million in revenue generated by online ads for prescription drug sales by Canadian online pharmacies. Although many large companies spend millions on advertising, when $500 million is spent by a network of independent retailers for search marketing, it is likely not a stretch to assume there is a lucrative business behind the scenes.

Despite all the controversy surrounding online pharmacies, there are legitimate ones considered safe; experts say they should not be confused with counterfeit sites. To distinguish between the two, the National Association of Boards of Pharmacy (NABP) developed the VIPPS accreditation program, which evaluates Internet pharmacy practice, including on-site surveys. “If you’re on a VIPPS site, it’ll be as close to a traditional pharmacy as you can get,” says Patrick Ford. You can identify VIPPS accredited websites here. At the time of this writing, there are only 29 online pharmacies holding VIPPS accreditation.

The economics and incentives behind counterfeit drugs

Why Counterfeit Drugs Are Made