Last month, Roger Bate, a scholar at the American Enterprise Institute and head of the Safe Medicines Coalition, published the results of a study which tested and compared the quality of drugs purchased from online pharmacies in the U.S. and abroad, including pharmacies verified by third-parties and those not verified. The findings were clear: PharmacyChecker-approved international online pharmacies sell medications of comparable quality to U.S. online pharmacies verified by the National Association of Boards of Pharmacy (NABP) and LegitScript.
In fact, overall, the results were better for PharmacyChecker-verified pharmacies than for those verified by NABP and LegitScript. Results were dramatically worse for pharmacies with no third-party verification. The drug testing focused on generic versions of Lipitor (atorvastatin) and of generic Cipro (ciprofloxacin), which were ordered from the online pharmacies by the researchers.
Comparison of Online Pharmacies (OPs) – Drug Failures and Counterfeits
|Total Orders Tested||50||168||231|
As shown in the above table, no counterfeit medications were found, but several samples were found to be subpotent, i.e., they failed to provide the listed amount of active ingredient. This was most common among non-certified international online pharmacies: 7% of samples were subpotent, including samples of both atorvastatin and ciprofloxacin. One sample of ciprofloxacin sold by an NABP/LegitScript verified U.S. pharmacy and one sample of it sold by a PharmacyChecker.com international pharmacy was also found to be subpotent, so that 2% of NABP/LegitScript and 0.6% of PharmacyChecker/CIPA samples failed. This sample was an FDA-approved medication, manufactured in India, and legally sold in the United States, as well as in other countries, suggesting failure in good manufacturing practices (GMPs) and oversight by FDA and India’s drug regulator, but not a failure of the verification organizations.
According to the study, sales of substandard/subpotent antibiotics, such as ciprofloxacin, exacerbate population level resistance to antibiotics, whether sold on or offline. Even worse, the non-certified sites do not require a prescription, which means some people who don’t even need the medication are getting it, even further exacerbating the problem. See U.S. Centers for Disease Control and Prevention for more on this issue.
Also, as we have reported before, not all Indian generics or generic medications overall are made equally well, including such medications sold in U.S. pharmacies. While overall, the results for the Indian medications tested were very strong from verified pharmacies, domestic and foreign, the larger number of failures from non-certified online pharmacies were Indian or Chinese-made medications, indicating a need for serious improvements in their drug regulatory systems.
Past studies led by Mr. Bate, which have focused on brand name, rather than generic medication, have found zero failures from PharmacyChecker-verified sites or those verified by other credentialing groups.
As it happens, Ciprofloxacin and atorvastatin are not medications that U.S. patients need to buy internationally because they are generic and often can be found very affordably in U.S. pharmacies – but are they safer doing so? Not according to this research.
Tagged with: Atorvastatin, CIPA, Cipro, Ciprofloxacin, LegitScript, Lipitor, NABP, Roger Bate, testing