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REVIEW: The Opioid Crisis in America Course from Harvard University

Over 700,000 people died in the U.S. from a drug overdose between 1999 to 2017. That’s about 130 American deaths daily. At PharmacyChecker, we are dedicated to helping fight this epidemic by learning more about the crisis and spreading awareness. I recently obtained certification for The Opioid Crisis in America course offered by Harvard University.

According to a report published by the Substance Abuse and Mental Health Services Administration (SAMHSA), the main channels that people obtain opioid drugs illegally are from a friend or relative for free; buying from a friend or relative; or buying from a drug dealer or stranger.

As our main focus is often online pharmacy and importation, it’s notable that Harvard did not identify online pharmacy or importation as contributors to the opioid epidemic.

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Prescription Opioids are Needed to Quell the Opioid Crisis

Prescription opioids needed to combat opioid crisis

This week Purdue Pharma settled with the state of Oklahoma for $270 million to avoid a trial charging the company with what I call opioid drug dealing. Purdue Pharma and members of the Sackler family–founders and managers of the company–are enmeshed in 1,600 cases throughout the U.S. They are accused of illegal marketing activities that led to over-prescribing and rampant distribution of Oxycontin, which paved the way for millions to the addiction of opioids, with hundreds of thousands dying over the last decade.

It was not just Purdue but many drug companies—and the entire drug supply chain—that fueled the opioid death spiral. As drug companies and their allies in the drug supply chain continue to use the opioid crisis as a means to oppose prescription drug importation to lower drug prices in the U.S., we can only look on with amazement at their audacity.

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Online Pharmacies Did Not Fuel the Opioid Crisis

Fuel Opioid CrisisThe role of the Internet as a channel to obtain and misuse prescription narcotics is tiny.

A report published by the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Centers for Disease Control and Prevention, blamed the Internet for 0.1% (one tenth of 1%) of all narcotic abuse. That data was from 2015. The latest such report, which is called the National Survey on Drug Use and Health has new data from 2017 that doesn’t even have a category for the Internet.

It’s hard to tell if the new number is lower or higher than 0.1%. While 0.1% appears to be statistically insignificant, people have died buying narcotic prescription drugs online and all channels of abuse need to be addressed.

Drug Companies Want to Hide Lower Drug Prices from Americans

On the other hand, drug companies are lobbying Congress to crackdown on Internet companies about opioids, but what they really want is for Americans to stop using the Internet to access lower prescription drug prices from Canada and other countries. In fact, drug giant Eli Lilly wants to censor the Internet by removing Canadian online pharmacies from Google search results in the U.S. Let’s address opioid sales online with a scalpel, not a sledge hammer. More importantly, let’s put resources into treatment and use law enforcement where it’s most needed.

According to the government’s survey, of the 11.1 million people who misused prescription opioids, here’s how they obtained them: 53.1% from a friend or relative; 36.6% from a doctor’s prescription; 5.7% from a drug dealer; and 4.6% some other way.

Channels of Obtaining Prescription Opioids for Misuse

I don’t know why SAMHSA removed the Internet as a category but believe there are two possible answers:

One, the internet channel was statistically insignificant.

Two, the incredibly small percentage, 0.1%, did not fit the agenda of the pharmaceutical industry to blame the Internet for illegally obtained prescription narcotics.

The data showing that only 0.1% of Americans who abuse opioids get them online doesn’t justify the major crackdown on the Internet desired by the pharmaceutical industry.

Yes, drug companies can lobby Congress and federal agencies to have questions removed and added to research on matters that affect them. The FDA has never reported a person seriously sickened or killed by buying medicine internationally from an online pharmacy that requires a prescription. The safest international online pharmacies don’t sell opioid medicine or any controlled drugs.

What does the category “some other way” account for according to SAMHSA?

Some other way includes write-in responses not already listed in this table or responses with insufficient information that could allow them to be placed in another category.”

That means they didn’t ask about the Internet, but people may have written it in. I’ll update this post when I find out more about it.

Consumer Advocacy

As drug companies continue to pressure Congress about stopping personal drug importation by censoring the Internet, it’s important for consumer advocates to stay on top of this data. As I wrote last week, if you look closely, the law, ironically, defends personal drug importation – even if it’s technically illegal.

Let’s beat the opioid crisis without stopping people from safe personal drug importation of non-opioid, non-controlled products.

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FDA Focuses on Illegal Fentanyl Imports, Neglects Off-Label Prescribing

FentanylThe FDA has made it it’s business to shine a bright light on the evils of illegal fentanyl imports, which are sometimes sold online. That focus seems like it’s a good one. Illegal fentanyl imports get into the hands of drug dealers who use the ingredients to make counterfeit, opioid-based drugs. They sell them to addicts who too often overdose and die. I’ve written a lot about the FDA’s crackdown on illegal fentanyl imports being misused to stop imports of prescription medicines on their way to American patients from Canada and other countries. However, something much more troubling actually has gone down over the past few years.

According to documents obtained through a Freedom of Information Act request by the John’s Hopkins Bloomberg School of Public Health, the FDA ignored information about off-label prescribing of the most dangerous prescription opioid drugs: fast-acting fentanyl or transmucosal immediate release fentanyl (TIRF). Those drugs were approved to treat the most serious pain experienced by cancer patients. Instead, drug companies encouraged off-label prescribing for patients experiencing lower levels of pain and certainly did not have terminal illnesses.

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Real Opioid Online Drug Dealers Indictment Unrelated to Rx Import Savings

Indictment of Evelin Bracy and Jorge Rodriguez Lopez Here’s a real story about online opioid drug dealers getting indicted and how pharma front groups conflate the opioid crisis with prescription drug importation. I write “real” to juxtapose rogue online pharmacies—that illegally sell addictive drugs—and safe international online pharmacies that don’t sell addictive drugs at all.

On July 9th, the U.S. Department of Justice for the Southern State of New York announced the indictment of Evelin Bracy and Jorge Rodriguez Lopez for illegal distribution of controlled drugs, including an analog of the opioid pharmaceutical Fentanyl – called U-47700. They are also accused of selling these drugs on the Internet from what the DOJ refers to as a website “purporting to be an online pharmacy.” The indicted parties were also alleged to have sold drugs under pharmaceutical names, oxycodone and alprazolam, that were found to have other ingredients, implying that the products were counterfeit. These counts can technically land a person in jail for 40 years.

If the allegations are true, then we’re dealing with bona fide drug pushers. The Partnership for Safe Medicines (PSM), a Pharma-funded non-profit group that seeks to conflate such drug dealing and counterfeiting with pharmacies in other countries that sell affordable prescription medicines to people here in the U.S. PSM is keeping a web diary of law enforcement busts that help stop the deadly fentanyl trade, which is taking the lives of thousands of Americans each year. We applaud law enforcement for disrupting these opioid dealing operations and bringing their orchestrators to justice.

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FDA Plan to Seize Illegal Opioid Imports Could Affect Prescription Deliveries

As reported by the Associated Press, FDA Commissioner Scott Gottlieb announced a plan earlier this month to stop imports of opioid drugs by doubling the number of inspectors at international mail facilities. This type of targeted enforcement against opioid drug products is the stuff of real public health protection, but it can easily be misused to refuse online pharmacy orders of prescription medication imports. Millions of Americans are ordering medications from abroad because they cannot afford the exorbitant prices here in the United States. Prescription medication orders from licensed pharmacies in Canada and other countries should not be conflated with illegal importation of opioids.

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