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A Tale of Two Drug Bills

Both opioid abuse and the high price of medication have wreaked hell on Americans and their families, and now two very different bills in Congress that affect drug importation aim to alleviate these crises. However, if the pharmaceutical industry has its way, the bill meant to address the opioid problem will worsen the catastrophe of inflated drug prices in the United States by threatening American access to lower cost medication imported from Canada and other countries.

While the high cost of prescription medication is often attributed to the greed of pharmaceutical companies, fewer people are aware that that same avarice aided in causing the epidemic of opioid abuse. Decades ago, drug companies successfully pushed for looser prescribing rules for opioids, which encouraged providers to overprescribe them to their patients.

According to the Centers for Disease Control and Prevention (CDC), 33,091 Americans died in 2015 from overdosing on opioid drugs, but high drug prices can kill, too. Approximately 45 million Americans did not fill a prescription last year due to soaring costs of medication. When people fail to take prescribed medication it frequently leads to illness and too often, worse, death. The CDC estimates that 125,000 people die each year because they are not taking the necessary medications for chronic conditions.

Introduced by Rob Portman (R-Penn.), the Synthetics Trafficking and Overdose Prevention Act (known as the STOP Act) seeks to curb illegal importation, mostly coming from China, of a synthetic opioid drug called fentanyl, which is 50-100 times stronger than methadone.

In 2015, the CDC reported synthetic opioid overdose as the cause of death of 9,580 people, a 72.8 percent increase from 2014. Many of these cases are tied directly to fentanyl. Granted, some deaths can be attributed to lawfully manufactured fentanyl, but the CDC believes that illicitly manufactured fentanyl, which is also used to make counterfeit prescription narcotics including imitation Vicodin and Oxycontin, is the real culprit.

The STOP Act’s language targets the United States Postal Service, through which the fentanyl is coming in, and this is at the heart of the problem.

Under current law, commercial carriers, such as Federal Express and UPS, must provide U.S. Customs and Border Protection, the agency responsible for policing imported goods, advance electronic data about incoming deliveries. That data makes it easier to stop illegal imports, which include illegal fentanyl from China, but also safe prescription medication from Canada.

The USPS does not receive advance electronic data at its international mail centers as uniformly as private carriers, which means fentanyl can be delivered by the USPS. The STOP Act would force USPS to demand advance electronic data from foreign postal services, like Canada Post, and operate similarly to private carriers – making it potentially much easier to stop the fentanyl imports. The twist is that safe and more affordable medication purchased by Americans can also be stopped this way. The bill should be amended to prevent that.

While the scourge of illegal opioid importation is something we should stop, importation of affordable, non-narcotic prescription medication is a lifeline for millions of families. Despite federal restrictions, about 19 million Americans have imported medication for personal use due to high prescription drug prices in the U.S. The practice is prohibited under most circumstances, but individuals are not prosecuted.

The Affordable and Safe Prescription Drug Importation Act, introduced by Senator Bernie Sanders (I-Vt.), would make importation of lower cost medications from Canada, and eventually other countries, lawful. According to a survey by the Kaiser Family Foundation, seventy-two percent of Americans want the law changed.

The bill would also prohibit importation of controlled drugs, such as prescription narcotics, whether lawfully manufactured or fake. Earlier this month, a coalition of non-profit organizations signed on to a letter to Congress supporting the importation bill and those Americans who currently need to import lower cost medication.

Killing the Sanders importation bill, a goal of the pharmaceutical industry, is just the latest chapter in its long campaign to scare people and politicians about importation. A key strategy is to conflate importation of real medicine with that of counterfeit drugs and narcotics, as well as safe international online pharmacies with rogue ones.

Organizations funded by drug companies are promoting the STOP Act, noting it will protect people from not just fentanyl, but counterfeit drugs online. They are conspicuously silent (but they know) that the proposed rules could also curtail imports of genuine medication ordered online from other countries.

There are rogue online pharmacies that are dangerous and sell counterfeit drugs, but they can be avoided with public education and targeting by regulatory and law enforcement actions. For those who buy from properly verified international online pharmacies, personal importation can be equally as safe as walking in your local pharmacy. The safest international online pharmacies all require valid prescriptions, do not sell controlled medications, and do not sell opioids. Their prescription drug prices are often 70 percent lower than in the U.S., and this access to affordable medication is something that should not face roadblocks by the USPS.

Although pharmaceutical companies did not cause illegal importation of dangerous synthetic opioids, their efforts to promote loose prescribing of narcotics fanned those flames. Clearly, skyrocketing medication prices at home have led Americans to illegally obtain lower cost medications from international pharmacies.

We must not restrict imports of safe and affordable medication in an effort to stop illegal opioid trafficking. Allowing the STOP Act to become law in its current form, while a gift to Big Pharma, could prevent many Americans from getting the medication they need.

Gabriel Levitt is president of PharmacyChecker.com, a company which verifies online pharmacies and lists drug price comparisons, and founder of Prescription Justice, a non-profit organization dedicated to ending the crisis of high drug prices in America. Financial disclosure: PharmacyChecker derives revenues from its Pharmacy Verification and Listing Programs. 

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This op-ed originally appeared in The Hill on June 23rd, 2017.

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Imported Medications From Credentialed Online Pharmacies Are “So Safe”

Getting the truth about Online Pharmacies

The economist and drug safety expert Roger Bate, PhD, affiliated with the American Enterprise Institute, published a short article this week, the title of which says it all: “Credentialed online pharmacies are so safe that peer review literature is no longer interested in results showing it.” The gist is that he and colleagues have been testing medications for several years, since 2008, as mystery shoppers ordering online domestically here in the U.S. and internationally for import. The research shreds the myths of the drug companies by presenting peer-reviewed data to derive what are called “facts” about the Internet and importation. The main fact proved is that importing medications, ones ordered online, can be equally safe as U.S. pharmacies.

In the studies from 2008-2016, 822 online medication orders were tested: 275 medications from 22 international online pharmacies verified by PharmacyChecker.com (12 of which are also verified by the Canadian International Pharmacy Association); 127 medications from eight U.S.-only online pharmacies verified by the National Association of Boards of Pharmacy and/or LegitScript.com, and the rest from websites with no verification.

Verified U.S. pharmacies sold zero counterfeits but one (out of 127) order of generic Cipro was substandard. Verified international pharmacies sold zero counterfeits but one (out of 275) order of generic Cipro was substandard. On a percentage basis, the PharmacyChecker.com-verified websites performed best (but that’s nitpicking). And for those of you thinking, well, one was substandard…that same medication is available at your local Walgreens or CVS. Read the research.

In contrast, online pharmacies with no verification (Dr. Bate calls it “credentialing”) sold eight counterfeits and 16 substandard drugs (out of 332 tested).

How about prices? When it came to brand name drug prices, the studies showed that credentialed international pharmacies were about 60% cheaper. (more…)

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Brussels Principles promote online access to affordable medication

Principles to guide the Internet community on ethical medication sales

A few months back, I wrote about a panel that I put together as part of my work with PharmacyChecker.com and Prescription Justice, a non-profit group dedicated to ending the crisis of high drug prices in America. The panel was one of hundreds of sessions at the RightsCon Conference in Brussels, an event that brings together Internet freedom, human rights and social justice activists. The panel discussed issues related to buying medication online, Internet freedom, importation and drug affordability – and the negative impact of the pharmaceutical industry on all of the above.

Essentially, drug companies have spent millions of dollars on funding “non-profit” groups, public relations efforts, lobbying Congress and international organizations, Interpol (I kid you not), etc., with the goal of making it hard, if not impossible, for people to buy safe and lower cost medication online from other countries, which include people in America, that can’t afford it locally. Their activities intentionally conflate the intentional sale of counterfeit and substandard drugs with safe international online pharmacies.

The panel was a great step forward in giving the consumer side of this issue a larger voice. The panelists discussed and edited a draft set of principles on medication sales and the Internet. It took a while, but, on June 15, 2017, Knowledge Ecology International and Prescription Justice finalized and endorsed what we’re calling the Brussels Principles, which are published below. (more…)

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Legalize it; don’t criticize it – prescription drug importation

In 1976, reggae legend, Peter Tosh, released his song “Legalize It” – calling for the legalization of marijuana. In it, he sings “legalize it, don’t criticize it.” Needless to say, that’s already becoming our reality in the U.S. where, to varying degrees, many states have made pot legal. The federal government has begrudgingly accepted dissension in the ranks of states. Yes, there are rumblings that under Attorney General Jeff Sessions things are going to change. We’ll see.

This week, journalist and pharmaceutical industry analyst, Ed Silverman, from Stat News, published an opinion article called “It’s time to make it legal for Americans to order prescription drugs from abroad.” Unlike the downpour of op-eds against importation sponsored by drug companies, Silverman has no financial interest in this.

To be intellectually honest, Silverman’s call to action is qualified. He seems to be saying to “legalize it,” but he’s not necessarily advising that we not “criticize it.” There are real threats from counterfeit and otherwise substandard drugs that need to be addressed in reforming the law. Dr. Aaron Kesselheim, professor of medicine at Harvard, offers his own thoughts in Silverman’s piece: “We should be able to address this safety issue…To not have the conversation and instead say there’s no way to import medicines safely is a cop-out.” (more…)

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Coalition of Non-Profit Groups Show Support for Americans Who Import Medication for Personal Use

Getting some prescription justice

This week, the group Prescription Justice sent a letter to Congress (House and Senate) signed by prominent non-profit activist and policy organizations – and PharmacyChecker.com (we were the only company!) – that clearly recognizes the lifeline of personal drug importation and the role that safe international online pharmacies play. The focus of the letter is support for the Affordable and Safe Prescription Drug Importation Act of 2017, which would help expand lawful options for importing lower cost medication, through retail and wholesale commerce. I wrote about this drug importation legislation a couple of months ago.

Too frequently I read articles in support or against drug importation that both drive me nuts. You’d think that I love the former and hate the latter but that’s not the case. I’m often equally annoyed when the authors either don’t know or care to write about the reality of prescription drug importation where people just go online, order their medication from Canada or another country, send in their valid prescriptions and get it by mail. As the letter iterates:

“Despite the federal restrictions, millions of Americans already import life-saving medications for their own use. While this practice can be done safely through properly credentialed international online pharmacies, it poses a real danger to patient safety because of rogue Internet drug sellers.”

And that’s why PharmacyChecker.com does what we do: verify and identify the safest international online options, educate and warn about rogue pharmacies, and get vocal about it. While the drug companies are obscenely powerful and are spending through the teeth to create anti-importation op-eds and reports, and giving members of Congress lots of money, the truth is a pretty powerful adversary as well. And importing medication from a licensed pharmacy in Canada (and many other countries) is, in the real world of facts, safe. (more…)

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Congressman James Greenwood Was Right on Prescription Drug Importation

Who are you representing?

In 2001, in a Wall Street Journal article called “Survey Shows U.S. Customs Allows Illegal Foreign Medication,” then Congressman James Greenwood (R-PA) expressed his belief that Americans who import medications, even illegally, for their own use, should be able to. As president and chief executive of the Biotechnology Innovation Organization (BIO), which represents leading biopharmaceutical companies (such as Abbvie, Amgen, Celgene, and Gilead), he has changed his tune.

Flashback to 2001…

Congressman Greenwood, who chaired the House Commerce oversight committee, stuck up for cash strapped older Americans. Congressman Greenwood said:

“While we would like to stop dangerous drugs from being brought in for abuse and stop people from getting drugs that are counterfeit or bogus, we don’t want to interfere … with an older person getting a better buy.”

He was referring to Americans importing small quantities of non-controlled, prescription drugs for their own use because they cost a lot less money than at U.S. pharmacies.

Fast forward to 2017… (more…)

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