Are All Medications Sold in Canadian Online Pharmacies Sourced from Canada?
As of 2019, there are at least 2 federal bills proposing to lift the ban on personal importation of prescription medications from Canada into the US. 19 million Americans already buy drugs from Canada even though it is technically illegal. Canada is the preferred potential supplier of pharmaceuticals for both the legislators and the customers because drugs cost up to 83% cheaper there yet the Health Canada quality control system is as strict as in that of the US FDA. Still, researchers like Drs. Scott Gotlieb, Robert Stein and Marvin Shepherd disagree with the majority. According to them, the pharmaceutical imports from Canada are not risk-free as the medications marketed as Canadian come from the Third World countries.
One of the early reports published in 2005 claims that 85% of the drugs advertised as Canadian online are manufactured elsewhere. Even if the package with the medication is sent from Canada or another Tier 1 country such as Australia or the UK, it does not guarantee that it originates from there. The scheme works the following way: the parcel with the medication is sent from its original location to a distribution center in Canada, where it is relabeled and forwarded to the customer. As the result, its country of origin remains undisclosed.
The 2017 report published by The National Association of Boards of Pharmacy reviewed 108 online pharmacies that had the words ‘Canada’ or ‘Canadian’ in the names and/or provided a Canadian address in the Contacts section. 74% of these pharmacies were sourcing products from countries other than Canada. 54 pharmacies, or 50%, get the medications either from India or from several countries including India, China, Hong Kong and Singapore at once. There are 26 manufacturers from China, 8 from India and 4 from Hong Kong among top 100 largest pharmaceutical companies in the world. Still, the risk of running into counterfeit medications remains as high as 20% in these countries.
The article by Griffin et al published in 2019 analyzed the contents of three generic drugs ordered from online pharmacies. The researchers purchased 3 black box medications – Nolvadex, Actos and Wellbutrin SR. Generics Tamodex, Piomore and Buprotic were received. Gas chromatography-mass spectroscopy revealed that one of the drugs contained an active ingredient different from the one it was supposed to contain. The other two contained correct active ingredients but the strength did not match the FDA requirements for generic medications.
Recently the US government started seizing more products sent across the border. While there were only 10,000 packages intercepted in 2017, the number was expected to reach 40,000 in 2018. This is done both to limit the importation of low-quality medication and to fight the opioid crisis in the States. The FDA news release says the operation targets opioid meds and illegal drugs claiming to treat cancer and HIV.
Does It Mean That All Canadian Pharmacies Supply Meds of Low Quality?
No, it does not. Legitimate online pharmacies from Canada either sell FDA-approved drugs or their equivalents that are safe and have the same effect.
There has been controversy over the way US government struggles with Canadian online pharmacies. In 2019, the US FDA issued a warning letter to Canada-based company CanaRX for facilitating the sale of unapproved new medications and misbranded drugs to American customers. No evidence was provided but the FDA officials say the investigation is still in progress.
A similar case was related to the wholesale division of Canada Drugs. This company unknowingly sold two batches of counterfeit cancer drugs, Avastin and Altuzan, to physicians in the United States. Both drugs contained no active ingredient. As the result, both the wholesale and the retail departments of Canada Drugs were shut down by the US authorities even though there were no accusations against the company’s retail department. There is an alternative point of view laid out in the personal blog of the PharmacyChecker.com President Gabriel Levitt claiming that the shutdown was aimed primarily at protecting the pharmaceutical market from cheaper generic drugs. Levitt also mentions that CVS and CVS.com were once accused of selling counterfeit Lipitor too but it didn’t lead to business closure.
How to Tell a Legit Canadian Pharmacy from One That Sells Counterfeit Meds?
One way to find out which Canadian online pharmacies are legitimate is by checking the websites of the organizations that verify reliable retailers of pharmaceuticals – for example, CIPA or Pharmacy Checker. It should be noted that both CIPA- and PharmacyChecker-approved pharmacies offer medications from Canada as well as other countries – the UK, India, Turkey, Mauritius, etc. The customers get to decide themselves, which manufacturing and shipping country to choose.
Alternatively, one can use the services of facilitator companies such as the Canadian MedStore or Canadian Discount RX Services, both located in Florida. These US-based companies don’t sell Canadian drugs themselves but help to steer the American clients to reliable online pharmacies from Canada for a fee.
What Canadian Drugs Are Commonly Searched for by the Americans?
Since there are no volume estimates for actual cross-border purchases provided in public sources, the following analysis was performed to figure out, which medications are popular among US-based customers buying from Canada.
- The Drugs.com Top 200 Drugs list was used as the source
- The name of each of the medications (for example, ‘Viagra’) was combined with the words ‘Canada’ and ‘Canadian’ to form keywords like ‘Viagra Canada’
- The resulting keywords were then checked using the SearchVolume.io tool to define, how many times each of them was searched for from within the United States in 1 month.
- The keywords were sorted from the most to the least popular.
Here is the resulting list of 10 commonly searched drugs from Canada in the US:
Adderall, Ambien, Hydrocodone and Oxycodone are controlled drugs and common substances of abuse in the United States. Viagra, Cialis and Levitra are medications used to treat erectile dysfunction. Albuterol and Flonase are asthma medications. Amoxicillin is an antibiotic used to treat upper respiratory tract and other infections.
Even though the drug quality control system in Canada is at par with the American one, ordering medications from Canada online puts US-based customers at risk of receiving counterfeit products. The new legislation on personal imports will regulate this market and reduce the risk. For now, the clients interested in buying drugs from Canada are recommended to shop at CIPA- or PharmacyCheker-verified online drugstores or use the services of facilitator companies.
- Kaiser Health Tracking Poll Report, November 2016 - http://files.kff.org/attachment/Kaiser-Health-Tracking-Poll-November-2016-Topline
- The federal bills to allow personal importation of prescription drugs from Canada into the US - https://safe.pharmacy/2019/02/01/with-new-congress-comes-renewed-prescription-drug-importation-efforts-at-the-state-national-levels/
- Medication price comparison, Canada vs the US - https://www.pharmacychecker.com/askpc/is-medicine-in-canada-cheaper/
- The risks of importing medications from Canada - https://www.healthline.com/health-news/fda-sends-warning-to-canadian-drug-company-what-to-know#Trading-FDA-protections-for-lower-prices
- 2005 FDA news release on actual origins of medications sold in Canadian online pharmacies - http://www.safemedicines.org/wp-content/uploads/FDA-Operation-Reveals-Many-Drugs-Promoted-as-_Canadian_-Products-Really-Originate-From-Other-Countries-captured-January-2017.pdf
- Drugs sold in Canadian online pharmacies get transshipped through several countries prior to being sent to the final customer - https://www.tmj4.com/news/i-team/fake-meds-draw-concerns-from-online-pharmacy-users
- 2017 NABP report on rogue pharmacies claiming to be Canadian - https://nabp.pharmacy/wp-content/uploads/2016/08/Internet-Drug-Outlet-Report-August-2017.pdf
- Top 100 largest pharmaceutical companies in the world - https://www.datawrapper.de/_/3qmpF/
- 2017 Special 301 Report by the Office of the US Trade Representative (USTR) - https://ustr.gov/sites/default/files/301/2017%20Special%20301%20Report%20FINAL.PDF
- Analysis of 3 black box drugs purchased from online pharmacies - https://www.tandfonline.com/doi/full/10.1080/14659891.2019.1595197?scroll=top&needAccess=true
- Growth in the number of medication shipments seized by the US border control, 2017-2018 - https://tarbell.org/2018/06/trump-administration-seizing-cheaper-medications-from-canada-and-other-countries/
- The FDA news release on seizing counterfeit medications shipped into the US - https://www.fda.gov/news-events/press-announcements/fda-launches-global-operation-crack-down-websites-selling-illegal-potentially-dangerous-drugs
- The FDA issues a warning letter to CanaRX, a Canadian company facilitating the sale of unapproved and potentially counterfeit medications to customers in the US - https://www.fda.gov/news-events/press-announcements/fda-warns-canarx-selling-unapproved-misbranded-and-unsafe-imported-drugs-unsuspecting-americans
- CanadaDrugs.com case - https://www.safemedicines.org/policymakers-media/canada-drugs-case
- The official website of the Canadian International Pharmacy Association - https://www.cipa.com/
- The Drugs.com Top 200 Drugs list - https://www.drugs.com/top200
- List of common substances of abuse - https://www.gatewayfoundation.org/addiction-blog/most-commonly-abused-prescription-drugs/