25%, 20%, 10%, 5%, 2%, 1%?

A few years back, the FDA published the results of a survey from 2012 that showed 23% of Internet users purchase medication online. That number has been used by a variety of groups funded by pharmaceutical companies and U.S. pharmacy corporations, and apparently the Government Accountability Office, to imply that a quarter of the U.S. population is buying medication from dangerous rogue online pharmacy sites. The number is probably lower than 2%, which is still too high but it’s important that the public and our elected leaders face and tackle the online pharmacy problems that really exist, not fake ones that distort public perception and serve entrenched business interests…and lead to fewer Americans getting medicines they need.

This week, in our continuing quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing the next section of our report called Online Pharmacies, Personal Drug Importation, and Public Health
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Unused Medication – What Do You Do With It?

PharmacyChecker.com’s focus is on helping consumers find safe and affordable meds online while avoiding rogue pharmacy websites. But what do people do with unused medication? Leaving unused prescription drugs in medicine cabinets at home can leave them susceptible to abuse or accidental ingestion. Unused medication includes those products that you no longer need or that are expired. Disposal methods include bringing medication to “take-back” programs in your community, safely throwing in the trash, and even flushing meds down the toilet – but there are important guidelines to ensure safety.

Medication disposal is a particularly critical issue when it comes to controlled drugs, ones susceptible to abuse, because prescription drug abuse has reached epidemic proportions in the U.S. About seven million Americans abuse prescription drugs, often powerful narcotics, such as oxycodone and Adderall, almost twice the number found to abuse illegal drugs, such as heroin and cocaine. About 70% of first time abusers get the drugs from friends or relatives, including from their medicine cabinets!

The U.S. Food and Drug Administration (FDA) recommends following the disposal instructions on the label of the drug. Don’t flush your meds down the toilet except when instructed to do so. Your community will likely have drug “take-back” programs. Call your local government offices to find them. In the absence of instructions or take back programs, the FDA recommends throwing most medications away in the household trash. Mix loose medication in a sealable bag or container with an undesirable substance such as coffee grounds or litter. It’s also recommended that you remove or scratch out any information on the prescription label so that it’s unreadable.

The FDA recommends flushing narcotic pain relievers such as fentanyl patches, morphine, Demerol, Percocet, and OxyContin, among many others, as soon as they are no longer needed because of their high risk of abuse. There are environmental concerns related to flushing medication, such water contamination. However, according to the Environmental Pro¬tection Agency, scientists to date have found no evidence of adverse human health effects from pharmaceutical residues in the environment. FDA provides a complete list of medications for flushing here.

Before throwing disposing of any medication, the FDA also recommends removing the labels on pill bottles to remove any information others might use

Drug and regulatory authorities have recently stepped up options for prescription painkiller disposal to combat the addiction epidemic. In fact, a relatively new FDA rule now allows pharmacies, doctors’ offices, and hospitals to collect controlled substances from consumers. The DEA has launched a drug collection site database to help you find one. The public may find authorized collectors in their communities by calling the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539

What about destroying your medication?

There are products on the market for consumers and healthcare providers for disposing of medications. We DO NOT ENDORSE them but here are a few that may meet your needs help you follow the advice noted above:

Medsaway Medication Disposal System

Pill Terminator

Disposing of your medication responsibly improves safety for you, your loved ones, and everyone else that may come into contact with it.

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What does the data actually show about the safety of buying medication online? Is it really dangerous to buy lower cost medication from a pharmacy in another country over the Internet? Do drug companies fund research in this area?

This week, in our continuing quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing the next section of our report called Online Pharmacies, Personal Drug Importation, and Public Health(more…)

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John Horton, the founder of LegitScript, a company which seems bent on preventing Americans from ordering affordable medication from outside the U.S., recently attempted to discredit PharmacyChecker.com with a false and misleading blog post. This is an old tactic of Mr. Horton. Why does he do this? At least two reasons come to mind: PharmacyChecker.com publishes information that helps Americans find safe and affordable medication from licensed foreign pharmacies and we have publicly exposed Horton’s seemingly unethical business practices.

LegitScript is allied with large pharmaceutical companies and U.S. chain pharmacies, entrenched business interests that lose money when Americans buy less expensive prescription medication outside the U.S.

Mr. Horton’s recent blog post discussed charges against Titilayo Akintomide Akinyoyenu, a pharmacist in Washington D.C. From 2005 to 2010, Mr. Akinyoyenu is alleged to have filled orders from his pharmacy for controlled medications pursuant to prescriptions written by a licensed doctor that were invalid because they were based on online questionnaires rather than a face-to-face examination. His pharmacy was licensed in the District of Columbia and is registered with the Drug Enforcement Agency to sell controlled medicines. He operated an online pharmacy, apexonlinepharmacy.com,which was associated with his licensed pharmacy. PharmacyChecker.com verified the licenses and DEA registration of Mr. Akinyoyenu’s pharmacy, and checked that the online pharmacy required a valid prescription and met other good online pharmacy practice standards, permitting his online pharmacy to be approved in the PharmacyChecker.com Verification Program until August 31, 2010.

Despite the fact that apexonlinepharmacy.com is not a PharmacyChecker-approved online pharmacy and has not been for about five years, Mr. Horton saw an angle in the allegations against Mr. Akinyoyenu to take a shot at PharmacyChecker and give his blog post the false and misleading title “Another PharmacyChecker Approved Internet Pharmacy Gets Indicted.” The indictment is not of the pharmacy, but of Mr. Akenyoyenu himself and it makes no mention of PharmacyChecker. (more…)

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Americans have been ordering medication over the Internet from foreign pharmacies for about 15 years. How many reported deaths or serious adverse reactions would you guess have been associated with purchases from international online pharmacies that require a prescription? Zero. Sadly, rogue online pharmacies, domestic and foreign, have contributed to injury and even death.

This week, in our continuing quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing the next section of our report called Online Pharmacies, Personal Drug Importation, and Public Health(more…)

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Access Our Medicine, a group whose mission is to “raise public awareness and engagement in the global problem of access to medicine” has launched a Thunderclap campaign to amplify its reach. While Access Our Medicine has a global focus, millions of Americans go without medication each year because of high costs; the Thunderclap campaign will help amplify these voices by sending out thousands of messages at once advocating for affordable medicine.

If you believe, as we do at PharmacyChecker.com, that everyone should have access to affordable medicine, THEN SIGN THE PETITION NOW!

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Continuing our quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing a section a week of our report called Online Pharmacies, Personal Drug Importation, and Public Health. Our report refutes a flawed GAO report about Internet pharmacies.

This week we look at the evidence that proves that illegal personal drug importation is not inherently unsafe. First of all, when Americans buy medication from a licensed pharmacy in Canada, India, Turkey, or the UK, the pharmacy itself is legal in those countries: after all its licensed. Unfortunately, it’s technically illegal under most circumstances for a consumer to import meds for their own use from those pharmacies. It’s very common for groups funded by big drug companies to confuse consumers and even lawmakers that this illegality means the practice is inherently not safe, but that’s not true…

Illegal Doesn’t Mean Unsafe

The GAO report misconstrues safety and legality in its analysis of Internet pharmacies. The report states: “By violating federal and state laws, rogue Internet pharmacies threaten the public health.” For about fifteen years, often in violation of federal and state laws, millions of Americans have safely imported medication ordered online, pursuant to a valid prescription for their own use. As evidenced throughout this report, it’s not the violation of federal or state laws that threaten the public health but the actions of rogue pharmacy operators who sell fake or otherwise dangerous medication, or real medication without requiring a prescription.

The facts about personal drug importation are as follows: 1) Through orders placed online, tens of millions of Americans have imported medication from licensed pharmacies that require a prescription over the past 15 years with no reported deaths or serious adverse effects; 2) the practice is technically illegal under most circumstances; 3) there is no evidence that shows personal drug importation of non-controlled medication where a prescription is required is inherently unsafe; 4) according to the FDA, no one has ever been prosecuted for importing small quantities of prescription drugs for personal use.1

If an American receives a drug ordered online that was dispensed and mailed properly from a licensed pharmacy, it makes no difference from a safety perspective whether the product came from a U.S. or foreign licensed pharmacy, as long as the drug has the right amount of the active ingredient, treats the condition as intended, and is administered in the manner intended by the physician who prescribed the drug. Like those sold in U.S. pharmacies, medications ordered from credentialed international online pharmacies are produced in factories employing Good Manufacturing Practices (GMP) and are distributed, stored, dispensed, and mailed properly. The drugs are the same as or foreign versions of those sold in U.S. pharmacies.


1“Should You Use an Overseas Pharmacy,” MoneyTalksNews.com, 2/1/2013. An email written by Christopher Kelly, Center for Drug Evaluation and Research, FDA, states: “FDA is not aware of any actions taken against an individual resulting from their purchase of small quantities of unapproved drugs for personal use.” http://www.moneytalksnews.com/2013/02/01/is-it-safe-to-use-an-overseas-pharmacy/, [Last accessed 12/17/2013].

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Continuing our quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing a section a week of our report called Online Pharmacies, Personal Drug Importation, and Public Health. This week we look at the reasons why Americans look online to buy medication:

High U.S. drug prices are one of the main reasons that Americans go online to buy medication. As stated previously, according to the CDC, about five million Americans buy medication internationally each year due to high domestic drug prices. The CDC’s figures and others identified below show that over the past 15 years, tens of millions of Americans have purchased medication from outside the U.S. using online pharmacies to save money or because they could not afford the prices at their local pharmacies. Fifty million Americans between the ages of 18 to 64 did not fill a prescription in 2012 due to cost, up from 29 million in 2001. The data demonstrates that Americans need international online pharmacies due to a public health crisis of high domestic drug prices.

There are other reasons Americans go online to buy medication besides cost. Online pharmacies offer convenience and anonymity. For some consumers with mobility problems or for those who live in rural locations, ordering online and receiving medication by mail can be very helpful. Others may feel embarrassed about their medical conditions, which are sometimes unintentionally disclosed at their local pharmacy counters, preferring to order privately online.

Unfortunately, some Americans go online seeking medication without first obtaining a prescription from their healthcare providers. Many such people should not be judged. Americans who are uninsured may be unable to afford the medical care necessary to get a prescription and shop from online pharmacies that do not require one. Others just don’t want the “hassle” of going to the doctor and getting a prescription. There are obvious and inherent dangers in taking certain medications without first consulting with a licensed prescriber. Additionally, online pharmacies, foreign and domestic, that do not require a prescription are more likely to sell falsified and substandard medication and not ship medication safely.

Growing numbers of insured Americans in the coming years, a result of the Patient Protection and Affordable Care Act, will lead to a decline in medications ordered online without a prescription. However, many newly insured will find that their prescribed medications are not covered by their plans and are too expensive to pay for out-of-pocket at a U.S. pharmacy. For some, international online pharmacies are the only route to obtaining needed medication.

Finally, some Americans looking to obtain prescription narcotics without a prescription turn to the Internet, but the prevalence of such purchases are a small part of America’s prescription abuse problem. Still, the most serious negative health consequences related to prescription drugs bought over the Internet are from controlled drugs purchased without a valid prescription. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which largely banned online prescribing for controlled substances, was named after 18 year-old Ryan Haight who purchased prescription narcotics from an online pharmacy based in Oklahoma without a valid prescription and died from an overdose.

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When a Canadian Online Pharmacy Isn’t Just Canadian

An article by Joe Rothstein in EIN News concerning personal drug importation and online pharmacies recently caught our eye for two reasons. First, Mr. Rothstein called out the pharmaceutical industry for funding groups that give poor advice to consumers about buying medication online. Second, Mr. Rothstein identified PharmacyChecker.com as a source for “providing a list of certified Canadian suppliers who sell at prices usually well below the cost of U.S. pharmacies.” It is true that we do that, but our efforts extend far beyond Canada; we also verify and inspect pharmacies in many other countries, which was not mentioned in the article.

So what’s the issue? Remember, that according to the FDA, personally importing medication under most circumstances is technically illegal. Of course, many of us believe that it can be and is done very safely. Mr. Rothstein’s article states “…defenders of the importation law argue that thousands of phony online sites claim to be ‘Canadian’ to fool the unwary, and for self-protection consumers should avoid Canadian sites entirely.” Opponents of personal drug importation use those quotes around Canadian because they believe that dangerous rogue online pharmacies deceive consumers by claiming to be Canadian, only to ship medication from another country. On this count we agree with Big Pharma, however there are also safe Canadian online pharmacies that do refer prescription orders to licensed pharmacies in other countries. (more…)

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Are All Generic Prescription Drugs Created Equal? PharmacyChecker President Says No.

As we all know, an unaffordable drug is neither safe nor effective. No less true, an ineffective drug, whether dirt cheap or super expensive, can have hazardous health consequences, even death. That’s why consumers seeking low cost medication online look to avoid bad meds by finding accredited online pharmacies with a PharmacyChecker or VIPPS seal. But that might not always be good enough…

People don’t like to talk about it but sometimes when switching from a brand name med to an “equivalent” generic can lead to serious health problems. And this happens at your local U.S. pharmacy, not just online. Tod Cooperman, MD, president of PharmacyChecker.com, knows about this more than most people. In his capacity as president of ConsumerLab.com, he participated on an expert panel at a Congressional briefing this past Wednesday, organized by a new group called the Safe Medicines Coalition led by economist and counterfeit drug expert Roger Bate, PhD. The panelists and others are authors of a new paper called “Drug Inequality: Allowable Variations and Illegal Underperformance in Off-Patent Drugs.”

Dr. Cooperman’s main contribution to the panel comes from his experience testing a generic version of the anti-depressant Wellbutrin XL. To make a long story short, in 2007 ConsumerLab.com tested Teva’s FDA approved generic of the 300 mg version called Budeprion XL – an extended-release product. A generic drug that is bioequivalent to the brand name drug is supposed to work pretty much the exact same way as the brand. Consumerlab.com found that Teva’s generic did not dissolve like Wellbutrin XL – it released the drug much too quickly. It took the FDA more than 5 years but it finally conceded that the product was not bioequivalent to the brand product because it released the active ingredient much faster.

According to the People’s Pharmacy, people taking this generic were feeling more depressed, and even suicidal – until they switched back to the brand or to a different generic. The People’s Pharmacy and ConsumerLab.com shared this information with the FDA back in 2007 only to be ignored.

In order for the FDA to approve a generic drug for sale in the U.S., it must be proven to be bioequivalent to the brand name drug –delivering approximately the same amount of drug over the same amount of time in a group of healthy volunteers. It turns out that Teva never did this for the 300 mg version of Budeprion XL. The FDA approved the drug anyway, based on the data and approval for a lower strength version, Budeprion XL 150mg. What’s more amazing is that generic medications, even though they are not the exact same as their brand name counterparts, under U.S. law, must have the exact same clinical data in their package inserts as the brand name drug. That is, the data shown in the insert is NOT actually the data for that generic. This is meant to give the impression that all generics are the same as the brand name product, even though that’s not the case. If that doesn’t seem to make sense then you’re thinking clearly.

In 2012, the FDA admitted ConsumerLab.com had been right, and stated that Budeprion XL 300mg is was not bioequivalent to Wellbutrin XL 300mg.

Dr. Harry Lever, a cardiologist, talked about patients who were not responding well when switched to certain generic heart medications, such as beta blockers. Most interestingly, problems not only occurred when patients switched from brand to generic but even from generic to generic, which takes us back to the efforts of ConsumerLab.com above and moves us into a new point: Not all generic drugs are equal to each other, and a particular generic might work better in one patient than another!

The key takeaway from Dr. Lever’s and Dr. Cooperman’s presentations is that if a certain generic drug is working for you, then try and stay on that exact same medication. You’ll find it’s not easy because pharmacies often interchange generic drugs in their dispensing practices. You can avoid this by making sure you ask for the same generic, meaning the same manufacturer, each time you visit the pharmacy.

Mr. Bate focused on the fact that drug quality, generally, is not equal from manufacturer to manufacturer, brand to generic, generic to generic, country to country, etc. Mr. Bate is not saying that most generic drugs don’t work but simply that they are not exactly the same. Dr. Preston Mason supported this by presenting data based on testing generic versions of Pfizer’s Lipitor. He found that different versions were not all equal. The lowest quality products, based on number of impurities, were made in India for export to poorer countries.

The final presenter was Dinesh Thakur, the whistleblower that outed major manufacturing problems and corruption at Indian drug manufacturer Ranbaxy. Ranbaxy was actually granted the first go at marketing generic Lipitor in the U.S., but their version was eventually recalled due to small particles of glass that may have contaminated the product. You might find FDA’s nuanced position on the recall instructive and of great interest: “Patients who have the recalled medicine can continue taking it unless directed otherwise by their physician or health care provider….To date, FDA hasn’t received any reports of injury….The possibility of adverse health problems related to the recalled atorvastatin is extremely low.” I don’t recall hearing that the drug was not effective either but its recall was precautionary.

So what the hell are average consumers and even their healthcare providers to make of all of this? I’m going to copy and paste from ConsumerLab.com:

  • If a generic doesn’t work like the original drug, be concerned, particularly if it is an extended release (often called “XL”) product.
  • Be aware that the labeling on a generic drug describing its performance is copied from the labeling of the original product and may not reflect the performance of the generic.  This is a deception required by the FDA, perhaps to create the perception of generics as interchangeable.
  • If a generic works for you, look carefully at the label and identify the manufacturer. Request the same manufacturer each time you refill that prescription. Other generics may not behave the same way.

From my perspective, despite the FDA debacle with generic Wellbutrin XL discussed above, the FDA is one of the best drug regulatory agencies in the world. Following the advice above, you can and should trust generic drugs sold in the United States. What about generic drugs sold over the Internet from foreign countries? Pharmaceuticals sold in the most highly regulated countries are generally equivalent in quality and efficacy to those sold in the United States. What about from Indian pharmacies? The highest quality medications sold in Indian pharmacies are on a par with those sold in the U.S., too, but there’s more deviation and far too little oversight from the Central Drugs Standards Controller Organization, India’s FDA.

For all of these reasons, if you’re buying online and getting a drug internationally stay away from websites that are not credentialed by PharmacyChecker.com. And remember, despite crazy price increases in a good number of generic drugs, most generic medications approved for sale in the U.S., sold at local pharmacies are less expensive than International online pharmacy prices – even cheaper than India! However, brand name products are usually far less expensive outside the U.S. (and apparently sometimes safer than generics) – and you can check those prices on www.PharmacyChecker.com.

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