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Protect Your Loved Ones from Online Counterfeit Drugs!

Dr. Carmen Catizone - July 16, 2012 08:12 AM

These days, buying prescription drugs from the Internet is easy, but finding a safe source for those medicines is not. Food and Drug Administration (FDA) recently warned consumers about a potentially dangerous counterfeit version of Adderall tablets being sold on the Internet – the tablets contained the painkillers tramadol and acetaminophen rather than the active ingredients of the authentic ADHD drug, Adderall.

The AWARXE Consumer Protection program encourages consumers to make an informed choice when buying medications online by using resources provided by the National Association of Boards of Pharmacy® (NABP®). As part of its mission to protect the public’s health, NABP has reviewed, and continues to review, thousands of Web sites to determine if they maintain safe pharmacy practices. Unfortunately, the majority of Web sites selling prescription drugs do not.

 NABP has reviewed more than 9,800 Web sites selling prescription drugs. AWARxE alerts consumers only 3%, or 328, of these sites appear to be in compliance with state and federal laws and NABP patient safety and pharmacy practice standards. The other 97% of these sites are considered rogue sites and are listed as Not Recommended on the AWARxE Web site, WWW.AWARERX.ORG.

Of the sites reviewed, those currently listed as Not Recommended are characterized as follows:

•    87% do not require a valid prescription
•    50% offer foreign or non-FDA-approved drugs
•    59% use an online questionnaire to evaluate patient health and medication needs, which can be very dangerous
•    24% are located outside of the United States and selling drugs illegally to patients in the US

Such sites often distribute counterfeit drug products that may contain too little or too much of the active pharmaceutical ingredient, and often these products contain toxins such as glue, chalk, and rat poison.
Be aware that a Web site claiming to be a “Canadian pharmacy,” may actually obtain its medications from countries in Asia, South America, or Eastern Europe, where quality standards are more lax and counterfeit medications more widespread. While counterfeit medications can surface anywhere, they are significantly more common in developing foreign countries. That is the problem with buying medicine from foreign sources – you never know what you’re getting.

In addition, it is illegal for pharmacies in Canada to fill prescriptions unless ordered by Canadian-licensed prescribers. So, if an online Canadian pharmacy is in compliance with Canadian law, it would not fill a prescription written by a US doctor. Also, Web sites using  online questionnaires to issue “prescriptions,” do not establish the valid patient-prescriber relationship recommended by both Canadian and US authorities and required by law for many prescriptions in the US. Further, US law does not permit Internet pharmacies in Canada to sell medications for importation to United States residents. So, AWARxE cannot recommend any Canadian site selling drugs to Americans because FDA regulations prohibit this activity. Prescription drugs imported from other countries are not FDA-approved and their safety and effectiveness cannot be ensured because they are outside the legal structure and regulatory resources provided by Congress.

Safest Way to Shop for Medicine Online

AWARXE wants consumers to know about the safest way to purchase prescription medications online. When ordering prescription medication online, consumers can look for the VIPPS® (Verified Internet Practice Pharmacy SitesCM) Seal, and check the VIPPS list on WWW.AWARERX.ORG to make sure the site is listed there. VIPPS-accredited sites are in agreement with all federal and state regulations and NABP safety standards. Some VIPPS-accredited sites may even offer discount prescription programs to help offset the cost of medications.

More information about the Not Recommended list and VIPPS-accredited Internet pharmacies is available in the quarterly NABP Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators. The April 2012 report is available for download from the AWARxE Web site at

Follow Safe Use Tips to Avoid Medication Misuse

Whether you have your prescriptions filled at your local pharmacy, or order them from a VIPPS-accredited Internet pharmacy, it is important to follow safe use steps to protect yourself and those in your care.
Recent reports show an increase in the number of hospitalizations and visits to emergency rooms by older people due to improper use of prescription and over-the-counter medications. When older adults misuse prescription medications they have a higher risk of accidents, falls, and injuries. Some tips for safe medication use are as follows:

•    When picking up a new prescription, ask to have the label and dosage explained to you. If there are any discrepancies between what the pharmacist tells you and what your doctor has told you, ask to have that discrepancy resolved immediately.

•    Follow your doctor’s instructions for taking the medication, and talk to your pharmacist about any questions you may have.

•    Remember to turn on the lights and get your glasses. It's easy to mistake one pill bottle for another. Make sure you double check and read the label every time.

•    If you miss a dose of your medication, or if you mistakenly take more medication than recommended, call your doctor or pharmacist.

•    Do not increase, decrease, or stop taking medicine without calling your doctor.

•    Do not crush or split pills unless you have been instructed to do so by your doctor or pharmacist. Some pills are designed so that the medication is released over time, and by crushing them you may absorb the medicine too fast. By splitting pills, you may not get the correct dosage because for some drugs it is very difficult to split the pill exactly in half, thus the actual dose in each half of a split tablet can be different.

•    Tell your doctor or pharmacist if you believe you are having side effects from a new prescription. Pay attention to how you feel. If you feel differently after beginning a new medication, call your doctor or pharmacist immediately.

There are many other tips for safe use of prescription drugs on the Medication Tips for Seniors page of the AWARxE Web site,

Secure Storage and Safe Disposal to Prevent Misuse and Abuse

One in four grandparents indicate that they leave their medications out, making these medications easily accessible to children and teens. Leaving drugs out can put children at risk for accidental ingestion. And often those who abuse drugs, including teens, take them right of the medicine cabinet or other easily accessible locations. In fact, over 50% of people abusing these drugs got them from friends or family for free.

These facts point to the importance of securely storing all medications to prevent accidental ingestion and intentional abuse. For example, you may want to lock your medications in a secure cabinet or a medicine safe. In particular, you should securely store controlled substance prescription drugs, such as certain pain medications and ADHD medications. You may also wish to keep track of the number of pills left in the bottle.

If you have pills or medication that is no longer needed or has expired, dispose of it at an authorized DEA Take-Back location, or a local medication disposal program. The next DEA Take-Back Day is September 29, 2012 and collection sites will be located across the country.

Also, cities and counties across the country provide permanent medication disposal programs. Many programs provide a drop-box at a police department—these programs can take controlled substance medications for disposal. Other programs are run by hazardous waste disposal agencies or other entities that cannot accept controlled substance medications, but can take all other unused drugs for safe disposal.

Many of the AWARxE Get Local pages have links to local disposal programs, and we are actively expanding these resources. We are happy to take information about local programs and post it on our Web site. Anyone who has information on a disposal program can e-mail the information they have to AWARERX@NABP.NET and we will review it for inclusion on the respective state’s Get Local page.
If there are no drug disposal sites near you, there are options for disposing of drugs at home. The information that comes with your prescription may provide instructions on home disposal. Only some medications should be flushed down the toilet and the US Food and Drug Administration has a list of these drugs on its Web site. If there are no instructions for disposal you can throw the drugs in your home garbage. But first, take them out of the container and mix them with an undesirable substance like coffee grounds or cat litter.

Click here to read Dr. William Simonson’s blog, “Happy New Year Medicine Cabinet Review!”

Dr Carmen Catizone is the Executive Director of the National Association of Boards of Pharmacy® (NABP®) and the Secretary of the Association’s Executive Committee. He currently serves as a Governor of the Pharmacy Technician Certification Board (PTCB) Board of Directors and Chair of the PTCB Certification Council. AWARxE® is a consumer protection program provided by the National Association of Boards of Pharmacy Foundation®. The National Association of Boards of Pharmacy is an impartial professional organization that supports the state boards of pharmacy in creating uniform regulations to protect public health.

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