A presentation given jointly by the Mississippi Independent Pharmacists Association, JustAdvocacy (MS advocate for people with disabilities) and PSM.

1. COUNTERFEIT MEDICATION AND THE
THREAT TO MISSISSIPPI PATIENTS

2. How Patients Are Protected
• Regulated, closed, licensed, secure supply chain, covering:
– Pharmacists and pharmacies
– Nurses, Physicians
– Wholesalers & Manufacturers
• FDA testing of medications
• FDA and company pharmacovigilance programs
• Pharmacist and physician supervision of medication choices and
interactions
Any break in the hand to hand regulatory chain
endangers patients. America is one of the few
countries with a closed, secure, drug supply chain.

3. How patients are endangered from
supply chain breaks
• Common: patients break it
– Buying online from unlicensed pharmacies
• Less common:
– Physicians, pharmacists, and distributors buying
from unlicensed distributors
• Uncommon:
– Manufacturing supply chain producer

4. Myths: Canadian online pharmacies are
pharmacies in Canada with a website
Unless you drive over the border into Canada to
a bricks and mortar pharmacy, when you order
from an online pharmacy you're getting a
company that pretends to sell non-Canadians
price-controlled medications for citizens.
These companies are not regulated by Health
Canada or the Provincial Pharmacy Boards.

5. Myth: Canadian pharmacists can legally
fill prescriptions from US physicians
• Pharmacists in Canada are not allowed to
legally fill a prescription written by an
American physician.
• Therefore if a “Canadian pharmacy” tells an
American to fax their prescription in, they’re
either breaking laws in their own country, or
there’s no pharmacist involved at all.

7. Save Money by Using FDA Approved
Generics
Not only can a generic be cheaper than a name brand, but a generic in the US
is usually cheaper than a name brand from a fake “Canadian pharmacy”. And
safer too.

8. UNIQUE THREATS TO THE MISSISSIPPI
DISABILITY COMMUNITY AND THEIR
FAMILIES

9. Unique challenges to our community
• Medicaid & Medicaid Disable Child at Home
Program provide access to Medicaid coverage for
children with disabilities, but limit prescription
drug coverage to 2 name brand and 3 generic
drugs per month.
• Individuals with disabilities and Seniors who are
Medicaid beneficiaries and transitioning to the
community out of care facilities have a limit of 5
prescription drugs where they had unlimited in
the facility.

10. Children with seizure disorders
• In most cases a generic is an easy swap with
no therapeutic difference, but we see
problems in this area.
• Parents have reported generic antiseizure
medications do not always work for the child
and, in fact can make the condition and side
affects worse.
• This can also be true of Psychotropic
Medications.

11. Patient Safety: How to find discounts
The NeedyMeds Drug Discount Card
saves you up to 80% or more off
the cost of:
Prescription Medicines
Over-the-Counter Drugs
Pet Prescription Drugs
The Partnership for Prescription Assistance
will help you find the program that’s right for
you, free of charge.

12. Our community needs information
• Patients and their caregivers don’t know the
risks or that even safe options exist.
• Many seniors aren’t computer-savvy, and
require assistance to take advantage of some
of these programs.

13. THE PROBLEM BEYOND MISSISSIPPI

14. 97% of more
than 10,000
websites
sampled were
out of
compliance
with laws and
pharmacy
practice
standards.
1 in 6
Americans buy
drugs on the
Internet
without a
prescription.

15. Patient story: Buying meds online isn’t
like buying socks
(where’s the cheapest price?)
• Even if it’s an over-the-
counter medicine, it’s still
medicine.
• Victims purchased over-
the-counter weight loss
medication from a
website, "www.2daydietsh
opping.com."
• Purchasers reported many
life-threatening side effects
including stroke.
• 2 people were convicted in
2011.
Containing sibutramine, a
prescription-only
ingredient, the pills could lead
to
• elevated blood pressure
• stroke
• heart attack
• anxiety
• nausea
• heart palpitations
• a racing heart
• insomnia
• increases in blood pressure

16. So, where do the fake pharmacies get
their medications?
These products are not made in a sterile environment. And then these fakes are sold
to American patients from “Canadian pharmacies” who ingest them.

17. YouTube videos and
cartoons teach IUD
and implant
insertion and
removal,
despite the risk of
infection and death.

18. First occurrence: fake devices
Two physicians in
Kentucky were
recently indicted
for purchasing IUDs
bought from an
unlicensed Chinese
manufacturer and
implanting them in
patients.

19. Patient story: Lorna Lambden
Even getting real medication can be deadly
She bought medication online without a
prescription and without a pharmacist to
inform her.
Said her family: “Lorna died after taking a
small amount of medication which she had
purchased on the internet to help with
tiredness and sleeping. This medication
turned out to be exceptionally dangerous.
The Coroner thought Lorna’s death was a
tragic accident. Please can this be a warning
to anyone purchasing prescription drugs on
the internet!”
Lorna Lambden, 27, ordered from
an online pharmacy ended up
receiving a very powerful sleeping
aid without any safety instructions.

20. Doctors have been found with
misbranded drugs
In the past year alone…
• Cancer drugs – 134 doctors in
28 states
• Osteoporosis – 20 doctors in 10
states
• Botox – 350 doctors in 38 states
Fragile biologics that require
in-clinic use and careful storage are
becoming new targets for
counterfeiters.
The clear liquid could be
medication, or it could be saline.

21. Map graphic courtesy of the Wall Street Journal.

22. Patient Safety: How to stay safe in the
doctor’s office
• Signs of suspicious medication in
the doctor’s office.
– Look for foreign writing
– Ask to see bottle/bag/unit with lot
number and write it down or take a
photo
• Pay attention to new or unusual
side effects or lack of therapeutic
benefit and notify your
physician/pharmacist.

23. Myths: Canadian online pharmacies sell
price-controlled medication from Canada
Canadian citizen Andrew
Strempler, 38, sentenced January
9th, 2013 to 4 years after pleading
guilty to conspiracy to commit mail
fraud.
Strempler’s
company, Mediplan, fulfilled online
medicine orders for ten different
online pharmacies.
FDA discovered that 90% of the drugs they seized from a Mediplan shipment were
counterfeit: Lipitor, Diovan, Actonel, Nexium, Hyzaar, Ezetrol (known as Zetia in the
US), Crestor, Celebrex, Arimidex, and Propecia.
These were not Canadian medicines, they were fakes from all over the world,
mailed from the Bahamas, with labels saying they were filled from Canada.

24. Distribute our resources to your
community
• Save Money Safely on Your Prescriptions from Online
Pharmacies (brochure)
• Learn 5 Kinds of Poisons Found in Counterfeit
Medicines (interactive)
• The 5 Secrets Canadian Web Pharmacies Don’t Want
You to Know (webpage)
• SAFEDDRUG: An 8 Step Checklist for Medicine Safety
(brochure)
• Safe Savings: Tips for Saving Money on Medicine Safely
(brochure)
• We can also design a custom patient safety handout
for your community.