As it stands today, older adults are the number one consumers of prescription medication in this country. With baby boomers rapidly transitioning into their senior years, this trend will not only continue, but skyrocket. In just the last ten years, the use of medication by seniors has risen by nearly 40%.
Here are some other facts to consider -- 90% of seniors use at least one prescription drug on a daily basis, four out of ten seniors ages 65 or older use five or more medications weekly, and of this group, 12% use ten or more different medication. Overall, prescription drug use by seniors account for over one third of all medications dispensed in this country.
Why this tremendous use of medications by seniors? Well, we could be pessimistic and say the pharmaceutical companies are profiting off of the graying of America but the real truth is that medications help contribute to the health and independence of our seniors. With the move to keep our seniors out of institutional care and aging at home, new and improved medicines will play an integral part in making this a reality.
Unfortunately, the development of pharmaceuticals does not come cheaply, and many new drugs come with a hefty price tags and, if they are covered by health insurances, the co-pays may be just as hefty. So, aging baby boomers, most of whom are tech savvy, have access to the world through the internet and are searching to find other sources of prescription medications in order to save money.
But, as with all things, comes a warning – the Food and Drug Administration
(FDA) reports that 97% of online pharmacies are fraudulent and even more alarming, are peddling counterfeit medicines which may contain toxic materials. This is a major problem worldwide.
The counterfeit drug market presents a global threat to the health and safety of millions of patients looking to buy inexpensive medications. The World Health Organization estimates that 10% of medications worldwide are counterfeit with some under developed countries having a counterfeit rate of over 50%.
The major drug counterfeiters, according to the FDA, are located in China, India, Russia, Nigeria, Egypt and Turkey, where there are absolutely no laws against making and exporting these medications. The leading country responsible is India, where nearly 75% of these counterfeit drugs come from, according to the Organization for Economic Cooperation and Development.
When it comes to our country, the counterfeit rate is less than 1%, thanks to strict regulations and monitoring. However, when we look at the numbers of Americans using medications with the projection that it will only increase, and our access to the world market through the internet, counterfeit medications pose a significant threat to our seniors.
So the question to be asked, are counterfeit drugs fake? That's a difficult question to answer in simple terms.
Many counterfeit drugs do possess the active ingredient required to be in the medication, but because of the lack of regulatory oversight, the ingredients may be too much, too little or an entirely different drug. In addition to these concerns, a buyer may be getting some unexpected surprises.
The locations where these drugs are manufactured are usually unsanitary and those working there pay little heed to how they formulate the concoctions they are selling. These medications have been found to be contaminated with floor wax, rat poison, concrete, chalk, boric acid, road tar, paint and antifreeze – and this is just a few of the dangerous and toxic chemicals found in counterfeit drugs.
So, it doesn’t take a rocket scientist to understand that using these medications cause side effects ranging from being ineffective to allergic reactions to an increase in the symptoms of their conditions. In the most severe cases, death has resulted.
For example, two medications used by older adults – Alli, a weight loss drug, and Viagra – are two examples of ready “availability” on the internet. But what people were getting was not what they thought they were paying for.
Alli, which is available over the counter, is expensive. However, the Alli that
was being sold cheaply online contained dangerously high amounts of a controlled substance called sibutramine, a serotonin and norepinephrine reuptake inhibitor that had been used for short and long-term therapy of obesity, but was withdrawn from use in 2010 because of the increased risk of cardiovascular events. Those who used the counterfeit Alli experienced dangerously high blood pressure, heart attacks and strokes.
Viagra, thought to be the most counterfeited drug to date, thrives because of the stigma associated with buying it from the pharmacy. Few want to admit to the doctor having a problem with ED, and even fewer want to be paying for a bottle of the purple pills from a twenty-two-year-old pharmacy tech. Although many of the fake Viagra products don’t work, people continue to shell out big money for the on-line product. But some of the counterfeit Viagra did contain the active ingredient - sometimes too much - and caused problems for those with cardiac issues who may have been taking medications for angina.
Even over the counter herbal supplements manufactured overseas and sold by major American retailers have been found to contain impurities or lack the advertised product. During a routine test, four supplement powerhouses – GNC, Target, Walgreens and Walmart -- found that 80% of the tested products did not contain the medicinal herbs listed on the labels.
And the concerns about counterfeit drugs are not limited to those purchased from internet pharmacies. Some ten years ago, over 300,000 people, mostly seniors being treated for end stage renal disease, were exposed to contaminated Heparin. A toxic ingredient had been introduced by a supplier in China in a deliberate attempt to lower production costs. As a result, numerous patients in the United States died and a major recall of all Heparin products resulted in a shortage affecting those who needed it most.
Now comes the question, what about the multiple storefronts that opened advertising cheap drugs from Canada? You may have seen them with names like Canada Drugs or Canada Direct, advertising inexpensive medications, but there are questions over whether the medicines being sold are pure, or even from Canada.
In one storefront that opened locally some years ago (it is now closed), upon entering the store you were greeted by a person sitting behind a desk with a computer. On the walls were some photos of medication and ads, trying to give an atmosphere of legitimacy, yet there were no products that would even closely resemble what would be seen in a pharmacy. When the person got up from their facebook page, the customer was asked for the prescription and what transpired next was the script was entered into the site and payment was made with the promise that delivery would occur in a "few days".
But after numerous investigations into these so-called Canadian connections, it was discovered that only a small percentage of the drugs being ordered from these stores came from Canada. In fact, a FDA regulator named Howard Sklamberg told an ABC news reporter that the overwhelming percentage of drugs obtained there did not meet the regulatory requirements of the FDA. “They could have dangerous contaminants,” he said. “And that's just a really, really, really big risk to take with your health.”
So what medications are most likely to be counterfeited? Here's some insight.
As a cardiologist friend of mine says, “Treat heart disease with a doctor and not with a website.” Good advice indeed especially when you consider that heart attacks are the number one cause of death for both men and women. Still, Americans continue to turn to the internet for these drugs with a real danger that they will be getting a counterfeit or sub-standard medication. Drugs like Lipitor were at one point a highly counterfeited medication.
Antibiotics are prescribed for an infection and trying to treat it with a counterfeit antibiotic will not only allow the infection to spread but could make you even sicker given that many fake antibiotics have been found to contain heavy metals and other dangerous chemicals.
Fake cancer drugs have been found in nearly all countries including the United States. Five years ago, the FDA warned medical providers that counterfeit vials of Avastin were found in 15 states. The vials contained nothing more than acetone and water.
Cancer drugs are by far are one of the most counterfeited substances mostly due to the fact that people with cancer are desperately looking for help. It is disgusting on so many levels how these cons take advantage of people in this situation.
Those who attempt to purchase such medications online risk deterioration of their condition and an even a faster decline if the medications are toxic. The red flags to watch out for are those sites that promise outcomes that they cannot deliver. These include:
Any drug that states it is for the treatment of any form of cancer
Drugs that promise to shrink “malignant tumors”
Drugs that promise to make skin cancer disappear
Any cancer drug that promises not to have any adverse side effects
Any drug that states it will take the place of surgery, chemotherapy, radiation treatment or any accepted treatments for cancer
Nearly four of ten fake drugs are ED medications. Again, this is a result of personal discomfort with buying them from pharmacies and purchasing them online offers a sense of anonymity to the buyer. The problem with doing this is that many have too much of the medication in them and can pose a risk to those with heart disease.
HIV, Alzheimer’s and Diabetes Medications
Chronic conditioners, like those in this category, require a measured pace to treatment. Purchasing online medications that may be counterfeit exposes the user to the dangers of a lack of treatment or exposure to toxic chemicals.
For instance, purchasing HIV medications on line that do not have the therapeutic levels of the drug may risk the patient developing a tolerance to a cocktail used to treat the virus. In situations like this, a new cocktail is prescribed to treat the virus. However, there are a limited number of cocktails available for treating HIV/AIDS. Eventually, all medications in this category could be rendered ineffective.
Painkillers and Weight Control Medications
Trying to buy painkillers online is an increasing problem and will only get worse as a result of the so-called "opioid epidemic". Those who may have opioid addictions or severe pain and unable to get these medications are turning to the internet for relief. Those who may think they are buying opioids like oxycontin online may be getting the stronger and deadlier substitute fentanyl.
In a real life example, law enforcement officers in Lorain County, Ohio, seized 500 pills that looked like oxycodone in 2016. However, analysis showed the pills contained no oxycodone but instead contained the research chemical U-47700, which is an unscheduled synthetic opioid unstudied for human use that has caused at least 17 overdoses and multiple deaths in the United States.
Counterfeit Adderall has been showing up through online providers and a Google search for drugs like Xanax, Ativan, Adderall or Ambien turns up hundreds of sites selling these 'alleged' medications without a prescription.
So how do you know if a website may be selling counterfeit medications? Here are some things that should tip you off that the online pharmacy may not be legitimate:
the site does not require a prescription;
the site does not provide verifiable contact information;
the site sells prescriptions after a patient answers only a few health questions;
the site does not fill orders through licensed pharmacies;
the site does not have a licensed pharmacist dispensing prescriptions;
the site offers to sell controlled substances.
And when it comes to these drug sites, you can count on one other thing, it does not protect personal and financial information, as rogue pharmacies have been implicated in stealing information for identity theft.
Now, we have talked about the bad, and remember the earlier number we discussed, the FDA says that 97% of these sites are phony. But that leaves 3% that are legitimate and some consumers may need to use them for a number of reasons, including disabilities.
Here are some steps to take to determine if the online pharmacy you may want to use is legitimate:
Buy medicines only from state-licensed pharmacies that are located in the United States. Find your state’s contact information at the National Association of Boards of Pharmacy website by clicking here: NABP
If using an online pharmacy, make sure it has a legitimate bricks-and-mortar street address, a licensed physician as well as a pharmacist on duty and available.
Look for the VIPPS (Verified Internet Pharmacy Practice Sites) seal at online pharmacies. A list of VIPPS-verified pharmacies is available by clicking here VIPPS.
There is some good news about fighting back against these counterfeit drugs. The New York Times has reported that some companies are now using a unique scratch-off code on the label of each medication. The consumer then texts the code to the company’s server. This gives the consumer the ability to know if the drug is real.
I saw this process when the drug suboxone, used for medication assisted addictions treatment, came in a film form that was placed on the tongue of the patient and melted quickly. Each dosage had a unique barcode that was listed under the name of the patient. If this dosage was diverted, law enforcement was able to trace it back to the patient. So technology can work both ways.
For more information on illegal online pharmacies and counterfeit medications, please click here for Fraud.
If you would like a poster to provide to a senior, please click on the photo below to download the document.
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Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.