Counterfeit Drugs: A Problem for All, Especially Seniors
by Don Drake, Connelly Law Offices, Ltd.
Brian, a sixty-eight-year-old retiree, had advanced spinal stenosis, a condition that can be extremely painful in extreme cases. "I had gone to Southern California for a college reunion, and brought all my medications with me, knowing I would be there for over three weeks, " Brian told us. But somewhere in all the traveling, he lost his pain medication. "I was taking 50mg of Tramadol (Ultram) four times a day, and losing that bottle was horrifying for me."
Brian reached out to his doctors back here in New England but trying to get the meds replaced was a nightmare. "This happened on a Thursday, I spoke with the doctor on Friday and the red tape was horrendous in trying to get a controlled medication replaced, especially for a high dose like I was taking and being on the other side of the country. Then I was told I would need to pay cash for it since my insurance would 'probably not' pay for the prescription a second time. It was well over $400; I guess I could have afforded to pay for it, but it was a big financial hit, especially when on a vacation."
Brian told some of the old college friends of his dilemma and they suggested a "friend" at a local bar could get him some pain medication to "hold me over" until he could travel to Mexico where he could replace the medication for a fraction of the cost. "Normally, I would never do anything like this, but these were people I went to school with and knew for decades, so I didn't figure they would lead me down the wrong path." Unfortunately for him, they did.
"Normally, I would never do anything like this, but these were people I went to school with and knew for decades, so I didn't figure they would lead me down the wrong path." ---Brian
"When I got the packet of medication from what looked like a pretty stand-up guy, I couldn't wait to take it. I asked several times if this was Tramadol and was told yes, so I headed back to my room hoping for some relief," Brian told us. "I took a tablet immediately and felt no relief, but I figured it would take time since I was without it for several days." He then fell asleep hoping to wake up pain-free. But that was not to be.
"My friends called and woke me up later that evening and wanted to go to dinner, but I felt terrible. By that time, I had taken three of the pills, still felt no relief, and began to feel queasy and my skin was getting itchy." He then began having problems breathing and was experiencing tightness of the throat. Brian called one of his friends back who immediately contacted emergency services and he was transported to Mercy Hospital where he was diagnosed with anaphylactic shock. The pills that Brian was given, thinking they were tramadol, turned out to be an antibiotic, a class of medication he was deathly allergic to.
"I certainly would never do this ever again," Brian told us. "But I'm not a drug addict, I needed the medication because of losing my bottle and did not want to pay for the excessive cost of replacing the prescription that I needed to control my pain. I was able to get a prescription from the ER at the hospital and gave up on the idea of traveling to Mexico to buy who knows what. Just to save a few bucks, I almost died. I started to wonder how many seniors who live on a limited income go through the same thing. It's scary." Unfortunately, some are not as lucky as Brian.
Death and Counterfeit Drugs
"When someone is severely injured or suffers from chronic pain, they would do almost anything to seek some relief," said certified elder law Attorney RJ Connelly III. "Obviously, pain affects the body, but it also affects a person's emotions, their relationships, and of course, the mind. It causes anxiety and depression which, in turn, will make the pain worse. It's a merry-go-round that's hard to jump off once you begin riding." And such is the story of a young man in Palmdale, California.
In December 2021, a 22-year-old powerlifter named Jordan Erickson injured himself at the Lock It Out Barbell Gym and was given a pain pill thought to be oxycodone by a peer. It turned out it was a fake oxycodone pill laced with fentanyl, and it claimed his life.
In early July, DEA agents executed a federal search warrant that resulted in the seizure of one million fentanyl pills linked to Mexico’s Sinaloa cartel. Agents executed the search warrant after investigating the drug trafficking organization that began in May. The fake fentanyl pills were reported to be worth $15 to $20 million.
Agents stated that their officers seized more than three million fentanyl pills last year. From January through April of this year, they have seized about 1.5 million fentanyl pills, which is a staggering 64 percent increase over the same period in 2021.
DEA Special Agent in Charge, Bill Bodner said, "a staggering number of teens and young adults are unaware that they are ingesting fentanyl in these fake pills and are being poisoned.”
But fake pills are not limited to opioids and what some see as "street drugs". They also include high-priced prescription medications and those seeking less expensive alternatives often end up as victims in this dangerous game. Sadly, seniors are the most vulnerable of all age groups when it comes to phony prescriptions.
Seniors and Prescriptions
"It probably comes as no surprise that older adults are the number one consumers of prescription medication in this country," said Attorney RJ Connelly III. "With the high number of baby boomers rapidly transitioning into their senior years, this trend can be expected to skyrocket. In the last ten years alone, the use of medication by seniors has jumped by almost forty percent! And with inflation currently running out of control and costs going higher, we may have some problems ahead of us."
And here are some other facts to consider:
Ninety percent of seniors use at least one prescription drug daily.
Four out of ten seniors aged sixty-five or older use five or more medications weekly, and of this group, 12% use ten or more different medications.
Prescription drug use by our senior citizens accounts 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 from the graying of America, but the 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 hefty price tags, if they are covered by health insurance, the co-pays may be just as hefty depending on which insurance plan is in place. 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 to save money is now possible for everyone.
But, as with all things bought online, let the buyer beware. This isn't as benign as getting a towel set that is not the same color as you ordered that you could send back, a mistake with ordering medication can be deadly -- and very quickly.
"The Food and Drug Administration reports that 97% of online pharmacies are fraudulent...many peddle counterfeit medicines which may contain toxic materials."
The Food and Drug Administration reports that 97% of online pharmacies are fraudulent and even more alarming, many peddle counterfeit medicines which may contain toxic materials. This is a major problem worldwide.
Counterfeit Drug Market
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 underdeveloped countries having a counterfeit rate of over 50%.
The major drug counterfeiters, according to the FDA, are in China, India, Russia, Nigeria, Egypt, and Turkey, where there are absolutely no laws against making and exporting these medications. The leading country responsible for this is India, where 75% of these counterfeit drugs come from, according to the Organization for Economic Cooperation and Development.
When it comes to the United States, 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 given our access to the world market through the internet, counterfeit medications pose a significant threat to our seniors.
That leaves this question to be answered, are counterfeit drugs fake drugs? That's a tricky question to answer in simple terms. Many, if not most, 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 included in the ingredients.
"These medications have been found to be contaminated with floor wax, rat poison, concrete, chalk, boric acid, road tar, paint and antifreeze..."
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 these are 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 causes 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.
Internet Medications and Ingredients
For example, two medications used by older adults in recent years – Alli, a weight-loss drug, and Viagra, for erectile dysfunction, 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 that they have a problem with erectile dysfunction, 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 online 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."
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 done a few years ago, 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. Just over a decade ago, over 300,000 people, primarily 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.
Canadian Drug Storefronts
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 in Fall River, Massachusetts 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, an 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 significant risk to take with your health.”
Highly Counterfeited Drugs
So what medications are most likely to be counterfeited? Here's some information.
Cardiovascular Medications - As a cardiologist friend 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 counterfeit or sub-standard medication. Drugs like Lipitor were at one point a highly counterfeited medication.
Antibiotics - Antibiotics are prescribed for 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.
Cancer Drugs - 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 fifteen states. The vials contained nothing more than acetone and water. Cancer drugs are by far one of the most counterfeited substances mostly because 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 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.
Erectile Dysfunction Medications - 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 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 of 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 online 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 because of the so-called "opioid epidemic". Those who may have opioid addictions or severe pain and are 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.
Psychiatric Medications - 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:
A prescription is not required.
Information to verify your identity is not asked.
A person is sold the prescription after answering a few non-related health questions.
The site does not list the pharmacy they order the drugs through.
There are no licensed pharmacists listed on the site.
Controlled substances are sold over the site.
And when it comes to these drug sites, you can count on one other thing, they do not protect personal and financial information, as rogue pharmacies have been implicated in stealing information for identity theft.
"When it comes to these sites...they do 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 several 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.
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.
If you would like a poster to provide to a senior, please click on the photo below to download the document.