Abstract. U.S. citizens depend extensively on medicines for health and quality of life. Yet a major problem attends the drug supply: counterfeit medicines. Although currently the United States has a relatively safe, closed system, it has not been immune to counterfeits, and harm associated with counterfeits has occurred here. Further, because terrorist activities have been connected to counterfeit production, and perverse legal incentives only lightly punish drug counterfeiting, terrorists and drug lords have shifted production to this highly lucrative, but less expensive and lower risk, activity. In addition, through secondary wholesaler and provider purchase and sale of drugs in the “gray market,” U.S. drugs may pass through many hands before finally reaching the consumer.
This process has allowed fake drugs to enter the supply chain and harm consumers. Similarly, Internet drug purchases also are a source of counterfeit drug importation that harms unsuspecting patients. Broad scale importation may result in opening the U.S. domestic gray market to scrupulous and unscrupulous suppliers from all over the world and, as has happened in other countries, may significantly increase the number of fakes introduced into ingested medicines. Public policy should ensure that safe, affordable drugs be the goal, with safety as the emphasis. Consumers should use available tools to protect themselves against harm associated with counterfeit drugs.