Gilbert T, Halwani S. Confusion and Contradiction: Untangling Drug Importation and Counterfeit Drugs. California Western Intl Law J. 2005;36:41-54.

Drug importation from Canada is an issue attracting tremendous
attention in the United States. The issue of importation is intertwined
with the potential for counterfeit drugs, and several considerations regarding
this issue deserve attention. First, drugs used in the United
States and Canada are manufactured around the world. Second, many
of the counterfeiting issues focus around entry, not at the consumer
level, but at the manufacturing or wholesale level. Finally, counterfeit
medicines are not a local or single-country problem, but a global issue.
Safety of the medicine supply, therefore, cannot be taken for
granted. Fundamentally, drug safety is not an importation issue, but
instead a highly complex problem of international regulation and necessary
harmonization. To effectively address issues of safety, and by
the same token, counterfeits and importation, there must be a closed
distribution chain without a gray market, electronic tracking and trace
security features must be implemented, and tougher penalties and better
enforcement of sanctions against counterfeiters must be put into