Perhaps it’s an obvious question, but after the recent truck hijacking of generic asthma medication this month in McKinney Texas, we wondered, “Who steals entire truckloads of drugs, and what do they do with them?”

It seemed like something right out of a mobster movie. We asked the counterfeit drugs experts on the Partnership’s board to sit down and talk to us about the topic.

PSM: Why do people steal truckloads of drugs, as opposed to truckloads of plasma televisons, or armored cars, for that matter?

Marv Shepard

Marv Shepherd, UT College of Pharmacy: Stolen pharmaceuticals can be diverted to the US distribution chain or the stolen product can be shipped out of country and sold to international operations, primarily web site pharmacies. In the U.S. the drug products, can be diverted to smaller wholesalers who have the links to retail pharmacies, hospitals and clinics.

Plus, diverters have been known to sell directly to pharmacies, flea market vendors, and a variety of typeof stores–not just pharmacies. These other stores sell the products “under the table.” You can hide your tracks better if you go through a shady wholesale operation, just fake the purchasing and shipping documents or if needed the drug labels. In addition, drug diverters have also been known to swap their stolen property for other goods, especially illicit drugs and narcotics.

Bryan Liang

Bryan Liang, UC San Diego School of Medicine: Pharmaceuticals are:

  1. Small and easy to store;
  2. have big margins; and
  3. limited potential for being caught.

Security on pharmaceutical transport are limited if not nonexistent [other than certain opioids shipped by Purdue Pharma], and hence they are easy targets. In addition the materials — including packaging — is readily usable for ‘legitimacy’.

PSM: Is the penalty any lower for stealing these than other goods?

Tom Kubic

Tom Kubic, Pharmaceutical Security Institute: No, the penalties are the same irrespective of the goods stolen. Federal charges include among others – theft of interstate shipment (Title 18); or interstate transportation of stolen property (ITSP) another Title 18 violation.

Bryan: The penalties on stealing pharmaceuticals, other than state-based crimes like those under the general area of theft, can also include transport without a license. On the federal level, there are unique penalties including diversion and drug trafficking.

PSM: Presumably most reputable pharmacies in the US are too smart to accept drugs without supply chain control. Except for online pharmacies, how would these make their way into the hands of Americans?

Marv: You would be surprised how many pharmacies (community and hospital and even physician clinics) would accept the purchase of stolen property. Many times they do not know that the drugs were stolen. All the paper work (bills of lading, invoices, etc.) has been counterfeited.

Others may know they are getting products from a “questionable” source, but just turn their head. In US when pharmacies buy in “bulk”–bottles of 1000s or more–the pharmacies just transfers the product to a smaller patient vial. The source bottle is really hidden behind the Rx counter. Pharmacists have been known to refill the larger bottles with drug samples–not for retail sale products. They can do the same with stolen drugs. How would the consumer know?

Another example is pharmacists going to Mexico buying large quantities, smuggling them across the border and then refilling their “stock bottles.” Physicians have been done the same thing. The US drug distribution systems needs to some drastic changes like going to the European style and using unit of use packaging.

Bryan: The challenges for small, independent pharmacies is that they cannot cross subsidize prices with lawn furniture like the larger players such as the CostCo’s, Walmart’s, and Walgreens. Hence, they look to any place they can to reduce their costs and increase their margins. When the availability of drugs at a significant discount comes about, the less ethical or even ethical but fighting for their financial life pharmacists disregard the aphorism that if it’s too good to be true, it probably is.

PSM: Do counterfeiters sometimes steal real drugs, in order to make larger batches of counterfeits, either for the active ingredient or for materials to reproduce packaging?

Marv: This is a possibility–many counterfeiters “dilute” their fake stuff with the real stuff–mix fake tablets with authentic tablets. Counterfeiting and diversion are linked together—many diverters turn into counterfeiters especially when their supply of drugs is disrupted.

A diverter is defined as one who takes or diverts legitimate drugs out of the legitimate drug supply chain, forges documents, or sells stolen prescription drugs. A consumer/patient who sells their prescription drug products is really a drug diverter. A teenager who steals from their parent’s medicine cabinet and gives or sells the tablets to their friends is a drug diverter.

Bryan: Salting–the process of placing real stuff [or diverted stuff] and mixing with counterfeits creates an illusion of legitimacy if inspected. Opening any box or storage container, one sees real stuff, and if one tests it, it comes out with active pharmaceutical ingredient and the real deal because it is. But the rest of the shipment is not, and hence one can salt a lot of shipments with diverted stuff.