Kenneth Thorpe. Source:

U.S. News & World Report published this editorial by Kenneth Thorpe, professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease, on August 23, 2017.

Why Cheaper Drugs Can Kill

The Senate is considering a bill that would allow individuals and pharmacies to purchase medicines from Canada. The Affordable and Safe Prescription Drug Importation Act could save the federal government more than $6 billion over the next decade, according to a new report from the Congressional Budget Office.

But these savings could come at the cost of Americans’ lives. Legalizing drug importation would make it far easier for harmful counterfeit and contaminated medicines to enter the U.S. drug supply. At a time when illegal, counterfeit drugs already cause hundreds of American deaths every year, importation represents a reckless way to cut health care costs.

On the face of it, the importation bill, sponsored by Sens. Bernie Sanders, I-Vt., Cory Booker, D-N.J., and Bob Casey, D-Pa., seems like a winning proposition for patients. After all, many prescription drugs are considerably cheaper in Canada. Why not let Americans enjoy these discount prices?

Of course, there’s a reason that drug importation is currently against the law: By the Food and Drug Administration’s own admission, it’s simply infeasible for federal regulators to monitor the quality and safety of drugs imported from foreign pharmacies.

The Senate bill would only allow drugs to be imported from Canada – but a Canadian postmark is no indication of a drug’s true origin. By one estimate, as many as 70 percent of the medicines Americans illicitly purchase from Canada are manufactured elsewhere in the world. Counterfeit medicines represent as much as 10 percent of the global drug supply. Making matters worse, the Canadian government doesn’t monitor the quality of the medicines that Canadian pharmacies export.

Just this June, U.S. authorities arrested six Canadian men accused of selling $78 million worth of unapproved drugs – including counterfeit versions of the cancer medicines Altuzan and Avastin – to American doctors. Among those arrested was the president of online pharmacy

Indeed, the phrase “reputable internet pharmacy” is almost a contradiction in terms. An investigation by the National Association of Boards of Pharmacy looked at 10,000 online pharmacies and found that more than 96 percent don’t comply with American laws and safety standards.

Almost 90 percent of noncompliant pharmacies didn’t even require patients to provide legitimate prescriptions from doctors. People can request whatever drugs they want with virtually no questions asked. Nearly half these pharmacies sell medicines that aren’t approved by the FDA. Many of these pills are counterfeit.

The threat posed by imported, knockoff prescription opioids is especially acute. Over the last few years, hundreds of thousands of counterfeit prescription opioids have been smuggled into the country from places like Canada and Mexico, according to the Drug Enforcement Administration.

Many of these fake medications contain fentanyl – a synthetic opioid that is 50 to 100 times more powerful than morphine. This deluge of counterfeit pain pills has helped fuel a national opioid crisis that killed a record 33,000 Americans in 2015, according to the latest data from the Centers for Disease Control and Prevention.

Sanders, Booker and Casey insist that their bill would impose stringent safety standards on all drugs imported from Canada. But that is a promise they simply can’t keep.

The FDA enforces America’s drug safety standards, which are the most rigorous in the world. Maintaining those standards depends on a closed drug supply chain.

Without strict restrictions on drug importation, regulators wouldn’t have the manpower or inspection powers they need to keep counterfeits out of America’s prescription drug supply. An importation free-for-all would almost certainly lead to a rise in illness and death due to substandard prescription medicines.

The CBO estimated that drug importation would only reduce total drug spending by about 1 percent. Moreover, it didn’t account for the lives that could be lost due to counterfeit drugs. Importation simply isn’t worth the risk to Americans’ safety.