Maine Pharmacist to Colorado: We found that importation doesn’t deliver quality or savings
This editorial by Amelia Arnold was published in the La Junta Tribune-Democrat on March 28, 2019. Arnold is a licensed pharmacist and pharmacy operations manager in Augusta, Maine.
Drug importation: Maine’s Cautionary Tale
As Colorado lawmakers consider a plan to allow prescription drug importation through Canada, they will claim that these drugs are safe and that they are the very same drugs taken by Canadian patients. We heard the same claims before importation was launched in Maine in 2013 — and as a registered pharmacist there, I saw firsthand the massive risks it posed to patients. The program was shut down in 2015.
The bottom line: You have no guarantee that the drugs you are getting from another country are of the strength you need, are not counterfeit or aren’t contaminated. And you have no legal recourse if you are defrauded, because these drugs are not approved by the federal Food and Drug Administration.
Maine’s journey to importation began in 2013. At the time, we pharmacists warned that trusting medicines ordered online was a game of Russian roulette with patient health and safety. We also knew that the substantial cost savings promised by advocates in our legislature simply didn’t add up.
But patients who are burdened by the high cost of drugs are eager to embrace any solution that could save them money. So, for example, I had a patient who told me he was confident that drugs he was buying from an unknown European online company were guaranteed to be safer than drugs I had on my shelves.
I knew this isn’t the case for two important reasons. First, neither the United States nor the Canadian government will guarantee that drugs transshipped into the U.S. through Canada are safe. Claims that a state-based testing program can be created are based on fantasy, not fact. Despite passing the law, Maine implemented no testing system which put patients at the mercy of anyone in the world who claimed the products were safe.
Secondly, while online merchants may be based in developed countries such as Canada, you have no idea where the drugs were actually manufactured. Living on the border between the U.S. and Canada, I can assure you that ordering from an online Canadian pharmacy is not the same as driving across the border to a bricks-and-mortar pharmacy in Canada. Mystery medicines are a dangerous prescription.
After the Maine importation law was passed, a respected researcher at the University of New England ordered three common generic medications from a Canadian-based online pharmacy. These medicines were widely available in generic form in the U.S. After pharmaceutical testing, he found that two of the medicines contained less than the stated dosage and one contained an unknown contaminant.
Think of how dangerous that is. A patient taking less than the prescribed dosage of medicine could see his or her condition worsen. Or a patient is taking a contaminated drug, which as we have seen with Fentanyl-laced painkillers across the country, can be deadly.
When we brought our concerns about the law’s implementation to the state’s attorney general, the office was unwilling to declare this scheme illegal or tackle the issue. The legislature in Maine basically had opened the door to dangerous criminals around the world making fake drugs and the state couldn’t stop it.
As importation is being debated again in 2019, some advocates have claimed that they can set up a state-based testing program. Leaving aside the massive cost — and the fact that the federal government finds such a notion unworkable — a testing program would have shown the widespread dangers of importation.
The Maine program was overturned by a federal court in 2015. To date, there is no count of the total patients harmed by using substandard medicines. If you wondered why you didn’t see headlines shouting that Maine had solved the problem of cost of medications, it’s because those savings didn’t materialize.
We pharmacists care deeply about the welfare of the patients we serve. If you go into your local pharmacy and speak with your pharmacist, you’ll find that pharmacists want to help you save money on medicines. There are options such as generic substitution, manufacturer coupons and patient assistance programs that allow you to get FDA approved medicines within the U.S. Don’t be fooled into thinking that this is the only way to save money on your medicines.
Given the highly problematic experience in Maine, I urge Colorado policymakers to pause and look at the evidence, science, and history around drug importation. It is a concept that makes big promises in terms of quality and cost savings that it cannot, and will not, deliver on for the people of Colorado.