Shepherd MD.* The effect of US pharmaceutical drug importation on the Canadian pharmaceutical supply. Can Pharm J. 2010 Sept/Oct; 143(5):226-33.

Abstract.
Background and objectives: For over a decade, many US politicians have advocated that the US allow personal and commercial drug importation. Currently, the only entities that can legally import a pharmaceutical in the US are pharmaceutical manufacturers. Our objective was to compare the number of prescriptions dispensed in Canada with the US and estimate the effect US drug importation from Canada will have on the Canadian drug supply.

Methods: A model was created to measure the potential effect on the Canadian drug supply. The model uses the number of US prescriptions being sourced from Canada and the number of prescriptions dispensed in Canada in 2007 as the baseline. The number of days to exhaust the 2007 Canadian drug supply was calculated.

Results: The model found that if 10% of the US prescriptions were fi lled from Canadian sources (manufacturer, wholesale or retail), Canada’s 2007 drug supply would be exhausted in 224 days. If the demand from the US reached 20%, the 2007 supply would be exhausted in 155 days. The model was redone focusing on brand name drugs, with generic drugs removed. It was found that with a US demand of 10% and 20%, the 2007 Canadian supply for brand name drugs would be exhausted in 268 and 201 days, respectively.

Conclusion: US drug importation is a threat to Canada’s drug supply. Even if the US demand were 10%, Canada would need to dramatically increase manufacturing, triple drug importation, or most likely control or halt pharmaceutical shipments to the US.

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Shepherd MD*, The effect of US pharmaceutical importation on the Canadian drug supply. CPJ. 2010 Sept/Oct; 143(5):226-33.

Abstract. Background and objectives: For over a decade, many US politicians have advocated that the US allow personal and commercial drug importation. Currently, the only entities that can legally import a pharmaceutical in the US are pharmaceutical manufacturers. Our objective was to compare the number of prescriptions dispensed in Canada with the US and estimate the effect US drug importation from Canada will have on the Canadian drug supply.

Methods: A model was created to measure the potential effect on the Canadian drug supply. The model uses the number of US prescriptions being sourced from Canada and the number of prescriptions dispensed in Canada in 2007 as the baseline. The number of days to exhaust the 2007 Canadian drug supply was calculated.

Results: The model found that if 10% of the US prescriptions were filled from Canadian sources (manufacturer, wholesale or retail), Canada’s 2007 drug supply would be exhausted in 224 days. If the demand from the US reached 20%, the 2007 supply would be exhausted in 155 days. The model was redone focusing on brand name drugs, with generic drugs removed. It was found that with a US demand of 10% and 20%, the 2007 Canadian supply for brand name drugs would be exhausted in 268 and 201 days, respectively.

Conclusion: US drug importation is a threat to Canada’s drug supply. Even if the US demand were 10%, Canada would need to dramatically increase manufacturing, triple drug importation, or most likely control or halt pharmaceutical shipments to the US.

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Shepherd, MD*. Black medicine. AQ. 2010 Summer; 4(3):82-5.

The exploring Internet trade in counterfeit medicine.

When you’re sick, taking the right medicine is almost as important as finding a good doctor. But what if the medicine is fake? A black market in counterfeit or low-quality drugs is fast becoming the world’s newest health hazard.

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Sugita M, Miyakawa M. Economic analysis of use of counterfeit drugs: health impairment risk of counterfeit phosphodiesterase type 5 inhibitor taken as an example. Environ Health Prev Med. 2010 Jul; 15(4):244-51.

OBJECTIVES: The size of the market for counterfeit drugs throughout the world is considerable. Many cases of health impairment due to counterfeits have been reported. The market share of counterfeits in drug markets in developed countries is smaller than that in developing countries. However, the size of the market for counterfeits of phosphodiesterase type 5…

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Shepherd M.* Beef up international cooperation on counterfeits. Nat Med. 2010;16(4):366.

Counterfeit drugs are a menacing and deadly problem worldwide. The proliferation of fake drugs is astounding, with over 100 countries reporting incidents of fake drugs, according to a 2008 report from the Pharmaceutical Security Institute. And incidents of drug counterfeiting show no evidence of declining: some industry insiders suggest that the number of counterfeit medicines…

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Liang BA.* International Drug Production and Supply: Challenges for Biopreparedness. J Biolaw Bus. 2010;12(3): 31- 34.

Biopreparedness uniquely relies upon drugs. However, the globalization of drug manufacturing and supply has created challenges to ensuring open and available access to these products. The heparin case illustrates the challenges of offshore and onshore efforts to secure the drugs necessary to address naturally-occuring and human-sourced biological agents. Economic incentives, international diplomacy, and alternative sourcing…

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Lewis K. China’s counterfeit medicine trade booming. CMAJ. 2009;181(10):E237-8.

It was a cringe-worthy moment for China when 600 000 counterfeit antimalarial tablets were intercepted by the Nigerian government in June. Produced and shipped from China, they bore an unexpected label: "Made in India." Even the fakes were being faked. It was a new low. Many things are faked in China —from Gucci sunglasses to…

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Liang BA.* Pigs, Drugs, and Terrorists. Patient Safe Qual Healthcare. 2008 Nov 1:10-12

Abstract. Making drugs is messy. Take heparin.You raise pigs and then slaughter them. You isolate the pig intestines and cook them. Then you scrape the intestinal insides, dry them, and get them to a factory to undergo more processing (Harris, 2008). Making drugs is also expensive. Outsourcing this messy activity to countries such as China…

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Trefi S, Routaboul C, Hamieh S, Gilard V, Malet-Martino M, Martino R. Analysis of illegally manufactured formulations of tadalafil (Cialis®) by 1H NMR, 2D DOSY 1H NMR and Raman spectroscopy. J Pharm Biomed Anal. 2008 May 12;47(1):103-113

Abstract. Counterfeit and/or imitation medicines are becoming a major health problem not only in developing countries but also in wealthier countries. The need of new and easy analytical methods for quality control of drugs is essential. We describe the use of Raman spectroscopy, 1H nuclear magnetic resonance (NMR) and 2D diffusion-ordered spectroscopy (DOSY) NMR to analyse…

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