Counterfeit pills are on the rise in Arizona
Fake pills disguised as medication pose an increasing and deadly threat in Arizona, law enforcement and pharmaceutical experts said Thursday. Panel participants included Sen. Martha McSally and Maricopa County Sheriff Paul Penzone.
Fake pills disguised as medication, such as painkillers and Xanax, are posing a deadly threat in Arizona, a group of law enforcement and pharmaceutical experts said on Thursday.
The eight experts, including Maricopa County Sheriff Paul Penzone, Phoenix pharmacist Randle House and Arizona’s U.S. Drug Enforcement Administration special agent in charge Doug Coleman, met with U.S. Sen. Martha McSally, R-Ariz., to ask for help with controlling the drug-supply chain in Arizona.
“As we have the conversation about access to health care, out-of-pocket costs for drugs and border security, this is an element that needs to be elevated,” McSally said. “There is a counterfeit industry out there. It could be deadly to you and your loved ones. And we’ve got to work together as a whole society to be able to stop it.”
But it’s a complicated problem, as drug costs escalate and people turn to foreign sources to get their drugs, and as doctors increasingly are reluctant to prescribe painkillers due to government crackdowns in reaction to the opioid crisis.
“What we’ve seen over the last three years is a doubling of the amount of fentanyl that we’re seizing,” Coleman said. “Clearly, the cartels have realized that we want it, and they have ramped up their manufacturing.”
Penzone and others emphasized that while counterfeit drugs are a big problem, they are affecting Americans in very different ways.
There is not one single narrative that covers it all, he said.
“It may be one umbrella, but it’s many different lanes,” he said. McSally agreed. She said there is some pending legislation related to lowering Part D Medicare prescription costs that are making drugs unaffordable for some seniors.
She’s also supportive of a bipartisan proposal under consideration by the Senate Health, Education, Labor and Pensions Committee that would allow generic drugs to enter the market more quickly to prevent pharmaceutical manufacturers from having a monopoly.
“What we’ve seen is abuse of loopholes and a variety of different behaviors once the initial (drug) patent has expired,” McSally said. “The intent is (to) bring down the price, more accessibility, more competition and allow people to get medicines that they need. I think there’s a second bucket of objectives related to stopping the illicit flow across the border. That is a border security, port of entry issue.”
Here are seven things about the problem that consumers need to know.
Drug cartels traffic fake pain medications made with fentanyl
In 2015, the United States began to see an influx of counterfeit pain medications made with fentanyl, a substance that is very cheap, often made in China, and also very deadly.
One well-known death was the singer Prince, who died in 2016 after taking fake Vicodin laced with fentanyl.
“As of today, the crisis has been so fast to spread. We found and documented counterfeit pills in 48 states, and they’ve killed people in 33,” said Shabbir Imber Safdar, executive director of California-based The Partnership for Safe Medicines, who led Thursday’s meeting with McSally. “One milligram is therapeutic fentanyl. Two milligrams is fatal, so it’s really hard for these garage, or even cartel manufacturers, to get it right.”
Counterfeit pill connections have been discovered in both Canada and Mexico, he said. The Washington Post reported last year that authorities in New York indicted a suspected Mexican drug kingpin for what they said was trafficking enough fentanyl to kill 10 million people.
“We see pills all the time that could easily pass for a prescription pill coming right out of a pharmacy,” Pinal County Sheriff Mark Lamb said. “It’s just too unsafe to check a lot of these pills. So now we have to send it to the DPS (Arizona Department of Public Safety) lab, which overwhelms the lab because all of us are sending it there. So we’re not getting results back for six months. Prosecution is delayed and it inhibits the investigation moving forward.”
It’s not uncommon for deputies in Lamb’s department to find 20,000 or 30,000 pills in one stop along the I-10 corridor, he said.
Opioid crackdown leaves unintended consequences
To address the opioid crisis, Arizona in 2018 passed the Arizona Opioid Epidemic Act. It puts a five-day limit on an initial opioid prescription. There have been unintended consequences of the prescription crackdown, the experts told McSally.
In some cases, the difficulty finding opioids are sending people who use illicit drugs to methamphetamine. In other cases, people desperate for and dependent on opioids are buying fake versions and suffering for it.
McSally said she noticed the same issues on a recent visit to Mohave County, which has been hard-hit by the opioid crisis.
“You have people who are addicted who just have no place to go to get the treatment they need in order to get off the addiction,” McSally said.
“Then you have patients with legitimate, lifelong medical conditions who are in a rural area and because of this one-size-fits all (policy), they can’t get access to the medicine they need. ... The impact it is having on these peoples’ lives is very significant, an unintended consequence of trying to crack down on the bad actors.”
Phoenix pharmacy owner Randle House suggested the creation of a medical opioid card, similar to a medical marijuana card, though others at the discussion said that could bring all sorts of other problems.
They are not as illegal, as well prosecuted or at least as identifiable as counterfeit drugs, Safdar said. Cartels and others who have the pill presses have been making drugs that look very authentic, he said.
It’s not just fake opioids and painkillers
Lamb said he noticed at least a doubling in the amount of methamphetamine circulating in his community. Others at the discussion with McSally talked about counterfeit birth control they’d encountered. Safdar said he’s particularly worried about fake Adderall, since the drug is popular with teenagers who think it will help them focus while studying.
But counterfeit Adderall is being made with methamphetamine and it’s extremely dangerous, he said.
“Adderall and meth is a bad thing, but Adderall is extremely dangerous because it’s traded by teenagers and college students very willy nilly,” he said. “Teenagers make even worse decisions than the rest of us.”
High drug prices lead some Americans to cheaper counterfeits
It’s no secret that drug prices are rising and that some insurance companies don’t cover drugs that patients need. For that reason, consumers are seeking cheaper medications in other ways.
House does not see the problem as originating with drug manufacturers. Rather, it’s the pharmacy benefit managers hired by insurance companies to manage drug spending.
But whoever is at fault, consumers are going to Mexico, Canada and online to find less expensive drugs. And House does not think importing drugs is the answer.
“Pharmacy benefit managers are not regulated,” House said. “You are starting to see a lot more states enact legislation to do that. That is a number one facet to focus on and look at.”
Retired Phoenix Police Detective Sgt. David Lake said consumers should also be wary of buying prescription medication in Mexico.
“Anyone who goes to Mexico (for medicine) is literally flipping a coin on whether they are getting real medicine,” said Lake, founder and CEO of the Center on Shadow Economics. “And there’s no recourse if you don’t get your medicine.”
Counterfeit cancer drugs have been in circulation in Arizona
A criminal supply chain in Canada reached a no jail plea deal with the U.S. over selling crossborder counterfeit drugs, including the cancer drug Avastin, in 2018, Safdar said.
“It was a plea bargain because the criminal was in Canada and you can’t extradite people for fake cancer drugs,” Safdar said. “The terms for cocaine, methamphetamine, fentanyl you can get extradited in a heartbeat for that. But not for counterfeit therapeutic drugs. That’s the treaty we made with them.” It’s hard to prove guilt those cases because in often evidence is destroyed. Also, because the patients have cancer, the defendants will often argue that it was the cancer, and not the counterfeit medicine, that killed them, Safdar said.
He cited the example of a Chandler woman, Betty Hunter, who died in 2011 of advanced lung cancer, but who had received an infusion of counterfeit Avastin at a local doctor’s office. The Turkish suppliers who provided the Avastin to the doctor’s office were eventually prosecuted.
Criminal wholesalers who have participated in such scams have called or faxed doctors’ offices, offering steep discounted brand-name drugs, Safdar explained. If the label looks right, medical providers will go ahead and administer it, he said.
“The only reason we know that Betty Hunter had a counterfeit cancer drug is because she had a reaction,” Safdar said. “The FDA went over to the office and grabbed a supply from the refrigerator and had it tested.”
The U.S. Department of Health and Human Services on July 31 issued a proposal to import some cheaper drugs from Canada. But Safdar said there are real patient safety concerns with that because in some states that have tried importing drugs from Canada, the drugs did not end up originating in Canada.
“We’re really worried that corners will be cut in the excitement about getting cheap drugs,” Safdar said. “That’s maybe a good place for congressional oversight.”
While Canadian pharmacies all do everything legally, there are criminal entities online posing as Canadian and selling fake and substandard medications that care not from Canada’s drug supply chain. And they are smart enough not to sell to Canadians, Safdar said.