Counterfeit Medications

My first introduction to the world of counterfeit prescription drugs was approximately 2 decades ago, when someone who worked for Pfizer showed me 2 identical-looking Viagra tablets on screen at a drug-training course. The packaging also looked identical. The point was that the difference in the tablets was undetectable without laboratory analysis.

Sometime later, I heard of someone who was ordering Viagra over the Internet for her boss. This was illegal, and the counterfeit version was being purchased for a mere $8 per pill—far less than the normal price for the drug. Apparently, the boss, who was more than capable of paying the retail price, was embarrassed to obtain the prescription from his doctor. He was unknowingly taking a huge risk, because replacement filler materials for the expected active contents of the medication have been found to be everything from drywall to cattle dung.

I recently had the honor of making presentations at 2 congressional briefings, 1 each to the Senate and to House of Representatives. The Partnership for Safe Medicines, a nonprofit organization, sponsored the events, which allowed several individuals like me to educate legislative aides to members of Congress. Question-and-answer opportunities were included at the end.

My responsibility was to discuss the current abuse of fentanyl and its more powerful cousin, carfentanil. Both drugs exist as legitimate pharmaceuticals, with carfentanil being restricted to sedating large zoo animals, such as elephants. The dangers of both drugs to humans are obvious, and they are causing unprecedented overdose deaths across the United States.

It is hard to remember how long ago law enforcement first discovered that fentanyl was being disguised inside legitimate-looking oxycodone, hydrocodone, and alprazolam. Professional pill presses are used to manufacture drugs with indicia resembling those of generic opiates, but that contain a much more potent form of illicit fentanyl. This clandestine form of fentanyl or carfentanil is not FDA-approved and is very often made in China. The drug is then shipped to Canada, the United States, or, more likely, Mexico.

The fentanyl or carfentanil is then mixed with heroin to enhance the potency, which costs less than simply increasing the amount of heroin. Kilos of pure fentanyl that were intended to either mix with heroin or sell in its pure form have been seized by law enforcement. The devastating impact on America’s addicts is the worst I have seen in my 49 years of law enforcement experience. The liberal use of nasal naloxone by emergency responders and law enforcement has kept this epidemic from being even more catastrophic.

To date and to my knowledge, no carfentanil has been found inside generic-looking pharmaceuticals, but there is absolutely nothing to keep that from happening. I hope it never happens, as the already overburdened emergency responders and coroners’ offices will not be able to keep up with the overdose deaths.

It is vitally important that America keeps its pharmaceutical supply closed and secure. Counterfeit drugs of all kinds have been found in health care facilities, pharmacies, and our nation’s medicine cabinets. Everyone must refrain from the temptation to purchase pharmaceuticals for bargain prices from an unknown wholesaler or supplier.

Organized criminal entities are even smart enough to make it appear that these drugs are from a Canadian wholesaler when they are actually from a developing country; there are no guarantees of proper handling or purity. Dispensing these drugs to patients may very well lead to their great harm or death, with a big dose of liability for the pharmacist.

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via www.rxdiversion .com.