The Surf's Up News

The Canadian Cross
Border Drug Trade
Volume 1, Issue 16
January 2005

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Online Exchanges

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The Canadian Cross
Border Drug Trade

The cross border pharmaceutical trade will take a hit this year as more pressure is put on Canadian provincial governments to crack down on online pharmacies.

The latest pressure against Internet pharmacies came on the heels of President Bush's visit to Canada on December 1.

The Canadian Health Minister, Ujjal Dosanjh, has increased pressure on the provinces to discipline pharmacists who don't follow provincial medical standards. Internet pharmacies that sell drugs to Americans are being warned that improper standards will result in license suspensions.

According to the Canadian Pharmacists Association there are now close to 200 pharmacies engaged in cross border drug trade in Canada.

Health Canada reported in early December the Health Minister welcomed plans by the Manitoba Pharmaceutical Association to take action against pharmacists who don't follow provincial medical standards.

According to Minister Dosanjh, "...the practice by some doctors of countersigning prescriptions without actually having a relationship with the patient and properly assessing the patient is absolutely unethical and unprofessional."

Most Canadian Internet pharmacies exist in the province of Manitoba where pharmacists were told of the 2005 crack down back in October in a Manitoba Pharmacists Association (MPhA) newsletter. The MPhA newsletter reported the association planned to take action in 2005 against pharmacists in that province who knowingly fill prescriptions contrary to provincial medical standards. This involves filling American prescriptions "that are or appear to be 'co-signed' by Canadian physicians".

Manitoba Premier Gary Doer, who said the Internet industry employs some 2,500 in his province, had asked Prime Minister Paul Martin in December to avoid putting restrictions on the lucrative trade, Canadian Press reported.

According to Julie Appleby in a December USA Today article, the issue may arise when the Canadian cabinet meets on Jan. 11.

She quoted Ken Polk, director of communications for the health minister, as saying that some of the changes being considered may not need Parliament's approval and that Prime Minister Paul Martin had told reporters the health minister was articulating the position of the government of Canada.

The Coalition for Manitoba Pharmacy is one of many groups who are putting pressure on the Canadian government to curb the cross border trade in pharmaceuticals. The coalition was formed by a group of concerned pharmacists in Manitoba who believe Internet pharmacies are causing pharmacist shortages in communities and hospitals.

"By buying less expensive drugs in Canada, then selling them at a much higher price in the U.S., international Internet pharmacies can make huge profits. This allows them to offer much larger salaries to Canadian pharmacists than those pharmacists could make caring for Canadian patients," the group reported on its website.

"As a result, Canadian community and hospital pharmacies cannot afford to compete in the hiring of pharmacists. Today, the shortage of pharmacists in communities is straining the ability of community pharmacies to ensure that each patient receives the proper care."

In October CTV interviewed Louise Binder of the Canadian Treatment Action Council saying Canada can't afford to continue to use its own stock to address U.S. drug shortages. "We call on the federal government, and particularly on the minister of health, to stop the cross border sale of Internet pharmaceuticals now," Binder was quoted as saying. The group is comprised of Canadian seniors, pharmacies and patients who are asking the federal government to ban the export of prescription drugs through cross border Internet pharmacies, warning there could soon be "full-scale disaster'' in the Canadian health-care system.

CTV quoted David MacKay of the Canadian International Pharmacy Association as calling the concerns "preposterous". He said the public had nothing to fear from Internet pharmacies and that the majority of opposition to the mail order pharmacies was being funded by the pharmaceutical industry and big chain drugstores.

Representatives from Manitoba's Ministry of Health, the Manitoba Pharmaceutical Association (MPhA), the Manitoba Trade Department, Internet pharmacy owners and pharmacists met on December 13 in an effort to avert the regulatory crackdown. According to Pharmacy Connects, following the meeting, which included assurances from all groups that they would work together to develop new regulations for online pharmacies, MPhA president Gary Cavanaugh said the association would not make good on its promise to suspend licences while the new rules were under discussion.

This gesture by Cavanaugh may not be enough to satisfy Health Minister Dosanjh, who warned Americans during a speech at Harvard Medical School in Boston in November that the Candian government might take action. The Boston Globe reported that Dosanjh warned Americans that the Canadian government may try to stop prescription drug shipments to US consumers if the trade kept growing.

"We certainly cannot be the drugstore for the United States of America," Dosanjh was quoted as saying.

In late November, The Canadian Pharmacists Association (CphA) released the results of a study that showed the Canadian Drug Supply Chain was vulnerable.

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In the Canadian Pharmacists Association study 80 per cent of pharmacists who responded said they had experienced drug shortages in the previous week and that they had noticed shortages becoming more frequent over the past year.

There were a number of factors that accounted for the shortages but the association couldn't identify one specific cause. The study did report that pharmaceutical companies, including Pfizer Inc., Eli Lilly, AstaZeneca, Novartis, Wyeth and GlaxoSmithKline PLC had taken action to limit supplies of prescription drugs in Canada because of concerns they were being re-exported back into the United States.

According to the CPhA, even if only 10 per cent of US residents bought their prescription drugs from Canada, the number of US residents involved would be equivalent to almost the entire population of Canada.

According to Harvard Public Health Now, many U.S. citizens, and a growing number of states and municipalities, including Boston, had programs to buy drugs from Canada for their city workers.

The Boston Globe reported Health Minister Dosanjh as warning that any large, US state purchasing programs or legalized bulk imports would create a tremendous strain on Canada's supply.

The results of a December report by the US Department of Health and Human Services indicated the Bush administration wasn't interested in creating any such program.

The purpose of the 13-member task force was to determine whether imports from Europe and Canada could be done safely to provide relief for Americans paying some of the highest drug prices in the world, Canadian press reported in December.

According to Barrie McKenna of the Globe and Mail, the results of the report were a blow to those trying to legalize drug imports, including many members of the U.S. Congress, who had long argued that doing so would temper soaring costs.

"Legalizing prescription drug imports from Canada would threaten the health of Americans, provide meagre savings and create a regulatory nightmare, the Bush administration has concluded," McKenna reported.

In December Vermont's Independent Rep. Bernie Sanders issued a statement on the result of the task force saying it was "reflective of the entire Bush policy to protect the financial interest of the pharmaceutical industry over the health of regular Americans. Four states in our country, a number of cities and millions of Americans are currently purchasing safe and affordable medicine from abroad."

"The fact that the Bush administration continues to bury its head in the sand and dutifully parrot the drug company line will not reverse this trend. If we can import beef, poultry and vegetables safely from abroad then there is no reason we cannot figure out a way to safely import prescription drugs. The momentum remains with the American people," he continued.

Sanders also made reference to the fact that millions of safe and affordable flu vaccine doses were being imported from Germany even though the report said drug importation couldn't be done safely and affordably.

Sanders was the first Member of Congress to bring a busload of seniors across the Canadian border to Montreal in 1999 to purchase cheaper medicine.

McKenna reported that U.S. Surgeon General Richard Carmona argued the risks of legalizing imports far outweighed the benefits. "It would be extraordinarily difficult and costly for personal importation to be implemented in a way that ensures the safety and effectiveness of the imported drugs."

According to Canadian Press, Dosanjh warned that legalizing imports could result in shortages and higher prices for Canadians.

"Many Internet pharmacists in Canada disagree, saying their system is designed to serve Canadians first and price increases would still be kept to inflation levels by a national review board," Canadian Press reported.

According to Layne Verbeek, the Communications Manager for the Ontario College of Pharmacists many jurisdictions come into play in the regulation of Internet pharmacies. Laws apply from both the federal and provincial governments in Canada as well as laws in the United States.

Although Canadian online pharmacies have been selling drugs to Americans since 2000, according to the FDA it is illegal for anyone to ship prescription drugs not approved by the FDA into the U.S., even though the drug may be legal to sell in the pharmacy's own country.

It is also illegal for American doctors to receive Canadian drugs for their patients but some doctors have been willing to take the risk on behalf of their patients.

Appleby reported that "tens of thousands of Americans, particularly seniors without a Medicare drug benefit, buy drugs from Canada in person or by mail. The government has not intervened, but the threat of prosecution remains."


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