[Music]
I'm going to introduce our speaker Marv
Shepherd and he has conducted research
on drug importation drug counterfeiting
and drug diversion for close to 20 years
he is currently the director of the
Center for pharmaco economic studies
College of Pharmacy University of Texas
Austin Texas and is also the president
of the partnership for safe medicines
the NeedyMeds and the partnership for
safe medicines have been partners for a
while is an organization dedicated to
fighting counterfeit medications drug
diversion and informing health
professionals and consumers about fake
substandard and diverted drug products
in 2010 Marv Sheppard was appointed to
the drug packaging and distribution
committee of the United States
pharmacopoeia and today we are going to
have information about how to buy
medications online safely and affordably
so with that I'm going to go ahead and
pass it over to Marv are you ready to go
Marv I'm ready to fly here yep okay take
it away thank you thank you I hope you
everybody's doing well got a pleasant
day here in Texas I don't know you guys
are spread all over the country but good
day here in Texas so if I actually get
you it's Bobby because it's changed a
little bit over the number of years I've
been in Texas but it's fine
one thing I want to point out right off
the top my email is on there Myra
Shepherd at Austin not you Texas edu you
feel free to send me an email anytime
you like about questions about
pharmaceuticals or buying medications
online or counterfeit pharmaceuticals
FDA or pharmaceutical pricing any of
that kind of stuff you have a question
all right please don't hesitate to give
me a buzz send me an email and I'll be
glad to get right back to you I get a
lot of them a day and I'm enjoying the
work and we'll get started here okay
so in the United States we have a unique
drug distribution system it's referred
to as a regular a very tightly closed
secure supply chain and then is because
it is so regulated by FDA and the Food
and Drug Administration at the federal
government level in states regulated and
other governmental agencies got their
fingers in it but it's really tightly
controlled and it's tightly controlled
from the drug manufacturers all the way
to the wholesalers even the transporters
on how the drugs are packaged and
shipped are controlled and these the
transporters and the wholesalers and
drug manufacturers got to follow some
very tight rules and down to the
pharmacist and the pharmacies the nurses
and the physicians in the they're all
tightly controlled through the state
regulations pharmacies are state
regulated in license and in pharmacists
or state regulated and licensed along
your lines so we've got a lot of people
involved in regulatory process and it
includes not only prescription drugs but
also includes over-the-counter drugs FDA
approves all drugs all drugs that are
supposed to be using in any States will
be FDA approved and that's the the
problem quite often with drug
importation or by an awful line because
the drugs are not FDA approved so FDA
inspects all drug manufacturing
facilities and approves the process of
manufacturing the drug let's walk over
this now even though the drug may be
manufactured in let's say in India
FDA has inspectors will inspect the
process of that manufacturing plant
specs how it's made under the guidance
of how the drug was approving the
manufacturing that's employed by it and
it expects the product that comes out of
that plant before it's allowed to come
into United States so so any break in
this system
dangerous patience and American is one
of the few countries with a closed
secure drug supply chains and I really
believe it's probably the status in the
world it's very safe compared to some
other countries so how do patients
dangers in the supply chain breaks the
most common way this distribution chain
is broken is by the patient's themselves
they're buying online from non vipps
pharmacies or verified internet pharmacy
provider sites that's what it stands for
VIPs pharmacy sites and when they buy
from online from these non verify
internet pharmacy providers sites since
when you get endangered so that
sometimes they buy from off lying non
pharmacies in United States and outside
United States and sometimes they travel
and bring back drugs from for example
from Mexico and some of those may those
will probably not be approved and
they'll probably be changed over a
period of time less common way are as
pharmacists and physicians and
distributors buy and from unlicensed
distributors it does happen but it's not
real common that we've had a couple
cases in the last couple years where
clinics have bought online drugs from
rogue websites from fraudulent
wholesalers and the manufacturing supply
chain producers that's less common -
that's very uncommon unless you go off
and look specifically for a counterfeit
or rogue manufacturer somewhere along
the line so is your online pharmacy safe
your web-based pharmacies some are safe
and some are not safe you know but na BP
may sell fake and dangerous drug
products and these websites are listed
as not recommended na bps and National
Association of boards of pharmacies and
they list a lot of sites that are not
recommended for use and there's an also
also another program I don't know why
this keeps popping up but a where rx
consumer protection program website is
referred to as the rogue sites they list
some rogue sites are those less than
regulated sites out there so NAB P has
analyzed thousands of websites selling
prescription drugs and found numerous
examples where the the ad is illegal
deceptive with some very common
characteristics but if we found out it's
been estimated that one in six Americans
drive by drugs online some of them
without a prescription if we pose
further problems which I'll talk about
later what what are the dangers of
buying drugs from an e zone
non-regulated websites and some quite
often as a consumer you don't know the
regulators are not regulated now we'll
talk just a little bit later about that
but they they sell fake of contaminated
products they like to take their money
they like your credit card number they
like your personal data they which they
can sell they very seldom have a domain
name that's registered they operate
their site on a server located in
another country and they do not they
dudes usually do not post a physical
address or a good telephone number a
landline telephone number in some of
these sites and some of the vestigation
as we did here the site could be located
and South America the drugs are coming
from India but the money's gone through
Pakistan so they got this convoluted
route of where products are coming from
and they could come from a lot of
different countries but the site where
it's located at the actual pharmacy site
is nowhere to be found on the website
anywhere I mean it just disappears sites
offer foreign unapproved drug products
these sites may be difficult to track as
I said they're reviewed when the rogue
websites review our offer foreign drugs
and drugs are not approved by United
States Food and Drug Administration our
FDA the rogue sites don't have a
physical address as I mentioned on the
website the sites do not offer any
secure ordering so they're not encrypted
so I
so when you put that credit card number
in just about anybody can get access to
it and they sell that number out to
other vendors along this long device so
the site sell prescription drugs without
requiring a valid prescriptions about
88% of them do that so you don't need a
valid prescription you just order it
hopefully it's the correct drug that
they sent to you and and sixty percent
of the rogue sites reviewed dispense
medications to consumers who respond to
an online questionnaire are only quite
often you'll see these sites fill out
this questionnaire and we'll see if
you're eligible or you're a potential
user of the pharmaceuticals they busted
on an online site a rogue site down in
San Diego and the guy had that same type
of questionnaire on it and he was known
as the viagra King he was getting his
viagra of counterfeit viagra out of
Mexico with no active ingredient he also
got it out of India but no active
ingredient you know and then he then he
collected all the questionnaires but he
never read them no he didn't have a he
didn't employ a physician to read them
but he just put it on there is a deceive
the consumer that came up with him so
12% of the rogue sites review the
legally self controlled substances the
oxycotin of vicodin all the painkillers
are out there quite often they sell rose
so here are some of the sites like this
one Canadian neighbor neighbor hood
pharmacies looks like a legitimate
neighborhood pharmacy on I'll talk about
that too a second was probably not even
located in Canada most likely Twitter
you can get online drugs to the Twitter
without a prescription all kinds of
deceptive pharmaceutical ads will they
say generic propecia generic cialis
right now generally cialis engineering
viagra is not legal in United States
matter of fact generating CLO shouldn't
be legal anywhere in the world because
it's a patented drugs it's illegal to
make that drug by the patent authorities
so
here's an example of a global pharmacy
Canada website Marv we've had a
suggestion from our users that you click
the bottom instead of the X it won't
come up again okay we got it now another
one pops up alright folks well so just
ignore those pop ups and Mark's computer
is just I'm trying to fit right in
mm-hmm maybe just keep the current color
scream and don't tell the message again
try that I said okay I'm sorry I
interrupt you mark go ahead
no I need all the help I can get I can
do two things at once
that's right so I got this flyer in the
mail a few years ago and benefactor got
another flyer from him not too long ago
I received this flyer from a pharmacy
website located in Misaka Ontario so I
got on a phone and called Ontario Board
of pharmacies to find out where is this
Pharmacy located and is it licensed in a
Board of Pharmacy and Ontario says we
don't have any pharmacy by that name we
don't have any pharmacy in our licensing
statistics that show that address up on
it so it's an online pharmacy not
legitimate Pharmacy in Canada and then
further they found out I was reading the
brochure it says the brochure states
states send us a fax or a copy the
original prescription or you can send a
copy a picture of the pill bottle label
or you can send us a detailed pharmacy
receipt or invoice voice and I said well
there's got to be some problems here
with that kind of verbage so problem
gosh think they want it the next time it
happens Marv click the keep the current
color scheme okay but I'm further
looking at this site I found out they
were offering most of the generic drugs
and they were all generating drugs you
know for example you look at the top and
it says lipitor at that price well at
this time and the thing comes out
lipitor is a patented medication they
were making an illegal generic product
of it so in matter of fact I think it
was like eighty-six percent of the drugs
they offered
was for the generic sight well finally
can the Canadian online pharmacy ordered
to close the Ontario operation amid
revelation it it wasn't stationed in
Ontario even though it had an Ontario
address it was stationed in Belize
Central America and so they finally said
let's close it down and Health Canada
finally did and closed the down suit now
you can't get access to it in Canada or
anywhere else along the way but I did
get a I didn't get a notice from from
global pharmacy operation done in Belize
the summer operation so fine meds the
line isn't like buying socks or even
buying shoes or buying clothes or
watches or anything out they even sell
over-the-counter drugs and in which
still a medicine and over-the-counter
drugs can be pretty dangerous if you're
not careful on how you use them and
especially acetaminophen products right
now this drug is an over-the-counter
drug is called a lie it had the wrong
active ingredient in it it's supposed to
have orlistat in it and the counterfeit
product contains sibutramine which has
been known to cause some complications
with people taking cardiac medications
so victims purchased over the counter
weight loss medication from this website
listed there and the purchase reported
many life-threatening side-effects and
two people were convicted in 2011 of
selling the drug United States so so
where did the distributors of the
counterfeit drugs get their fake drugs
most of the fake drugs right now are
coming from outside United States are
not manufactured in the United States
and we've had a couple manufacture here
but learn but that's been a good decade
ago very few are manufactured here the
number one producer of counterfeit drugs
is China
number two is India although we've get
them out of Pakistan Turkey Mexico
Colombia Russia Indonesia all those
countries have huge problems with
counterfeit drugs for example Russia
about
to 22% of all the drugs sold in Russia
are counterfeit fake drugs and I haven't
defined what a counterfeit drug is but a
counterfeit drug could have the active
ingredient and could not have the active
ingredient it may have no active
ingredient and then it may have the
wrong quantity of active ingredient and
it's made to deceive people it looks
like the real thing but it isn't the
real thing the packaging looks real the
product looks real looks authentic but
it's not the real thing it's made to
deceive and unfortunate ly fully that's
what it's made to do the think that you
got the real thing is sort of like a
fake Rolex watch or a fake polo shirt or
a fake Reebok shoes that they made to
look good but they're not not the real
real product itself and pharmaceuticals
are a little dangerous when you buy them
by buy them that way because you expect
the real thing you're not getting the
real thing so they're not made in the
starless confinement environments either
in some pictures like tourism one
picture of news vials they collected use
Wiles and they put to counterfeit
antibiotic into the use file it was made
in Colombia another counterfeit lab
busted their fake drugs from China
busted in Egypt
viagra made in Egypt looks pretty clean
and sterile there I'm not too sure I
want to buy anything from these from
these organizations and how they're
ingested is they said they look like the
real thing here's a fig lipitor and anti
cholesterol drug the the fakes on the
right and the lipitor is on there you
there's very little difference in them
and you can see at the top we got
celebrex at the very top vicodin
you got a lot of different fake products
and the page the packaging looks real to
use the right packaging they copy it off
their copiers they go to the printers
and they copy it it it's interesting to
see other guys work
fake adderall came in United States
tramadol with acetaminophen came in the
United States there's fig vicodin in one
case alone nesting ninety-five million
dollars in fraudulent selling unapproved
drugs to Americans in one pharmaceutical
done and it's a pharmaceutical Asian
getting into United States so it's an
interesting scam that they pull and
they're very good at it extremely good
at it so as your teenager daughter
buying contraceptions online without a
prescription
you can certainly buy a lot of
contraception devices online and some of
us counterfeit and some what's real
matter of fact just last week in Peru
they busted a counterfeit contraceptive
plant there it was making plan B
contraception with no active ingredient
in sell in the United States YouTube
videos cartoons and teach IUD and
implant insertion or remove and removal
despite the risk and so they get active
online and they can buy just about
anything you want to you can think about
in contraceptive my own line another
real problem with buying drugs online is
that you probably haven't seen a
physician that's one of the huge
problems you you may have seen its
physician a year ago to get the original
prescription was probably filled at a
licensed pharmacy and then after time
some people say I want to get it cheaper
so they buy online or in fact they never
been back to the physician or haven't
seen the physician lately and then it
becomes dangerous dosage may have
changed the medication use may have
changed you may have added another
medication to your existing regiment so
you may have a drug interaction possible
so you got this death of this patient
was due to taking a painkiller
medication at the wrong dose that she
bought online it was up it was a sleeve
excuse me it was a sleeping medication
she bought on day so without knowing
safety instructions
that our physician or the pharmacist
could informed her of if she had
purchased a drug from legitimate sources
so it's it's it's not exactly the safest
way of getting doctors have been found
to purchase misbranded on the
counterfeit drugs black-market cancer
drug cases they're shown up across the
country and FDA has managed to send it
over a thousand letters to physicians
noting the counterfeit drug sellers are
out there and the fragile biologics
acquiring clinic use and careful storage
of becoming new targets for
counterfeiters the expensive biological
agents would have to be refrigerated
they can't be shocked or shaken they
they have to be really stored well and
distribution chain remember I talked
about earlier the distribution chain now
how do you ship pharmaceuticals whether
it's cold storage all the way from the
manufacturer through the trucking to the
wholesalers and now these new biological
agents out there it to be shockproof in
the packaging and and how they're
packaged to be to put on transport
vehicles whether they're trucks or
airplanes because if you just drop them
you could destroy the molecule in the
vial the counterfeit a vast in case the
cancer drug case is an interesting case
the counterfeit is on the left
it came in United States in the
authentic offending Avastin is on the
right now they contain no active
ingredient yeah he's not approved
labeling when you slick at the product
labeling it was in French on one side
and it was Arabic on the other side I'm
still puzzled how a US position would
would dispense this drug when the US law
requires it all the labels have to be in
English and then they turn around and
look at the label and see it's in French
why wouldn't they raise the question is
this a legitimate pharmaceutical
especially when you got two languages on
the same label and then you get the
wrong company manufactured that
it's labeled rosh manufactured this drug
and the only product approved in the
United States for this drug is made by
genatech not Roche so the problem the
label itself had many errors in it I
think it was 78 physicians offices got
this product gun was dispensed to to
cancer victims of the cancer patients
originally the product came out of
Istanbul and it was sold to a contractor
not even a pharmaceutical wholesaler in
Switzerland the question mark and in
this slide shows that they don't really
know where it came from the rumor has
that it came out of Egypt I'm not quite
sure if that's true or not or originally
was manufactured in Egypt so I went to
Turkey went to Switzerland then shipped
up to Denmark then went into UK United
Kingdom and then I was shipped into
Gainsborough Tennessee through a buyer
in Winnipeg Canadian internet buyer
through Winnipeg Menace Manitoba
which had offices in Belgrade Montana so
there were a lot of people involved in
got shipped I believe to 78 doctor
clinics in the United States was the non
approved drug and the drug was shipped
to California Texas New York and Florida
to those clinics and you can see where
the the authentic Avastin desert here's
a here's an example of the closed
distribution system number one is FDA
approved it's manufactured in Avastin in
it's only shipped to license carriers of
the product McKesson Kirra scrip in
California ASD healthcare in Frisco
Texas
and then there's something there's two
cardinal health and Bessie medical in
Ohio and then from there those places it
shipped out to the physicians or doctors
clinics that's the closed authorized
distribution system instead of going
through the other distribution system
that the fake drug came through another
example of a counterfeit case happened
in Ontario in 2000
five with a pharmacist who bought
norvasc a heart medication from a vendor
who pulled up and avoid white van and
the pharmacist bought the product which
happened a week counterfeit product
the pills were made at Telkom powder and
not the active ingredient with eleven
people have died the pharmacist got off
on this one of all things I cannot
believe this myself the pharmacist was
acquitted by the court in 2011 because
the prosecutors failed to prove criminal
intent I would have got the the
pharmacist for buying Finnell legal
wholesaler see well there weren't
license probably their United States
that you can't do that just a closed
system so he was sued and God got he
sued the pharmacy board and got his
pharmacy license back and he's still
practicing pharmacy today in Toronto
even though eleven people have died from
the case fake drugs appear a gar all
over the world we you know I'm going to
divert here for a second
remember I said one in five drugs and
Russia are counterfeit we got countries
or forty percent of the drugs
counterfeit so four out of ten are
counterfeit in the pharmacies or where
they purchase pharmaceuticals in some
countries Brazil it's got a huge
problems about one and three in Brazil
South America's plagued with it Africa's
very plagued with the problem because
they buy the cheap drugs and they sell
them flee markets open open air vendor
markets across Africa Nigeria Cambodia
you name it and it comes across them
especially anti-malarial drugs are being
counterfeit UK is a fifth most likely
country in which you will find a
counterfeit drug which probably
surprised you in England so it's quite
off they had seventy thousand packs of
counterfeit life-saving drugs and
pharmacies UK now back to the Canadian
online pharmacies unless you drive over
the border into Canada go to a Canada
brick or mortar pharmacy the
those all those products sold by the
brick-and-mortar pharmacies may drive
across the border are approved by Health
Canada that's the legal distribution
system and health canner which is
equivalent to the United States FDA has
to approve the product and so these
companies are not regulated by Health
Canada that what the online pharmacies
are not regulated by Health Canada or
provincial pharmacy both boards they can
sense they buy in the drug from other
countries and are not selling to
Canadians they don't have to have the
drug approved by in Canada if so it's
kind of fascinating so Canadian online
pharmacies sell price controlled
medications from Canada no that's not
price controlled because they can't sell
those drugs to Canadians they can only
sell them outside of Canada and so in
this example of Andrus trembler in Mehta
plan operation he ran in Canada he was
finally arrested a few months ago in
Miami
ninety percent of the drugs they seized
from the mana plant met a planned
shipments with lipitor some hides high
used drugs and all of them were fakes
from all over the world that he was
selling to primarily US residents across
the country so they are cheaper I don't
think so
generics are often cheaper in United
States versus the Canadian prices so if
you're looking to buy a cheaper drug in
the United States the first question you
guy gotta ask is what's a generic price
in the United States that's the first
question
85% of all drugs dispensed right now our
generic Aran generic form so you can buy
them in the United States in generic
form and they're much cheaper than the
brand-name drugs in Canada or in the
brand name drugs in United States and
you can look at the difference in the
extra cost of patients from Canadian rx
versus what the Canadians say once in a
while you'll find a drug goes be cheaper
in Canada but by far that generics in
the United States are cheaper than what
you can get in Canada they can can
Canadian pharmacist of legally filled
America
prescriptions the answer is no it's
illegal for a Canadian pharmacist to use
or legally fill a prescription written
by a US physician unless that US
physician also has a Canadian license
then he can fill the prescriptions got
both licenses and countries but he can't
fill them so your doctor can bill
insurance back for imported drugs no
they can't do that either
because there are misbranded drugs you
can't you can't build the insurance
company for a misbranded drug nap and
misbranded drug is a drug that's
mislabeled says it's made by Roshan it's
not made by Roche is made by genatech
for example or if it's made by another
company it's not approved United States
any of the non approved drugs used in
the United States it's illegal to build
an insurance company for that product so
how do I stay safe if I'm not in control
the medication when it comes from here
are some signs you can look for look for
signs of the suspicious medications in
the doctor's office look for foreign
writing on the label ask to see the vial
or the bag or a unit with a lot number
write it down or take a photo of the
label I did a good idea with your cell
phone take a photo of the label and you
can check it when you get home and pay
attention to new or unusual side effects
or therapeutic effects of the drug
that's the I always tell physicians when
talk to them the first question you
should ask if the person is not
responding to the drug is where did they
buy the drug and sometimes it will take
six months to nine months to know the
response of a drug take a
cholesterol-lowering drug it may take
six months for your cholesterol comes
back up high again and so you were
taking the original drug you moved over
to a counterfeit drug with no active
ingredient and now you go to the
doctor's office and see your cholesterol
goes up he thinks you're still taking
the original drug the authentic drug
then you turn around and what's he do he
does one or two things he either changes
the therapy to a different
cholesterol-lowering drug or he raises
the dose of the initial drug and now you
got probably twice or more
drug than you really need when in fact
you were taking a drug that didn't have
any active ingredient and that's why
your cholesterol rose so telling me
you're buying the drug from and look for
the benefits or the lack of the benefits
of the drug or the side effects of the
drug so how do you find discounts the
first place I would go to go to the
NeedyMeds drug discount card site that's
the first place I would go you could go
to the partnership for prescription
assistance help you find a program
that's right and are all free of charge
when you when you do then you can look
up the drug and get the information
where is the cheapest place to go and
you can shop comparison from a pharmacy
helper com where at list all the online
remember the verified internet pharmacy
provider sites these are located United
States these are websites and they're
verified by the National Association of
boards of pharmacy of good quality
pharmacists and pharmacies and you can
compare the sites of the different
internet pharmacy sites across the
country on the prices of different
pharmaceuticals and you certainly can
save money by buying the fda-approved
generics as I already mentioned you can
also compare shops locally you can go to
we are XCOM louis Medicom or good rx
comm to make sure your pharmacist knows
all the medications you're doing when
you're doing that but you can go in
there and look for the cheapest drugs at
these three sites to within your local
community so you can find out they will
shop side so and we have a website
called the partnership for safe
medicines it's the safe medicines org
and the bottom of the screen
however just found out this morning some
hacker got into the site and just in it
put some problems with the site and will
probably be up later this afternoon but
right now it's the site is down but safe
medicine org offers some some brochures
and some things you can print out on
counterfeit drugs where to buy drugs and
how to
they say from counterfeit drugs you're
welcome to look at them and download
anything you want to you can off that
say because it's a consumer friendly
site the partnership for safe men is
concise you're welcome to get all the in
literature you need on the site so what
can my patient organization do to
educate our community well we can help
you develop a webinar like what this one
is we can provide two handouts to you to
your patient community if you need them
for a school board session you need them
for us held session or some kind of Club
we'll be glad to do that you can take
one or more the 26 to tubes use
Facebook's Twitter email or print some
newsletters we have safe medicines org
offers a variety of newsletters that
come out weekly that you can look on how
to get the safest medications possible
so you can our members conduct joint
educational projects we can provide go
to your your your conventions or your
meetings will be glad to travel and give
presentations on safe medicines to
pharmacists physicians nurses
distributors educators and you can
contact Sarah at safe medicine stout
Oregon so our amber will be glad to help
you to provide the educational content
so I really want to thank dr. Marsh
eppard for giving us this presentation
Shea we really appreciate it I'm here at
NeedyMeds were always trying to keep our
users as informed as possible we know a
lot of them are looking for lower-cost
medications and need some help with
their healthcare costs so we hope that
this webinar was informative for all of
you and again thank you Marv and please
visit our webinar page for upcoming
webinars and I hope everyone has a
wonderful day so thank you so much thank
you
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