PSM board president, pharmacist explains why foreign drug importation can’t deliver.

Kenneth McCall

This editorial by Kenneth L. McCall, PharmD FAPhA was published in the Corpus Christi Caller-Times on June 30, 2023. McCall is co-chair and clinical professor of Pharmacy Practice at the School of Pharmacy and Pharmaceutical Sciences at
SUNY Binghamton, and board vice president of the Partnership for Safe Medicines.

Opinion: Foreign drug importation for Texas isn't as great as it sounds

A national news report on the Texas House of Representatives passing legislation to allow the importation of prescription drugs from Canada quoted a Dallas resident as saying that such a move would be “absolutely amazing.” As someone who lives in a state that has legalized foreign drug importation and having ordered medicines from a seller outside U.S. borders, I can attest that it is indeed amazing, but not in a way Texans might expect or would desire for themselves and their families.

Now that the bill has been signed into law by Gov. Greg Abbott, the Lone Star State has become the seventh in the nation to legalize foreign drug importation. Of course, there are very real questions as to whether this is anything but a symbolic action. There are 30 million Texas citizens. Canada’s entire population is 37 million and the nation endures constant drug shortages. It is inconceivable that Canada can or would provide a steady flow of price-controlled pharmaceuticals to meet Texans’ demands for cheap drugs.

But, I can tell you from my own experience that this is a dangerous direction for Texas to travel. After Maine’s legislature passed foreign drug importation legislation nine years ago, I acted in my role as the president of the Maine Pharmacy Association to buy three popular prescription drugs – an acid reflux drug, a blood thinner, and an anti-inflammatory. I guess you could say the results were, to quote that aforementioned Dallas resident, amazing.

Surprise number one was that, even though I had ordered brand-name drugs, what I actually received were generic versions of the drug. And the drugs shipped to me did not originate in Canada, but rather India, Turkey, and Mauritius. This is an important point to keep in mind for states considering drug importation programs. Canada is not a home for producers and manufacturers of pharmaceuticals. It is an importer, and the U.S. Food and Drug Administration has no control over the origination point of drugs in Canada.

Surprise number two came when I had the drugs tested. The acid reflux medication contained only 58 percent of the dosage level stated on the packaging. The anti-inflammatory had only 87 percent of the labeled dose and, worst of all, the blood thinner contained an unknown contaminant.

This underscores the inherent danger in importing drugs from outside our closed pharmaceutical manufacturing and distribution system in the United States, where every step of the process is closely monitored by the FDA. Canada’s government has already put measures in place to limit bulk exports for fear they would exacerbate shortages. The alternative then for Texas citizens would be to turn to private vendors, not unlike the one who sold me substandard and contaminated drugs.

The world is currently battling a counterfeit drug crisis. Even more relevant to the point at hand, the Alliance for Safe Online Pharmacies has found that 95 percent of the approximately 35,000 pharmacies on the internet are operating illegally. It boggles the mind that politicians who are raising the legitimate alarm about lethal quantities of fentanyl entering the United States would then enact drug importation legislation that would make it even easier to do so.

The motivation for drug importation legislation in Texas and other states is understandable. Many people are paying too much for the medicines they need, and they want relief from that cost burden. Foreign drug importation, though, is just an illusion posing as a solution – and a dangerous one at that. Policymakers should instead look at the flaws in the drug supply chain, where corporate middlemen are negotiating rebates with drug companies but not passing savings along to consumers at the pharmacy counter.

The notion of foreign drug importation promises something it can’t deliver, dependably safe drugs at low prices.