Counterfeit Medicines in Canada

By: Aastha Vaidhya

The threat of counterfeit pharmaceutical drugs is on the rise in Canada and puts patients at great risk. From April 2016 to March 2017, Health Canada seized almost 5500 packages on route, most of which were in the form of sexual enhancement drugs.¹ In 2018, Canada seized $2.5 million in fake medication at the border.¹ In December of 2018, companies under online pharmacy “Canada Drugs” foreited their proceeds in the sale of illegal drugs from 2009 to 2012, amounting to a sum of $29 million.¹

Figure 1. Viagra is one of the moust counterfeited drugs in the world.²

Counterfeit drugs pose risk to individuals as they may contain no active ingredient, harmful ingredients, the wrong concentration or dose, expired medicine, or the wrong medication altogether; leading to reduced treatment effectiveness and giving way to unexpected side effects or even death.¹ Furthermore, a risk is also created to global health. Pharmaceuticals containing a significantly reduced dose of the active component contribute to global microbial resistance, gradually leading to more virulent forms of diseases for conditions like shigella, cholera, salmonella, and tuberculosis.¹

While counterfeit drugs in Canada’s licensed phamaceutical supply chain are rare, existing cases have occurred when brick-and-mortor pharmacies have dispensed these drugs by mistake.¹ However, more often these counterfeits are obtained via the illegal drug trade, such as through illegal Internet pharmacies. This leads to economic implications on drug manufacturers and distributors, with the World Health Organization estimating a loss of $75 billion a year on the global pharma industry.¹ Beyond lost revenue, other costs are also imposed on legitimate players in response to counterfeiting, including increasing costs to secure the supply chain, investments in anti-countfeiting technologies, and the risk of liability.¹ These consequences only exacerbate the human toll of counterfeiting, as there are less resources to invest in the development of potentially life changing drugs.¹

Experts find that the sale of counterfeit drugs is growing at twice the rate of legitimate pharmaceuticals and estimate an annual growth of twenty percent in the coming years.¹ This demand is driven by both inadequacy in the regulatory architecture and enforcement as well as the demand for prescription drug misuse.³ In Canada, fentanyl is mixed with heroin and pressed into counterfeit prescription pills.³ This results in tragedies such as one seen in the spring of 2017, in which several middle schoolers died from fentanyl poisoning after taking counterfeit pills.¹This import is exacerbated by the fact that pill presses and tableting machines are currently not regulated by Canada’s federal government.³ Additionally, drug shortages brought upon by manufacturing issues and market pressure that have been rampant in Canada in the last ten years facilitates the trade of counterfeit pharmaceuticals.³ A report by the Senate of Canada points to Health Canada’s poor record of inspecting foreign sites and level of unpreparedness to provide country-of-orgin information for drugs to be sold in Canada.³ Harmonized regulatory insight is strongly needed to prevent counterfeit medication from spreading in the country, potentially through stiffening criminal penalties, regulating shipments, or pursuing an international treaty.¹

Figure 2. Consumer Protection from Counterfeits.⁴

In the meantime, consumers can protect themselves by avoiding internet pharmacies and making sure to only ship from reputable sources. Additionally, a thorough examination of all medication —looking out for differences in taste, appearance, or structural integrity—and confirmation with a pharmacist in the case of suspicion is important.⁵

Figure 3. Examining pills and packaging.⁶

The World Health Orgnanization also warns to be wary of websites stating they are Canadian—the FDA finds that 85% of drugs being promoted as such have come from 27 other countries, consisting of counterfeit products.³ Despite Canada’s standardized pharmaceutical system that lessens the potential market for illegitimate supplies, no country is immune from counterfeiting. Health agenies hold a responsibility to Canadian patients and legitmate manufacturers to continue examining the extent of the problem in linkage to organized crime and policy responses.¹

Reference List:

1. Fraser Institute. Counterfeit drug trade poses increasing danger to Canadian patients: op-ed. Fraser Institute. Published March 2, 2018. Accessed March 27, 2023. https://www.fraserinstitute.org/article/counterfeit-drug-trade-poses-increasing-danger-to-canadian-patients

2. Gatehouse J. Counterfeit medicines, from headache pills to cancer drugs, have become a multibillion-dollar problem. CBC. Published February 12, 2019. Accessed March 27, 2023. https://www.cbc.ca/news/thenational/national-today-newsletter-counterfeit-drugs-medicine-1.5014784

3. Pharmaceutical counterfeiting in Canada from Pharmaceutical Counterfeiting:: Endangering Public Health, Society and the Economy on JSTOR. Jstor.org. Published 2023. Accessed March 27, 2023. https://www.jstor.org/stable/resrep23987.8?seq=5

4. Counterfeit Drugs – Fraud. Fraud.org. Published 2023. Accessed March 27, 2023. https://fraud.org/fakerx/

5. CTVNews. Counterfeit medications a growing problem in Canada, warns new report. CTVNews. Published February 8, 2018. Accessed March 27, 2023. https://www.ctvnews.ca/health/counterfeit-medications-a-growing-problem-in-canada-warns-new-report-1.3795239?cache=almppngbro%3FclipId%3D68596

6. Partnership for Safe Medicines. Patients, protect yourselves. You are the last line of defense. Published November 30, 2022. Accessed March 27, 2023. https://www.safemedicines.org/2022/11/patients-are-the-last-line-of-defense.html