Ordering Your Drugs Online from Foreign Countries

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Ordering medications from Canada? Here's a guide to help you play it safe.

"How to buy less expensive medications is one of the top questions I get from my patients," says Johns Hopkins lung specialist Peter B. Terry, M.D. One way to purchase medications at a reduced cost is to buy them online or by phone from Canadian pharmacies. The U.S. Food and Drug Administration (FDA) opposes foreign drug purchases, warning that these sales pose serious safety problems. While importing Canadian medications is against U.S. policy, the FDA has said that it will not prosecute individuals who import small amounts (three months or less) for personal use. If you are considering ordering medications from Canada, remember that the FDA cannot guarantee the safety of those medications. The FDA’s concerns include:

* Quality assurance. Medications that have not been approved for sale in the United States may not have been manufactured under quality assurance procedures designed to produce a safe and effective product.
* Counterfeit potential. Some imported medications -- even those that have the name of a product approved in the United States -- may, in fact, be counterfeit versions that are unsafe or ineffective.
* Presence of untested substances. Some imported medications and their ingredients, although legal in foreign countries, may not have been evaluated for safety and effectiveness in the United States. These medications may be addictive or contain other dangerous substances.
* Risks of unsupervised use. Some medications, whether imported or not, are unsafe when taken without adequate medical supervision. You may need a medical evaluation to ensure that the medication is appropriate for you and your condition. Or you may require medical checkups to make sure that you are taking the medication properly, to assess whether it is working for you, and to check for unexpected or life-threatening side effects.
* Labeling and language issues. The medication’s label, including instructions for use and possible side effects, may be in a language you do not understand and may make medical claims or suggest specific uses that have not been adequately evaluated for safety and effectiveness.
* Lack of information. An imported medication may not have information that would allow you to be treated promptly and correctly for a dangerous side effect caused by the medications.

The American Association for Retired Persons (AARP), the leading non-profit, non-partisan membership organization for people aged 50 years and over in the United States, does not encourage Americans to break the present drug importation law. But with an estimated two million Americans already buying prescription medications from Canada, AARP has come up with guidelines to help consumers minimize their risk and ensure that the medications they receive are the ones their doctors have prescribed. AARP recommends that you pick a pharmacy that:

* Provides its license number on its website and the name of the Canadian regulatory agency that granted the license so that you can check the pharmacy’s authenticity.
* Displays the seals of the Canadian International Pharmacy Association (CIPA; see www.ciparx.ca/) or Internet and Mail-Order Pharmacy Accreditation Commission (IMPAC; see www.impacsurvey.org/). These organizations set standards for safety and service among Canadian mail-order pharmacies that sell to Americans. Those that meet the standards receive accreditation.
* Requires a prescription for medication from your doctor. Reputable pharmacies may allow you to fax in a prescription but will then either confirm the prescription by a phone call to your doctor’s office or wait until they receive the original one in the mail before filling your order.
* Requires you to submit details of your medical history and clearly states the pharmacy’s policies for ensuring medical and personal privacy.
* Requires you to have taken a medication for at least one month before you order by mail so that you and your doctor know the medication is working and is safe for you.
* Provides a full mailing address and a toll-free phone number on its website so that you can call a pharmacist to ask any questions you may have.
* Explains differences between American and Canadian drug names and labeling and why the pharmacy does not sell some medications.
* Normally sends medications in the manufacturer’s original container, with seals intact. An exception to this rule occurs when the quantity of pills in the manufacturer’s own container exceeds a 90-day supply. In these cases, medications may arrive in ordinary pharmacy bottles.
* Sends medications with labeling that includes strength, dosing directions, expiration date, appropriate warnings, and a Drug Identification Number (DIN) that shows the drug has been approved by the Canadian government health authorities.
* Displays on its website full information about shipping fees, payment policies, and refunds. Reputable pharmacies offer secure (encrypted) online payment for credit cards, alternative options for payment (such as electronic fund transfers and regular checks), and do not charge any separate fees except for shipping.
* Charges the cost of the medications to your credit card only when the drugs are shipped, not when the order is first placed.
* Refunds your money or reships medications immediately if your order does not arrive.

Final word of advice: If you’re wondering where to start looking for pharmacies online, visit www.pharmacychecker.com, a website run by an independent American consumer research group that provides ratings and price comparisons for more than 40 online pharmacies based mainly in the United States and Canada. This site rates them on a scale of 1–5 and notes whether a pharmacy is licensed, requires a prescription, provides its address and phone number, and offers personal privacy and payment security. The site compares prices for more than 1,000 drugs at these pharmacies and gives details on shipping fees and delivery times.

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Prescription Drugs Special Report
Ordering Your Drugs Online
Johns Hopkins Health Alerts
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NOTE: It is our understanding that ordering prescription drugs that are sold in the US from another country such as Canada is against the law, period. The FDA, in general, will permit ordering up to a 90-day supply of drugs that are NOT available in the U.S., for which a doctor confirms there is a medical need. Shipments that do not meet FDA guidelines may be seized, without compensation.