Mounties bust Montreal counterfeit pharmaceuticals network

In case you weren't convinced that counterfeit drugs are a big problem in Canada, maybe this will change your mind.

The photo above depicts some of the more than 15,000 counterfeit pills RCMP officers seized on Thursday from seven Montreal locations after a major, 18-month-long investigation, which also resulted in nine arrests.

Drug counterfeiting is an area of concern not only for the police but also for Health Canada officials and physicians, and a large portion of the concern arises from the growing popularity of the internet. In response to the RCMP's announcement of its sting operation, Health Canada issued a reminder to Canadians about the risks of purchasing drugs online. "If you order from these sites, you may get counterfeit drugs that may contain the incorrect dose, the wrong ingredients, dangerous additives, or no active ingredients at all, which could result in potentially serious health risks." Irregular dosages and unadvertised ingredients and additives were all present in the counterfeit erectile-dysfunction pills seized in Montreal. "Even if these drugs do not harm you directly or immediately, your condition may get worse without effective treatment," Health Canada also warned.

Much of the problem stems from the fact that, in recent years, patients have become increasingly reliant on the internet to diagnose themselves and even to obtain drugs. While none of last week's raids targeted counterfeiters who were distributing via the internet, RCMP spokesperson Sgt Luc Bissette told Canadian Medicine, "There are ongoing investigations into online distribution" but he couldn't discuss details because they are still underway. "This time we hit the stores," he said. "Maybe next time we'll hit online."

The seriousness of the dangers posed by the growing online market for counterfeit drugs was made manifest in December 2006 when British Columbia resident Marcia Bergeron became the first person definitively shown to have been killed by fake drugs bought online. After Vancouver Island regional coroner Rose Stanton filed her report the following summer, she permitted to take a look at the document, including the toxicology figures. I wrote in the National Review of Medicine: "The Burnaby, BC, lab found diphenhydramine (an OTC sedative), acetaminophen, mirtzapine (a prescription antidepressant), dextromethorphan (an OTC cough medicine) and methocarbamol (an OTC muscle relaxant). But most shocking were the dangerously high levels of metals, including aluminum (15 µg/g), phosphorus, titanium, tin, strontium, arsenic and other metals in Ms Bergeron's liver. The level of aluminum alone was 15 times higher than what's considered normal."

If that's not evidence enough to convince doctors that their patients could well be be at risk of serious injury as a result of fake drugs distributed online -- well, I'm not sure what else to say.

When I wrote that article in 2007, Dr James Wright, a University of British Columbia professor of internal medicine and pharmacology provided some excellent advice. With the government struggling to keep up with the counterfeiters, he said, physicians must take more responsibility for protecting their patients from this threat. "We are not very good at asking patients what medications they are taking other than what we are prescribing," said Dr Wright.

That advice remains as true today as it was then. Last week's RCMP raids in Montreal should not only remind patients of the risks of fake drugs bought online but should also tell doctors that the problem is likely with us to stay.

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