It’s no secret that illicit drugs and other unlawful products are flooding our nation’s overwhelmed international mail facilities on a daily basis. The sheer volume of incoming packages is staggering. Law enforcement and regulatory agencies have been dealt an insurmountable challenge, but changes may finally be on the horizon. Congress has set its sights on foreign mail shipments of fentanyl, and a recent Statnews.com article is shedding light on the extent of the problem. Counterfeit Viagra from China and Cialis knock-offs from India (two of the most common pharma-related examples) were bad enough, but fentanyl takes this problem to a whole new level of criticality!

According to the article, “Hundreds of millions of dollars worth of fentanyl-and likely more-is pouring into the United States through international mail-and the federal government isn’t equipped to track it or prevent it from happening, according to a nearly yearlong bipartisan Senate investigation.” While the focus of this article is solely on the opioid crisis, the pharmaceutical distribution supply chain implications are chilling.  If our government is unable to stop fentanyl from being smuggled into our country via a porous international mail system, the likelihood that counterfeit prescription drugs of all types are also flowing undetected cannot be ignored.  This problem extends way beyond so-called lifestyle drugs, like Viagra and Cialis.

International mail represents a gaping hole in our pharmaceutical distribution supply chain that must be plugged or vulnerable patients will continue to be exposed to counterfeit drugs.  While Internet pharmacies are widely seen as the greatest risk to patients in this regard, another looming and still silent counterfeit drug threat exists that must not be discounted.  Counterfeit drugs can make their way onto pharmacy shelves (and probably already have) when corrupt pharmacists do business with illegitimate suppliers. Drug diverters who buy and sell non-controlled prescription drugs in the shadows of our supply chain care only about profits.  It’s therefore quite reasonable to envision a scenario where counterfeit pills from foreign sources can be sold directly to pharmacies and ultimately dispensed to patients in such a fashion.  Are any of these bad actors going to question where a bag of loose HIV or blood pressure pills came from?  Making matters worse, law enforcement and regulatory authorities at the international mail facilities are currently ill-equipped to solve this problem, and there is little to no oversight of susceptible pharmacies on supply chain issues.  It is a catastrophe waiting to happen.

Of course, the scope of this threat is largely unknown, but it will remain that way until a counterfeit drug incursion involving a pharmacy (or pharmacies) takes place, or federal and state regulators resolve now to adopt collaborative measures designed to protect patients from this menacing, and all too likely, scenario.