Wow natalieemt-ga,
This is a huge and complicated issue!
There is so much information out there on purchasing prescription
drugs from Canada (and other countries), that it's quite daunting to
weed through it all. I spent a good portion of today trying to sort
through it all.
My focus then has been to address the specific question, "How does one
go about ordering prescription drugs from Canada?" which I've answered
using your sub-questions as a guideline. Of course this led to the
whole legality of the issue, which isn't exactly straightforward.
Here's what I found ---
=========================
SHORT ANSWER
==========================
In general, if you have a VALID prescription for an FDA-APPROVED drug
written by your US LICENSED doctor, it is possible to have that
prescription filled by a pharmacy in Canada either online or in
person.
BUT Canadian law prevents pharmacists from filling prescriptions
written by non-Canadian doctors.
SO HOW DOES IT WORK?
For the online prescription services, US consumers must fax or mail
their prescription to the online pharmacy AND must supply a detailed
medical history and contact information for their physician. This
information is reviewed by a Canadian doctor who then decides whether
or not to rewrite the prescription and complete the order.
This is a bit iffy legally, because technically the doctor never sees
the patient face-to-face. Some pharmacies get around this by only
offering refills of established prescriptions.
To visit Canada and have a US prescription filled; consumers do need
to be examined by a Canadian physician. I've addressed the details of
this process in the last sections below.
AND depending on what you are ordering, the practice is not
necessarily legal in the US. In short, it is illegal to order or
import prescription drugs from other countries.
The law is established by the FDA and is enforced by US Customs and
the US Postal Service.
Large infractions (such as the import of large quantities of
medications, the import of illegal or controlled substances and the
import of prescriptions from questionable countries of origin) are
handled quickly and severely.
However, there are "personal use" clauses and specific exemptions in
the law which do allow the import of 90-days worth of some
prescription drugs. Much of what people currently order or import do
not fall within these exemptions, however their infractions are often
overlooked by the authorities. I've also addressed this in detail
below.
==============================
ASSESSING ONLINE PHARMACIES
==============================
You asked -- Are there certain sites or companies that are especially
reputable, and others that are not?
Yes!
First of all, customer should never use an online pharmacy that offers
to sell prescription medication without a valid prescription. This
includes shipping without a prescription to US customers, drugs that
are non-prescription in Canada, but require a prescription in the US.
Note that this obviously cannot apply to US customers who walk into a
Canadian pharmacy and buy OTC medication off the shelf.
Second, there are accreditation associations in Canada and the US that
essentially provide the "stamp of approval" for pharmacies (both
online and "real"). Making sure a pharmacy is licensed in Canada and
is recognized by an accrediting organization is essential for the
safety of the consumer.
NORTH AMERICAN PHARMACY ACCREDITATION COMMISSION
http://www.napac.org/Frameset.asp
THE CANADIAN INTERNATIONAL PHARMACY ASSOCIATION (CIPA)
http://www.ciparx.ca/
NATIONAL ASSOCIATION OF BOARDS OF PHARMACY (NABP)
http://www.nabp.net/vipps/intro.asp
PHARMACY REQUIREMENTS IN CANADA By Province
http://answers.google.com/answers/main?cmd=threadview&id=117399
Thirdly, any online pharmacy (Canadian or otherwise) offering
prescription-filling service to US customers should provide a REAL
phone number and telephone access to a licensed pharmacist who can
answer specific questions about the drug being prescribed. If there is
no phone number provided, the site should be avoided.
Finally, reputable online pharmacies will have standards for what they
will or will not ship to you. For example:
"Cross Border Pharmacy will not handle any habit forming or narcotic
pharmaceuticals
will not ship any pharmaceutical product to you that
does not have an approved version in your country of residence
."
CROSS BORDER PHARMACY
http://www.crossborderpharmacy.com/drug-policy.html
Beware sites that offer to ship you "anything" you request.
And DO NOT assume that, just because a pharmacy says it is located
in Canada, that it is. Phone numbers can be redirected and IP
addresses can be hidden. There are numerous "back-alley" prescription
filling services in countries that are unregulated.
===================================
SPECIFIC ONLINE PHARMACY RATINGS
===================================
This website http://www.canadiandrugstores.com/ has reviewed many
Canadian pharmacies that offer services to Americans through websites,
and has rated them based on website content, quality of service, and
drug price.
Also, this article refers senior citizens to some approved sites.
http://www.vintagejournal.com/VJ0302/index.cgi?template=tpl00&page=resources.htm
============================================
ARE THERE DRUGS THAT SHOULDN'T BE ORDERED?
=============================================
Consumers should be aware some drugs have been identified by the FDA
as too dangerous to purchase via international sources for a variety
of reasons. They are listed here on this FDA website
FDA CONSUMER SAFETY ALERT
http://www.fda.gov/oc/buyonline/consumeralert120902.html
FDA STRENGTHENS CONTROLS, ISSUES CONSUMER ALERT ON IMPORTING CERTAIN
PRESCRIPTION DRUGS
http://www.fda.gov/bbs/topics/NEWS/2002/NEW00856.html
=============================
WHAT MUST MY DOCTOR DO?
=============================
You asked: Can a consumer order prescription drugs from Canada using
a handwritten prescription from a U.S. doctor, or does the doctor need
to get directly involved?
As I said above, as long as you have a VALID prescription and as long
as the Canadian doctor reviewing your medical records has no
questions, then the Canadian pharmacy will normally fill your
prescription without your doctor's direct involvement. Since a valid
prescription contains your doctor's name and contact number, the
pharmacy or the reviewing doctor may of course contact your doctor if
there are any questions about your health or prescription.
For the consumer's own protection, they are advised to have their
doctor phone the Canadian pharmacy to make sure the order is filled
properly. Consumers should avoid any pharmacy that refuses to speak to
their physician.
===========================
WILL I GET IN TROUBLE?
===========================
You asked: Assuming that a drug has been legally prescribed by a U.S.
doctor to a person in America, is it legal to buy that drug from
Canada? Can the individual consumer or the prescribing doctor get
into trouble for buying drugs from Canada?
Is it legal? In many cases no.
Can an individual get in trouble? That's a really good question.
We get a bit of a mixed message from the FDA. Sort of a "No you can't,
but if you do, be careful."
I'm not going to attempt to interpret the law here. I'm just going to
give you the relevant links. But basically, the entire practice of
ordering and importing pharmaceuticals into the US is teetering on the
brink of the legal wall ---
Here's what the FDA says (in part):
"The United States Federal Food, Drug, and Cosmetic Act (Act) (21
U.S.C. section 331) prohibits the interstate shipment (which includes
importation) of unapproved new drugs. Thus, the importation of drugs
that lack FDA approval, whether for personal use or otherwise,
violates the Act."
"Unapproved new drugs are any drugs, including foreign-made versions
of U.S. approved drugs, that have not been manufactured in accordance
with and pursuant to an FDA approval."
" The guidance document is not, however, a license for individuals to
import unapproved (and therefore illegal) drugs for personal use into
the U.S., and even if all the factors noted in the guidance are
present, the drugs remain illegal and FDA may decide that such drugs
should be refused entry or seized."
" That said, FDA's guidance for coverage of personal importations of
unapproved drugs identifies several factors that should be considered
by FDA personnel when determining whether to exercise enforcement
discretion and refrain from taking action against the importation of
unapproved drugs. The General Guidance Section states that FDA should
consider not taking enforcement actions against such importation:
"when
1) the intended use [of the drug] is unapproved and for a serious
condition for which effective treatment may not be available
domestically
2) there is no known commercialization or promotion to persons
residing in the U.S
3) the product is considered not to represent an unreasonable risk;
4) the individual seeking to import the product affirms in writing
that it is for the patient's own use (generally not more than 3 month
supply) and provides the name and address of the doctor licensed in
the U.S. responsible for his or her treatment with the product or
provides evidence that the product is for the continuation of a
treatment begun in a foreign country."
"
a person may decide that his or her FDA approved heart medication
is cheaper in Mexico, and attempt to import the unapproved version of
the drug from Mexico. FDA cannot assure that such products have been
properly manufactured and are effective; therefore, given that such
products are available in the U.S., their use would present an
unreasonable risk and the guidance would not apply"
" We appreciate that there is a significant cost differential between
drugs available here and those in other countries. However, many drugs
sold in foreign countries as "foreign versions" of approved
prescription drugs sold in the United States are often of unknown
quality with inadequate directions for use and may pose a risk to the
patient's health."
Information on Importation of Drugs
Prepared by the Division of Import Operations and Policy, FDA
http://www.fda.gov/ora/import/pipinfo.htm
Other resources ------
Things you should know about purchasing medications outside the United
States
http://www.fda.gov/cder/consumerinfo/border.htm
FDA: Reporting Unlawful Sales of Medical Products on the Internet
http://www.fda.gov/oc/buyonline/buyonlineform.htm
FDA: Buying Drugs Online:
It's Convenient and Private, but Beware of 'Rogue Sites'
http://www.fda.gov/fdac/features/2000/100_online.html
Despite US Law, Seniors Click On Canada For Drugs
http://bernie.house.gov/documents/articles/2001-08-17-Globe-Rx_Drugs.asp
=========================================================
CAN I DRIVE TO CANADA TO GET MY PRESCRIPTION FILLED?
==========================================================
You asked: Can an American who lives near the border go to Canada and
purchase prescriptions there using a U.S. prescription?
Yes and No.
No, because Canadian law requires that a Canadian doctor writes your
prescription. And for a doctor to do that, he or she must examine you
and take your medical history. Therefore, in order for you to have
prescription filled in person, in Canada, you must first make an
appointment to see a doctor in Canada.
Yes, however, because many doctor's offices near the Canada US
border specialize in conducting physical exams to confirm your
prescription. These generally take 15 -30 minutes, and according to
those who use the service, are priced such that there is still a
savings on the total cost of the drug.
It should also be noted that, travelers are limited in the amount of
medication they may import across the border. Only a 90-day supply of
medication is allowed to be brought into the country. It must be
intended for personal use only, must be in its original container and
the person whose medication it is must be present in the vehicle.
Supplies greater than 90-days may be seized by US Customs and the
subject the individual to prosecution.
US Customs -- Medication/Drugs
http://www.cbp.gov/xp/cgov/travel/alerts/medication_drugs.xml
Also, drug products which are not approved by the U.S. Food and Drug
Administration (FDA) may not be acceptable for importation. If one
were to apply the FDA law to the letter, this would preclude
importation of most drugs that consumers purchase from Canada, because
the FDA does not approve their products. However, the practice appears
to allow the 3-month supply rule to stand, without close scrutiny of
the exact medications being imported (unless they are banned or
controlled substances).
Also see this website for more details on driving to Canada to get
prescriptions filled -----
VT REPRESENTATIVE BERNIE SANDERS
PRESCRIPTION DRUG INFORMATION PACKET
http://bernie.house.gov/documents/Rx_Info_Packet.html
========================================
So, that should pretty well wrap up what you were asking for. As I
said at the beginning, it is a complex issue. Although thousands of
people are doing it every day (to the tune of $2M dollars last year),
the practice is still illegal in many of those cases. The practice
also carries great safety and health risk to the unwary consumer.
If there's anything here that isn't clear, please feel free to ask me
for clarification. I'm happy to oblige.
Thank you so much for your question, and for allowing me to answer it
in place of PinkFreud.
Best of luck with your article!
--K~
search terms:
FDA regulation import prescription
FDA regulation import drug
FDA Controlled Substances Act
Canadian health law prescriptions US
law fda prescription drugs Canada |
Clarification of Answer by
knowledge_seeker-ga
on
22 May 2003 11:29 PDT
Hi natalie,
This is in response to your Comment/Question below -----
There are several ways in which US consumers can find doctors licensed
in Canada who are willing to do a brief examination and co-sign their
American prescription.
===============================
1. Take part in an organized trip for just that purpose.
Many cities and senior organizations near the border now offer bus
trips to people who want to have their prescriptions filled in Canada.
Consumers can search for such trips online or should call local senior
citizen organizations.
(Note that the trips are not limited to seniors, just that in most
cases they are organized by seniors groups)
------------
PHARMTRIP (MISSOURI)
For more information on bus trips to Canada, contact
Pharmtrip
The next trip is planned for May 23rd.
Cost: $50
http://www.wsyx6.com/home/links/pharmtrip.htm
Drug Traffic: Trip to Canada Money Saver
" Moses, through a Westerville-based company called Pharmtrip, offers
to ferry people to the Windsor Medical Pharmacy in Windsor, Ontario,
where they are seen by a Canadian physician - a requirement of
Canadian law - and can purchase up to 90-days' worth of medications to
bring back."
http://www.personalmd.com/news/n0605112916.shtml
---------------
RX EXPRESS
" Several members of Congress joined the bus trips that departed from
such cites as Burlington, Vt., Detroit, Mich., Grand Forks, N.D.,
Seattle, Wash., and Anchorage, Alaska."
Seniors Buy Drugs, Save Money on Cross-Border 'Rx Express'
http://www.aflcio.org/issuespolitics/healthpolicy/ns05292002.cfm
"[2003] Trips are currently planned to depart for Canada from:
Connecticut, Minnesota, Indiana, Maine, Pennsylvania, Washington, New
Hampshire, Ohio, Oregon, New York, and Michigan"
http://www.retiredamericans.org/issues/issues_rxexpress.htm
RX Express Maine
U.S. Senator Debbie Stabenow and the Alliance for
Retired Americans Kick off Rx Express Bus Trip to Canada
http://stabenow.senate.gov/press/2002/061002rxexpress.htm
"For information on MCSC's Rx Across the Border,
prescription-purchasing bus trips to Canada, call MCSC
"
The Maine Council of Senior Citizens (MCSC)
http://www.rxmaine.com/home/cheap/mcsc.cfm
RX Express Minnesota
http://www.mnseniors.net/pdrug/rxexpressq&a.html
http://www.mnseniors.net/0303snmar/rxexpress.html
MORE GOOGLE SEARCH RESULTS
RX EXPRESS BUS
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&q=rx+express+BUS
-------------------
National Council of Senior Citizens, South King County Chapter
"BUS TRIP TO CANADA TO BUY PRESCRIPTION DRUGS - On September 24,
Monday local 751 of the Aero Space Machinists Union will sponsor a
free bus trip to buy drugs at 60% percent off the U.S. price. Call
"
http://mytown.koz.com/servlet/community_ProcServ/GID=00025000000962232479410506
================================
2. Make individual arrangements with a doctor before going to Canada.
The best way to do this is via the internet and/the phone. I've been
unable to find any doctors advertising online that they offer service
to Americans. I suspect this is an ethics issue.
But some list their clinics in local US newspapers or come recommended
through affiliated Canadian pharmacies. Most physicians will be listed
in Canadian and US phone directories.
How to find a doctor and buy drugs in Canada
http://www.rxmaine.com/home/cheap/programs.cfm?CheapDrugsArticleID=136#canada
One way to search for a Canadian doctor is the same way you would find
one in the US -- just to do a yellow pages search for "CLINICS
MEDICAL" in the Canadian city you will be visiting.
INFO SPACE YELLOW PAGES - CANADA
http://ypng.infospace.com/_1_26MHUTC03FZI6HN__home/ypv3ca/dsearch.htm?&fromform=dsearch
YELLOW PAGES CANADA
http://www.yellowpages.ca/
===============================
3. Find a doctor in the US who is also licensed (dual or dually
licensed - DLD) in Canada.
" Dually licensed doctors. If you live near the Canadian border, there
may be doctors in your community that hold licenses to practice in the
US and in Canada, in which case they can write Canadian prescriptions
that you can use to get the lower prices at Canadian pharmacies. Ask
your doctor if he/she is dually licensed or check with your county
medical society."
Options for Affordable Medication
http://www.nysenior.org/Issues/affordmed.htm
These will usually be located in border states and some Senior
organizations maintain current listings.
DUAL LICENSED DOCTORS IN MAINE
http://www.rxmaine.com/home/cheap/doctors.cfm
=========================
4. Ask at the pharmacy you intend to use
If a consumer is already in Canada and has not made preliminary
arrangements, the best bet is to ask the pharmacist. Pharmacists
located near the Canadian border (or in major cities such as Toronto)
would likely know which doctors have a history of working with
American customers.
Some online pharmacies also offer search functions to help consumers
find doctors in their area --
------------
Find Doctors that are Legally Licensed to write prescriptions
When
you visit a Dually Licensed Doctor (DLD) in your city, his/her
prescriptions are automatically lawful for dispensing in Canada.
MEDICATIONS CANADA DOCTORS IN YOUR AREA
http://www.medicationscanadaonline.com/doctors.htm
===================================
That should give you enough avenues to help people find doctors in
both the US and in Canada. It really is the same process for finding
any doctor finding the listings then calling to see if they offer
the service you are looking for.
--K~
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