Over 20,000 deaths from overdoses related to prescription opioids were reported in the U.S. in 2015. An even higher proportion of the population have lost their lives in Canada from opioid abuse. In fact, according to a recent UN report, Canada consumes more prescription opioids on a per-capita basis than any other country. In short, both countries are in the grips of an opioid abuse crisis that is claiming thousands of lives.
The illegal trade in both prescription and illicit opioids between Canada and the United States is rampant. Canada is a primary destination for counterfeit fentanyl, a super-potent, highly addictive synthetic opioid that has been illegally manufactured in China and shipped through Mexico and Canada into the U.S. As a report in Canada’s Globe and Mail noted, online suppliers are “exploiting gaps at the border.”
The report noted that counterfeit fentanyl “manufactured in China, easily crosses our porous borders”. The report concluded: “for online suppliers, the borders may as well not exist.” According to the DEA’s Louisville field office, fentanyl has caused numerous deaths in Kentucky. Jim Scott, resident agent-in-charge of the DEA’s Louisville Division, expects to see overdoses from fentanyl rise this year. “It’s often made in China and shipped to Canada or Mexico and then hauled into the United States.”
According to a recent report by the CBC, Canada’s national broadcaster, “law enforcement in both the United States and Canada have long been aware of the illegal movement of opioids between Canada and the U.S.” In 2016, a man was convicted of smuggling thousands of doses of a deadly new synthetic opioid into the U.S.
Monitoring and policing the illegal movement of diverted and counterfeit prescription drugs across borders in North America is a daunting task. Proposed changes in U.S. laws and regulations to make the movement of drugs across borders easier can only make the current opioid crisis worse.
Recently, four former U.S. Food and Drug Administration Commissioners signed an open letter to members of Congress stating that importing medicines from Canada and elsewhere is “a complex and risky approach.”
In their letter, Robert M. Califf, MD Margaret B. Hamburg, M.D. Mark B. McClellan, M.D., Ph.D Andrew Von Eschenbach, M.D. express their support of efforts by Congress to control drug costs in the United States, but say that trying to do this by allowing importation of drugs from Canada is too simplistic and endangers public health. “There are far better ways to improve access to safe and effective drugs. We believe Congress should consider other approaches to address problems with current drug pricing, and take steps to bring down drug costs and health care costs more generally,” they said.
As in the past, current legislative proposals to facilitate the flow of prescription drugs across the Canada-U.S. border are a politically driven effort to circumvent laws designed to protect patients and the safety of our drug supply system. Making importation legal means circumventing American and Canadian laws that are intended to guarantee the safety of the drug supply. Legalization would result in the expansion of importation in order to meet the demand for product that inevitably will rely on foreign supplies that do not meet FDA safety or efficacy requirements.
Given the tragic consequences of the flow of prescription and illicit opioids that currently exists, easing the rules for drug importation between Canada and the U.S is an even worse idea today with potentially deadly consequences.
The FDA commissioners make it clear where they stand on the issue of drug importation. “We urge Congress and the many others concerned about the cost of drugs to deal directly with the issues driving the cost of medicines and not to place false hope in measures that will place patients who need treatment at risk and jeopardize public health.”
Robert Freeman, PhD is professor & vice chair for research at the University of Maryland Eastern Shore School of Pharmacy & Health Professions. He held senior positions in the global pharmaceutical industry, dealing with health policy and economics.
The views expressed by contributors are their own and are not the views of The Hill.