Drug importation: bad for our health

December 14, 2009|By John Michael O'Brien

The U.S. Senate is once again considering drug importation. The amendment proposed by Sen. Byron Dorgan, Democrat of North Dakota, won't save money and will hurt patients. His remarks describe prescription drugs as commodities that should be easily and cheaply available without regard to their appropriate use. He could not be more wrong.

America has a number of serious drug problems, including a rise in prescription drug abuse. The drug-related deaths of Michael Jackson, Anna Nicole Smith and Adam Goldstein (known as DJ AM) made headlines. Less publicized was the news that three times as many Floridians died from prescription drugs last year than from all illicit drugs combined.

In an article last month about the death of University of Maryland pharmacologist Carrie John, Sun writer Scott Calvert reminded us that even smart, local scientists can abuse prescription drugs. However, it wasn't an overdose that killed Ms. John. It was an allergic reaction to a counterfeit version of a drug legal in the United States but purchased illegally from the Philippines.

The drug she ordered wasn't the drug she injected, but it so closely resembled the legal version that two pharmacologists couldn't tell the difference. Local police don't know what was in the syringe, though Ms. John was reportedly so allergic to mice and rat dander that she couldn't work with lab animals.

Counterfeit drugs are dangerous to use, difficult to detect and profitable for criminals to make. The Food and Drug Administration can't assure that drugs purchased from Canada, Australia or the United Kingdom didn't come from China, India or the Philippines. Congress can't make drug importation safe - but it can improve medication use in the United States.

When used appropriately, prescription medicines are the best value in health care, offering hope to tens of millions of Americans. But all medicines have risks, and medication errors are a serious problem, sending 4 million people to emergency rooms, doctors' offices or hospitals every year. Safe medication use deserves more public attention. (Sadly, a Florida Highway Patrol report questioning Ambien use during Tiger Woods' car crash has received more press coverage than the FDA changing Ambien's label and warning doctors about the risk of sleep-driving, sleep-eating or having sex while asleep.)

Unsafe medication use is dangerous and expensive. An estimated $290 billion is wasted when people don't take their medicines appropriately or don't take them at all, a problem known as medication nonadherence.

Patients who don't take their medicine have almost twice the total yearly health costs as those who do. Medication nonadherence leads to otherwise avoidable health costs adding up to nearly 13 percent of total U.S. health spending. Business Week magazine recently included improving adherence in its list of 10 ways to cut health care costs. Every dollar spent helping patients take their medicines as directed can save $7 for patients with diabetes, $5 for those with high cholesterol and $4 for people with high blood pressure.

The House and Senate health reform bills already have sections related to improving medication management. New Medicare Part D rules make it easier for seniors taking multiple medications to be coached by a pharmacist on how to use them safely and effectively. Two new FDA programs seek to improve medication safety, and the Maryland Board of Pharmacy has taken a leadership role in preventing liver damage and death caused by the overuse of acetaminophen.

If Congress is serious about helping Americans get well, stay healthy and save money, it should support proposals to improve medication use at home instead of trying to import drugs from abroad.

John Michael O'Brien is an assistant professor of clinical and administrative sciences at College of Notre Dame of Maryland School of Pharmacy. His e-mail is jobrien@ndm.edu.

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