It’s been just over a month since we last discussed cases of misfilled internet prescriptions and misbehavior by a US drug wholesaling firm. Yesterday, Sandra Kiume at OmniBrain told us about the death of a woman in British Columbia from what sounds like another case of terribly misrepresented drugs purchased over the internet (a second story is here). As Sandra noted,
A “strong sleeping pill and sedative” which “has been linked to overdose deaths in other countries and is not legally available in Canada” [nobody says which one!] along with an “anti-anxiety” medication and acetaminophen were found in her system, and the pills contained some unexpected filler.
“Our toxicologist wasn’t sure what was going on,” said [Vancouver Island regional coroner] Rose Stanton. “There was strontium and uranium and lead [also arsenic, aluminum and barium] — things in these drugs that shouldn’t have been there. …The strontium level in one of the pills is quite high, and the presence of uranium is of concern,” she said. “We had Health Canada into the toxicology centre today to confirm that in fact her tissue samples are not radioactive.”
As Sandra noted the sedative was one not available in Canada, leading me to believe that the drug(s) most likely came from southeast Asia. There are a number of drugs considered obsolete that are still available in countries like China. For example, phenylbutazone is a non-steroidal anti-inflammatory drug still available there that is no longer used in North America because it can cause serious blood disorders like aplastic anemia and agranulocytosis. However, they are cheap chemicals these days because their patents have long expired. These kinds of drugs often show up as adulterants in herbal medicines that are imported from China or other southeastern Asian countries. One case report even showed pathogenic bacterial contamination of an Indonesian herbal tonic that also contained phenylbutazone. The presence of heavy metals is also indicative of a southeastern Asian or Indian source:
Toxicology tests conducted on the pills revealed many of them contained dangerously high levels of heavy metals which had apparently been used as filler.
But I am stumped as to the identity of the obsolete sedative in this Canadian case. Any guesses from readers?
However, Stanton said investigators are still not sure what Bergeron thought she was taking.
The actual medicine detected in the three types of pills — an anti-anxiety drug, acetaminophen and a strong sedative — are not consistent with those usually ordered online, like antidepressants or Viagra.
Sandra also shows some interesting graphics from a project where she was attempting to establish a link between patient peer support groups and internet drug buying (there was no relationship). Still it is very interesting to look at her Google trend timeline to see the explosion in internet drug sales sites beginning around mid-2005 and sedative/anti-anxiety drugs like Valium, Xanax, Ativan, Soma, and Ambien being the most prevalent group of drugs popping up in Google results. Sandra also links to a lively comment thread at the Toronto Globe and Mail where readers are discussing this trend.
But as I noted last month, you really need to do some homework if financial considerations are driving consumers to purchase their prescription drugs over the internet:
[A]n independent consumer rating subscription service called PharmacyChecker.com is a reputable resource for buying drugs from Canada or other online pharmacies. Established by the founder of the dietary supplement rating service, ConsumerLab.com, PharmacyChecker provides detailed information on licensure and 40 other characteristics they have verified regarding specific site (ficitious sample evaluation of TrustWorthyPharmacy.com and DubiousPharmacy.com are illustrated here). A 90-day trial subscription is $15 but it seems that the 12-month membership for $19.95 is the better deal. (Disclosure: I have no financial relationship with either ConsumerLab or PharmacyChecker, but have recommended and subscribed to ConsumerLab for several years.)