http://boston.com/dailyglobe2/218/metro/Despite_US_law_seniors_click_on_Canada_for_drugsP.shtml

8/6/2001
By Liz Kowalczyk, Globe Staff

AMHERST - In a classroom at the Bangs Community Center, Jean Viecelli, 64, claimed one of the few empty chairs, pulled out a legal pad, and began taking careful notes on how to buy medicine illegally.

Her teachers, Rosemary Morgan, whose gray hair was just growing back after chemotherapy, and Isaac BenEzra, whose crutches leaned against the table next to him, explained to the 30 seniors one recent afternoon how to order cheap prescription drugs from Canada on the Internet, a practice that federal officials say is both against the law and dangerous.

''My understanding is it's legal, but if it's not, you can chain me to a fence with all the other bald-headed ladies,'' said Morgan, 66, who orders her breast cancer drug from CanadaRx for $44 - a 90 percent discount from US prices. ''It's a justice issue.''

Viecelli, who takes four drugs to prevent high blood pressure and blood clots, plans to place her first online order next month. ''The technicalities of the law don't matter to me,'' she said. ''I told my husband I'll go to jail, then they'll be responsible for buying my prescriptions.''

Growing frustration over prescription drug prices is putting the elderly on the opposite side of the law from the US Food and Drug Administration, which is proposing a crackdown on personal importation of medicine. Health and Human Services Secretary Tommy Thompson is considering whether to adopt a proposed FDA enforcement plan that would stop foreign drug shipments before they reach American buyers. In another wrinkle, Congress will debate this fall whether to lift the ban altogether.

Meanwhile, hundreds of senior citizens have grown dependent on cheaper drugs from Canada. In Western Massachusetts, BenEzra, 75, is almost single-handedly responsible for starting an online drug-ordering movement. He estimates that he has trained 1,000 seniors to order their medications from CanadaRx in the last two years. At his urging, the Marlborough senior center has shown the ropes to 500 more people, including how to get their doctors to cooperate in writing the prescriptions that most Canadian Internet pharmacies require. Volunteers at the South Hadley senior center have printed out order forms for another 150 elderly people and hold regular weekly two-hour classes on Internet ordering.

BenEzra, who has been arrested for handing out fliers outside his town's Big Y supermarket and has organized a town-to-town fast for universal health care, says the Internet ordering movement is a natural response to the ''artificially high prices'' pharmaceutical companies maintain in the United States.

He has persuaded several physicians in Amherst to write prescriptions for their patients and fax them to CanadaRx, including Dr. Deborah Smith, an oncologist who said that many of her patients can't afford to travel to Canada every few months to buy their medicine.

For years, seniors have ridden buses into Canada, where the government regulates drug prices, to buy cheaper prescriptions, which the FDA says is legal because the patient is personally examining the drugs. But the Internet has made cheaper drugs available to thousands more. Seniors, many of whom are on Medicare health insurance plans that don't cover prescription drugs, have growing access to computers with Internet hookups - their own, their children's, or those at senior centers.

As a result, 2 million packages of prescription drugs were mailed into the United States last year to Americans of all ages. Even though Internet ordering accounts for less than 1 percent of the prescription drug market, its share will jump to 9 percent in the next three years, according to Forrester Research in Cambridge.

Tom McGinnis, the FDA's director of pharmacy affairs, said the agency lacks the staff to enforce the personal drug importation laws, which is why Morgan and BenEzra are regularly receiving packages of medication.

But during a five-week enforcement test at the Carson City, Calif., US customs mail facility earlier this year, the agency stopped 721 packages containing medications from 19 countries. One of the shipments contained pills hidden between magazine pages. Several boxes held three drugs that were once approved by the FDA but were withdrawn from the market because they caused fatal heart arrhythmias, fatal infections, and strokes. Even packages containing common, accepted drugs in sealed manufacturers' bottles were sent back or destroyed, McGinnis said.

The FDA wants to tighten inspections at all 14 customs department mail inspection facilities. Meanwhile, FDA agents are focusing on the most serious violations and have made 11 Internet pharmacy arrests, including that of a Bangkok man who was mixing homemade Viagra in ''a filthy, vermin-infested kitchen,'' according to customs inspectors.

''It's illegal to order prescription drugs from any site outside the US and have them shipped here,'' said McGinnis, stressing that the drugs could be counterfeit, poorly made, or contaminated by extreme heat. ''You just don't know what you're getting. Some sites look sophisticated, like a CVS, but they could be someone operating out of their garage in Southeast Asia. Even if they say Canada on their site, they could have a switching system into a Canadian phone number.''

A visit last month to two popular Canadian sites that Americans use, CanadaRx and TheCanadianDrugstore, found that their operations really are in the Toronto area as advertised on their sites.

John Lubelski runs CanadaRx out of two small rooms in the back of Kohler's Drugstore in Hamilton, Ontario, a small city 30 miles south of Toronto. Three dozen cardboard boxes containing sealed bottles of pills sat open on the blue carpet and on the white Formica counters, awaiting a final check by the pharmacist. There were 90 capsules of Prozac headed to Massachusetts; a three-month supply of Fosamax and Lipitor also bound for Massachusetts; and three packages of Lamisil ordered by a woman in Connecticut. A teenage boy taped the boxes closed and addressed them; 60 to the United States every day.

Lubelski said Americans are so grateful for CanadaRx that he's received dozens of letters. He pulls out a manila folder stuffed with Christmas cards and thank-you notes, including one from a Pennsylvania couple starting, ''I want you to know how much you're appreciated.''

And he believes it's all within the law. Lubelski requires the customer's doctor to fax a letter requesting the drug for the patient, which he said complies technically with rules allowing physicians' offices to act as pharmacies to import drugs.

Billy Shawn, owner of TheCanadianDrugstore, said he discovered another way around the US law with the help of his attorneys: Patients sign releases giving the company limited power of attorney, allowing it to act as a purchasing agent for a patient who would otherwise have to travel to Canada. Shawn requires a prescription from a US doctor, which is then reviewed and rewritten by a Canadian doctor. Six young women sit at computers in the company's pumpkin-colored loft handling orders.

FDA officials do not agree with Lubelski's or with Shawn's interpretation of the laws and McGinnis said that these shipments are still illegal. But clearly the agency has decided to look the other way for now.

''The problem is separating the wheat from the chaff,'' Lubelski said. ''There are people who are hustling money and will ship crap. There is undoubtedly bad product going into the US, either counterfeit or improperly labeled. But everybody is being painted with the same brush.''

Many of the elderly agree, saying that medications sold in the United States and Canada often are manufactured in the same plant under the same rules in one of the two countries and therefore are equally safe. They say they'll keep logging on and ordering until told directly by a law enforcement officer to stop.

''This can't be illegal,'' said Viecelli, who lives in the Berkshire Hills town of Peru; she will lose coverage under her husband's insurance when she turns 65 next month.

''The Canadians can buy all of their drugs at lower prices, why can't this country do that? I'm not buying these as a druggie. I'm not getting high. They're preventing me from having a stroke.''

Liz Kowalczyk can be reached by e-mail at kowalczyk@globe.com
 

This story ran on page 1 of the Boston Globe on 8/6/2001.
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