'Disciplining' Canadian pharmacists - from Nevada
'You can't be everywhere,' notes a Health Canada spokesman.
- Tuesday, September 27, 2005
Are Nevada politicians who’ve been pushing schemes to reimport drugs from Canada putting at risk the very seniors they say they’re out to help?
It’s an obvious question, now that at least five Canadian deaths have been tracked to a licensed pharmacist in a Toronto suburb who dispensed bogus versions of a U.S. drug.
In exchange for heart patients’ money, say Canadian authorities, the owner of King West Pharmacy in Hamilton filled prescriptions for the Pfizer heart medication Norvasc with look-alike pills made of talcum powder.
At least five people filled their angina-medicine prescriptions at the pharmacy and later died of heart attack or stroke. On September 9, the Royal Canadian Mounted Police charged the 28-year-old pharmacist, Egyptian native Abadir Nasr, with selling the counterfeit Norvasc.
Nasr and fellow King West pharmacist Bhusmang Mehta were referred by the Ontario College of Pharmacists—the equivalent of an American state’s board of pharmacy—for disciplinary proceedings. Mehta has been licensed in Ontario since 1986, while Nasr, owner and manager of the drugstore, received his Canadian pharmacist license in 2003. According to the Canadian Press association, Nasr graduated from an Egyptian university in 2001.
The Nasr-Bhusmang drug counterfeiting case has been widely reported in Canada since at least June 23, when the King West pharmacy was placed under court-approved management. During the same period, the Nevada state pharmacy board has been working to implement Assembly Bill 195 and license Canadian pharmacies. The bill, passed by Nevada lawmakers this year, was sponsored by Assembly Majority Leader Barbara Buckley and signed into law by Gov. Kenny Guinn.
On September 8 the Nevada pharmacy board licensed seven Canadian pharmacies that it said it expected to visit soon. One day later, the Royal Canadian Mounted Police—equivalent to the U.S. FBI—officially charged Nasr.
According to pharmacy board attorney Louis Ling, Nevada will be the first U.S. state to license Canadian pharmacies. “If they comply, it’s a safe system,” he told Las Vegas Sun reporter Cy Ryan.
Although Nevada has no legal authority within Canada, a sovereign nation, Ling asserted that Nevada’s state pharmacy board would be able to discipline Canadian companies for mistakes or abuses. He also said, however, that handling disciplinary cases against Canadian pharmacists would be up to Canadian authorities.
So how well-protected, really, would Nevada seniors be in ordering drugs from Canada? How rigorous is Canada’s regulatory system? According to an online statement by the Ontario College of Pharmacists that licensed Nasr and Bhusmang, pharmacists in Canada are members of a “self-regulated profession.” The college’s responsibility is ensuring that pharmacists “provide Ontarians with high quality, ethical pharmaceutical care.” The college “sets the requirements to enter pharmacy practice, establishes and enforces the profession’s standards of practice and ethics, and ensures the continuing competence of pharmacists.”
However, “We don’t go in and inspect the drugs,” says Della Croteau, the college’s deputy registrar. Instead, she said, the group checks whether balances are properly adjusted, whether dispensing practices are sanitary and whether medications are properly labeled and locked up.
Health Canada is the federal agency responsible for the integrity of drugs sold through Canada’s approximately 7,700 pharmacies. A spokesman, Jirina Vlk, said the agency’s 200 inspectors have been largely focused on Internet pharmacies.
“You can’t be everywhere,” said Vlk.
What about police charges against Nasr? According to his lawyer, Nasr was originally told he would be charged with mischief endangering life, a serious accusation. Now the Mounties have instead filed three milder charges: fraud under $5,000, “passing off,” and possession of property obtained by crime.
The Hamilton, Ontario coroner examining the angina-related deaths of Abadir Nasr’s pharmacy customers is also looking into the drug-induced death of Nasr’s younger brother last year. Anton, 24, was visiting Canada from Egypt where he lived and was also employed as a pharmacist. He died of an overdose of Fentanyl, a powerful narcotic painkiller. A few months later, Abadir bought the Hamilton pharmacy.
According to Peter Pitts, director of the Center for Medicines in the Public Interest at the Pacific Research Institute, the United States accounts for nearly 50 percent of the world’s medicine sales and is already a prime target for drug counterfeiters.
But an even greater threat, he says, “is that massive drug imports would create a major opportunity for international terrorists to kill thousands of Americans with intentionally contaminated drugs packaged as legitimate pharmaceuticals.”
Proponents of a Nevada state website to hook seniors up to Canadian pharmacies should stop dismissing the inherent risks of their scheme.
Steven Miller is policy director for the Nevada Policy Research Institute.