Michael Albano had big budget problems. As mayor of Springfield, Mass., the fourth largest city in New England, Albano faced massive cuts in state aid, forcing him in February 2003 to announce layoffs of more than 300 city workers, including police officers and firefighters.

As father of a 13-year-old boy with type 1 diabetes , Mike Albano also had a personal financial crisis, caused by the skyrocketing cost of his son's daily insulin, needles, and blood sugar testing supplies.

As a partial solution to both problems, Albano did what no other U.S. city leader until then had dared to do: he went to Canada.

In July of 2003, Albano launched an innovative, voluntary program that allows city employees and retirees to purchase maintenance medications -- such as drugs to treat high cholesterol , high blood pressure , and diabetes -- from Canadian suppliers. Because the Canadian government -- like the governments of nearly all industrialized nations except the U.S. -- mandates price controls on medications and limits the prices that Canadian pharmacies can charge, drugs sold in Canada often cost substantially less than the identical medicine sold in the U.S.

He's not alone. By September 2004, one-third of American adults who use prescription drugs said they already buy or intend to buy drugs from online Canadian pharmacies, according to a survey by the Results for America (RFA), a project of the nonprofit and nonpartisan Civil Society Institute.

The reason is simple economics. According to the Congressional Budget Office, brand-name drugs on average cost from 35% to 55% less in other industrialized nations than they do in the U.S. The CBO also estimates that if Americans in 2001 could have bought brand-name drugs at Canadian pharmacies, they would have saved more than $38 billion (under the new Medicare prescription-drug benefit, the government is expressly forbidden from negotiating lower drug prices on the behalf of beneficiaries).

As for Springfield, Mass., the city saved more than $3 million in the start-up year, and is on track to save $6 million this fiscal year, Albano says.

Pharmaceutical Outsourcing

In an interview with CBS's 60 Minutes earlier this year, former FDA commissioner Mark McClellan said that "under current law we don't have the authority to ensure the safety of foreign-produced, foreign-distributed drugs." He warned that the practice of "drug reimportation," as it's called, violates federal law and puts patients at risk because they can't be sure about the source of the drugs they receive.

But advocates for cross-border drug buying point out that most medications purchased from reputable Canadian or European pharmacies are the identical medications -- brand names as well as generics -- that are available at your local drugstore. In addition, those medicines, including some of the blockbuster drugs advertised on the network evening news programs, may be made not just in North America but also in Europe, South America, the Middle East, or Asia.

"There are about 60 locations where the pharmaceutical industry manufactures all across the world," Albano tells WebMD. "Lipitor, for example, comes from Ireland, is manufactured and shipped to the United States and then shipped to Canada. And some Lipitor goes right from Ireland to Canada, so this whole notion that Canadian medications are not safe is simply ludicrous."

Barry Power, PharmD., director of practice development for the Ottawa-based Canadian Pharmacists Association tells WebMD that "most drugs are made in one or two global locations and then exported to all the countries, so even the term 'reimportation' is technically incorrect. And there are actually quite a few drugs that are made in Canada, so it's all just a matter of spin-doctoring in a lot of cases."

Mayor Albano had confidence in the source of the lower-cost drugs his city offered to municipal employees and retirees because he had done his homework, he says. "Before we started the program officially in Springfield, I went to Canada and went to the pharmacies. I spoke to the pharmacists, and then we started my son on his insulin and related products three months prior to the official beginning of the program. The idea was that it's a medication that you have to take precautions with, and I thought my public employees would realize that 'if it's good enough for the mayor's family, then it would be good enough for me.'"

As for the regulatory authorities, Albano says that the FDA made a lot of noise at the time the program was announced but took no real action to stop it. Since then, many city and state governments have implemented or announced similar plans. The FDA has continued to shy away from enforcing regulations in many cases.

Buyer Beware

But while buying cheaper drugs from reputable online pharmacists at home or abroad can save you plenty, obtaining drugs blindly from a site you've never heard of could also buy you major trouble. The FDA, Federal Trade Commission, and consumer watchdog groups warn that when you order from web sites you're not sure about, you could be getting counterfeit drugs that contain no active ingredients or even harmful substances.

Most consumers are smart enough to know that the "Rolex" watch offered by a street-corner peddler is sure to be a cheap knockoff. If you want the real thing, you go to a reputable jeweler down the street. But when the street is just one little block on the information superhighway, how can you tell whether you're dealing with a respectable storefront operation or a sidewalk hustler?

You only need to glance at the spam clogging your inbox to see that some charlatan somewhere -- whether it's in the Bahamas, Beijing, Africa, or Alabama -- is willing to take your money in exchange for drugs that promise to make your sex life better, grow hair on a billiard ball, double your lifespan, or let you eat deep-fried Twinkies while you watch the pounds melt away!

Some sites offer the chance to "buy drugs (FDA-approved prescription drugs) and other medications with NO prescription." Others promise that only a brief online or telephone consultation is needed. When Consumer Reports magazine senior editor Tod Marks went online to see what he could get without a valid prescription, he found this: "Without visiting or speaking to a doctor, Marks was able to buy seven different prescription drugs -- to help him lose weight, quit smoking, combat osteoporosis, and fight aging, depression, seasonal allergies, and bacterial infection. Except for the antihistamine, which might have helped his hay fever, Marks, a healthy 44-year-old nonsmoker, had no business taking those medications," the magazine reports.

An Ounce of Prevention

How can you tell whether a cyberpharmacy is legit? A bill currently before the U.S. Senate, called the Dorgan-Snowe Drug Importation Bill, would establish a system for ensuring that imported drugs are approved by the FDA and are made in FDA-inspected facilities. In addition, drugs could only be imported from countries with a drug regulation system comparable to that of the U.S. The bipartisan bill also calls on the FDA to establish a list of approved Canadian pharmacies on its web site and furnish a toll-free phone number for Americans to verify the legitimacy of a Canadian pharmacy. The FDA would also be required to inspect both Canadian pharmacies and U.S. importers of prescription drugs to ensure that they comply with the law.

At least three similar drug importation bills have been passed by the House of Representatives, but to date no drug importation bill to benefit consumers has made it into law.

In the meantime, consumer advocates in the U.S. and Canada recommend that people who are considering buying drugs from online pharmacies -- domestic or foreign -- follow the following steps:

 

• Don't take any prescription drugs that have not been prescribed for you by a doctor or other qualified health care provider who has examined you in person.
• Don't order drugs from web sites that don't list a street address, telephone number, or means of directly contacting a pharmacist.
• Don't buy from sites that offer prescription drugs without a prescription, or that will issue prescriptions after you fill out an online questionnaire or telephone consultation.
• Do check to make sure that the site participates in the Verified Internet Pharmacy Practice Sites (VIPPS) seal program, run by the U.S.-based National Association of Boards of Pharmacy. NABP certifies pharmacies in the U.S. (including territories), eight Canadian provinces, Australia, and South Africa.