Health Care Information and Resources

The $75 million heist at a pharmaceutical warehouse in Connecticut this week was just the most audacious example of a growing phenomenon: Thieves are stealing large quantities of prescription drugs for resale on the black market.

Pharmaceutical heists in the U.S. have quadrupled since 2006, a coalition of industry and law enforcement estimates. And experts say the reasons include spotty security and high drug prices that can make such thefts extremely lucrative.

While some stolen pills wind up overseas, others show up on pharmacy shelves in the U.S. with fake labels and lot numbers.

The theft from an Eli Lilly & Co. warehouse early Sunday is the largest of its kind on record and attests to the growing sophistication of those who pull off such crimes.

Authorities say the thieves cut a hole in the roof, lowered themselves into the building on ropes, disabled the alarm system and stole enough drugs to fill a tractor-trailer. The stolen pharmaceuticals included best-selling antidepressants Prozac and Cymbalta.

“The people that target the pharmaceutical industry are an organized criminal element,” said Charles Forsaith, director of supply chain security for drugmaker Purdue Pharma. “This isn’t a couple of guys walking by a warehouse and saying, `I’m going to hit that place.’”

Forsaith heads a coalition of drug companies, distributors and law enforcement officials who have been working to prevent such thefts since 2006.

In the past four years, reported thefts of prescription drug shipments have quadrupled from 11 to 46, according to FreightWatch International, a security firm. Last year, roughly $184 million in pharmaceuticals were stolen in the U.S., up from $96.6 million the year before. Most of the heists involve cargo stolen from trucks or cargo containers, though company warehouses have also been hit.

Widely abused drugs like morphine and codeine are often peddled on the street, but federal officials say drugs like those stolen from Lilly are often sold back to medical suppliers.

Major drugstore chains say they purchase pharmaceuticals only from manufacturers or wholesalers that certify the source of their product.

But with layers of drug wholesalers, distributors and online pharmacy businesses across the U.S., experts say stolen prescription drugs can easily be resold.

“Some of these thieves completely redo labels, and they pass muster if no one’s looking too closely,” said Food and Drug Administration spokesman Tom Gasparoli.

The danger to the public comes if the thieves decide to hold onto the product until it expires and becomes unsafe.

“If they flood the market with this stuff now they’re going to get caught. If they hold on to them too long, you’re going to have shelf-life issues,” said Steve Brozak, president of WBB Securities, an investment firm focused on the drug industry.

A year ago, a refrigerated truck of insulin worth more than $10.9 million was stolen from Novo Nordisk in North Carolina. Months later the FDA reported several cases of diabetics showing up in emergency rooms with unsafe blood sugar levels; the cases were traced to the stolen insulin, which was not properly refrigerated.

Security experts say the incentives behind pharmaceutical theft are largely confined to the U.S. and unlikely to change anytime soon.

“Whenever you have a health care system where drugs are very expensive and there’s a fragmented supply chain, you’re going to have a means to profit from stolen drugs,” said Ron Greene, a spokesman for FreightWatch.

According to Greene, pharmaceutical theft is virtually nonexistent in Europe, where government controls keep drug prices low and most people have health care coverage.

Drugmakers are taking steps to protect their products. FreightWatch advises companies to hire security personnel to protect major shipments. In other cases they can install electronic tracking systems to monitor where their trucks are at all times.

The FDA has stepped up its own efforts, issuing alerts to the public, working with manufacturers, wholesalers, pharmacies and law enforcement, and publishing lot numbers of stolen drugs on a Web site.

“FDA stresses that it is everyone’s responsibility in the supply chain to look closely, to care about the quality of the products they sell,” Gasparoli said. “If there is not a solid market for these stolen goods, the thieves will do something else.”

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Bacterial infections, hepatitis B and C, and possibly even HIV are being transmitted via acupuncture through the use of contaminated needles, cotton swabs and hot packs, experts warned on Friday.

In an editorial published in the British Medical Journal, microbiologists at the University of Hong Kong said the number of reported acupuncture-related infections worldwide was the tip of an iceberg and they called for tighter infection control measures.

“To prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures and aseptic techniques,” wrote the researchers, led by Patrick Woo, microbiology professor at the University of Hong Kong.

“Stricter regulation and accreditation requirements are also needed,” they added.

Acupuncture is one of the most widely practiced strands of alternative medicine and is based on the theory that inserting and manipulating fine needles at specific points in the body helps to promote the flow of “Qi” or energy.

It has its origins in ancient China and has become widely accepted in the West in recent decades particularly in the treatment of pain. It is also used for conditions like obesity, constipation and arthritis, among others, although documented scientific evidence for these are patchy.

Woo and his colleagues said acupuncture may be risky as needles are inserted up to several centimeters beneath the skin and they warned of a new syndrome — acupuncture mycobacteriosis — in the 21st century.

“This is an infection caused by mycobacteria that rapidly grow around the acupuncture insertion point as a result of contaminated cotton wool swabs, towels and hot-pack covers. There is a long incubation period but the infection usually leads to large abscesses and ulcers,” they wrote.

“So far, more than 50 cases have been described globally. In most cases … bacteria were transmitted from the patient’s skin flora or the environment because of inadequate skin disinfection before acupuncture,” they wrote.

While most patients recover from these bacterial infections, 5 to 10 percent of the reported bacterial infections end up with serious problems including joint destruction, multi-organ failure, flesh-eating disease and paralysis.

There have been at least five outbreaks of hepatitis B virus infection that are linked to acupuncture.

In most of these cases, the sources were infected patients and the virus was transmitted through dirty needles, although in one case, it was the acupuncturist who was the source, they said.

The paper also laid out the possibility of transmission of hepatitis C and HIV via acupuncture.

“Although no clear evidence exists to support a link between acupuncture and HIV infection, there are reports of patients with HIV who had no risk factors other than acupuncture,” it said.

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Just as when they were pregnant, breast-feeding moms need to monitor the drugs they take, which could reach their infants.

The American Academy of Family Physicians offers these medication guidelines for breast-feeding mothers:

• If you must take medications orally, take them just after breast-feeding, to give the medications time to travel through your system.
• Generally, acetaminophen and NSAIDs are safe pain relievers for nursing women, but always check first with your doctor.
• Don’t take aspirin while breast-feeding, as it may lead to bleeding and skin rash in babies.
• Don’t take antihistamines long-term while breast-feeding.
• Carefully monitor your baby for any side effects from your medications. Be especially aware of symptoms such as trouble breathing or skin rash.

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Combined treatment with the antidepressant Zoloft (sertraline) and the alcoholism drug naltrexone improves the likelihood that people with both major depression and alcohol dependence will be able to stop drinking, U.S. researchers report.

Their 14-week study of 170 patients found that 54 percent of those who received the combined treatment were able to stop drinking, compared with 21 to 28 percent for patients who received a placebo, Zoloft only, or naltrexone only.

The patients who received the combined treatment also went for a longer period of time before they started drinking again — 61 days compared with 15 days for patients in the other groups.

The findings may prove an important advance in the treatment of patients with alcohol dependence and depression, said the University of Pennsylvania researchers.

“When depression and alcohol dependence occur together, each condition has a negative influence on the outcome of the other, so not only does this pairing of illnesses affect a lot of patients, it also makes the individual disorders worse,” study author Helen Pettinati said in a news release. “Combining sertraline and naltrexone could be a practical approach for these patients because both have (U.S. Food and Drug Adminstration) approval.”

The study was published March 15 in the The American Journal of Psychiatry.

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A generic drug widely prescribed for arthritis shows promise in treating type 2 diabetes, according to U.S. researchers.

They found that salsalate — an atypical non-steroidal anti-inflammatory drug, chemically similar to aspirin but easier on the stomach — helps control glucose levels.

The finding came from a three-month clinical trial of 108 people, 18 to 75 years old, who had type 2 diabetes. Those who took salsalate, the study found, had a 0.5 percent drop in levels of hemoglobin A1C, a measure of blood glucose levels. The decrease was in the range of several recently released diabetes treatments, according to the study, led by Joslin Diabetes Center researchers.

The findings are published online March 16 in Annals of Internal Medicine.

“These results are exciting,” Dr. Allison Goldfine, director of clinical research at Joslin and an associate professor at Harvard Medical School, said in a news release from the center. “They indicate that salsalate may provide an effective, safe and inexpensive new avenue for diabetes treatment.”

She stressed, however, that the findings were preliminary. “At this time we do not recommend patients use this medication for their diabetes treatment until further studies are completed,” Goldfine said.

Goldfine added that salsalate also could help combat atherosclerosis (narrowing of the arteries). The study found that people who took the drug had lowered triglycerides and higher levels of adiponectin, a protein believed to help protect against heart problems.

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