Dr. Al Carter, PharmD 
Executive Director and CEO National Association of Boards of Pharmacy

When Education Means Protection from Faux Pharmacy

Dr. Al Carter, PharmD is the Executive Director and the CEO of the National Association of Boards of Pharmacy. He joins our host Julie Soukup, VP of The Medical Memory to discuss the imperative importance of educating patients about online and faux pharmacies. 

In our podcast, he discusses the importance of nurses educating patients about the concerns of misusing medication or utilizing illegitimate online pharmacies. He talks about the programs the State Board of Pharmacy is putting in place to track the dispensing of controlled substances, for not only pharmacists but for prescribers. Especially in the Pain Clinic era where some patients go state to state in hopes of 'beating the system.' A Platform that connected all systems to protect patients became imperative. 

What was incredibly powerful was his conversation about online Pharmacies. Over 95% of the pharmacies that are online are actually not credible. The concern and fear of this are that these can be pharmacies that are not licensed and not following FDA regulations. Many of the medications are laced or have no active ingredients. For some patients this can be fatal and over 109K patients died last year due to overdose, or taking something and not understanding whats in it. 

There are many ways to verify pharmacies, and he gives tips for doing so.

Transcription of Podcast


Al Carter

Thu, Apr 13, 2023 12:37PM • 25:38


patients, medication, pharmacies, pharmacy, pharmacist, provide, internet, prescription, sites, licensed, providers, prescribing, bit, healthcare professional, social media, challenges, pain clinics, popping, check, line


Hi, thanks so much for joining another episode of take one patient. I'm really, really excited to be talking to Dr. Al Carter. He is the CEO of the National Association of Boards of Pharmacy. And we have such an awesome and interesting conversation. So I'm so excited for everyone really to hear from you and what you do, and all of those things. So I'll let you go ahead and start to introduce yourself and tell me tell us all a little bit more about like kind of how you got into your role and what you're doing now. Sure, and thank you, Julie, for having me today. Good afternoon, everyone. My name is Earl Carter, Executive Director, CEO of National Association of Boards of Pharmacy, also known as na BP. And I've been in this capacity for about three years and actually be three years in two weeks. And I NADP first is a nonprofit, independent, impartial organization that serves our membership to with the vision and mission of protecting public health. Our membership are the 50 State Boards of Pharmacy, are actually 54 State Boards of Pharmacy because includes the US territories. And then our membership also includes the 10 Canadian provinces. And so we've been in this organization has been around since 1904. With a focus again, on protecting public health. We do that through a number of different ways, whether it's education, whether it's competency assessment, whether it's providing resources to the Boards of Pharmacy to be able to do their job. How do I get into this role, I actually used to work for Walgreens and work for Walgreens, for right out of pharmacy school. And then through


the first 18 years of my career. And I did many roles, but one of the biggest roles that I had the most focus was in pharmacy Regulatory Affairs. And in doing that, I also served on the Illinois State Board of Pharmacy for seven years. So I've been actively engaged within ebp for several years. And then when the opportunity came up, due to my predecessor retiring, I jumped at the opportunity to interview for his position and take on this role. And here I am today. And so I wouldn't say it's been an easy job because it hasn't. As we i i started right in the midst of COVID. And so as we as the world was dealing with COVID. And as we as healthcare professionals have been dealing with COVID and everything that's come along with this pandemic, it's let's just say it's been fun, but it's been challenging. Yeah, I can imagine it actually, especially in your role kind of getting that right during this time.


So it's a couple of things that I thought were really fascinating that I didn't know much about, that I love you to kind of dig a little bit more into one of which is a little bit more about kind of the prescription monitoring program and kind of like what you guys are doing. And kind of you had mentioned a little bit this really started during the pain clinic with a lot of pain clinics. Now that goes just talk a little bit about about that and how it impacts not just patients but also those pharmacists that are prescribing these medications. Sure. So Prescription Drug Monitoring Program, or PDMP, is how we refer to it has been around for over 10 years. And so when when the pain clinics were were up and starting and really doing a lot of


bad work by providing just pain medications to anyone from off the street. What we started seeing is we started seeing pharmacies that were getting long lines have patients coming in for any a pain medications, there was no way of tracking this information. So the State Boards of Pharmacy started to track the dispensing of controlled substances, not only for for to for the pharmacist, but also for prescribers. What we did is once the state started building this up, there was no way to connect the state. So you had patients that were happening state lines, and we'll say going from Florida to Georgia and Mississippi and Alabama, to get pain medications because they were being denied in their state. And so what we helped develop what is what we call PNP interconnect, and that interconnect basically provide a gateway for all these PNP or PDMP programs to start talking to each other. So now if that patient went from Florida to Georgia, the pharmacist in Georgia could look into that PDMP program and we'll see okay, you just got this prescription filled yesterday in Florida and you got to fill you know week before that in Alabama. We're not going to fill it for you because it is too soon. And so they helped. This helped. I won't say eliminate the pain claimants claim pain clinics and the opioid epidemic that we're dealing with, but it helped provide providers and healthcare professionals, better access and better knowledge to help eliminate as well.


which is a could, or help patients to seek help for addiction and and, and other things that they were going through. Whereas otherwise, it would only be in the confines of that state that they would be able to see that information. And P the PMP interconnect program, we actually just celebrated our 10th year anniversary last year. And so, we've been operating for extras, I feel like it was last year, we've been operating for a little bit over 10 years now with this program by helping to provide services to to all states. Well, and that's definitely I mean, that was probably such a huge undertaking is even, you know, seeing it's a challenge that building common network, such as that, especially for a lot of patients that really need it. And for those that are bumping, you know, space to space is really scary and limiting that, I'm sure had a profound effect on a lot of families being able to kind of, okay, we need to seek different or outside help, because the access just isn't there. Correct. And what it's been able to do for prescribers, who now have access to the system, and many of them go into before he prescribe controlled substances to anyone, it's basically given them a leg up to see to transparency into a patient's dispensing records for controlled substances, to allow them to either provide


additional services or other medication services, or prevent them from from becoming addicted or getting more pain meds and what they need. That couldn't be too severe injury or even death. Right? Absolutely. Um, so app, that's a great program to really help, you know, prevent people from taking advantage or to kind of finding loopholes in the system. Another thing you really talked to me about that I think is very interesting, and I had no idea about it was the rise of internet pharmacies and some of the challenges that come from that. So talk a little bit about you know, what these are, and why are they why are these internet pharmacies? And you can say, well, I've seen quotes are even existing. You say interesting, I say scary. Yes.


So you've had, you've had internet pharmacies that have been around for some time. But with the onset of COVID, you've just seen a huge spike in in pharmacies, because for over 18 months, patients couldn't go to the pharmacy or they couldn't seek the care they needed. So they resort resorted to telemedicine, or other online services that were able to help, you know, first get them


get the help that they needed for whatever condition or acute illness that they had. And so with that, you also have internet pharmacies that are saying, Hey, this is an opportunity for us to get into this space, because now the patient doesn't have to go to the pharmacy, they can come to us and we can ship it directly to them. The challenge with this is this is over 95% of pharmacies online are acting illegally. And they're doing so because they're either not a licensed pharmacy, or the product that they're shipping is illegitimate. It is fake, or it doesn't contain the complete active ingredients of the medication that they should be taken. And so there are so many bad actors out there rogue pharmacies that are in this space, and are trying to dis manipulate and take advantage of COVID Take advantage of all the drug shortages that we're dealing with take advantage of the abortion


issues that certain states are having the shortage in antibiotics, any type of opportunity that gets media press, the internet pharmacies, many of these rogue internet pharmacies are taken advantage of and you'll see the next day, get your amoxicillin capsules here for you know, X amount of dollars, no prescription needed, or whatever the case may be. When you see these things are red flags, and it's just, it is abundantly happening across internet. And we know and we live in an age of Amazon where, you know, we anything we need, it's right at our fingertips we have on our smartphone or hop on our iPad, or whatever else may be the case. And we order it and it's here the same day or the next day. And pharmacy is getting to the point, especially in this digital age, where it's no different. And that's where we're having the challenges that we're seeing with many of these rogue pharmacies that are shipping products that are illegally or not licensed, or whatever the case may be. It's just unsafe. It's scary. Right. And I was blown away by that number that it was 95% that are acting illegitimate and that a lot of patients that you know, are looking to maybe have some savings or they're not insured or they're like Man, this is so tight, are looking for an easier answer only to have it


As you said least or placebo, or who knows what that they're even getting, because it's not even that licensed medication. And that can have huge, you know, fatal consequences for these patients. Right, I'll throw some more numbers for you. Since we've started doing this. We have found over 40,000 Internet pharmacies that are acting illegally, and my team that are any BPS team that works on this, we find about 200 sites a week


200 sites a week I repeat that, that are acting illegally or rogue internet pharmacies that are that are doing no good.


So how, and it's interesting you say that because even after our conversation, I all of a sudden became acutely aware on social media, how much this stuff is popping up, I never even noticed it. And then now send I was like, Oh, like this here and this here. And you can do you know, therapy online, which is great for like, also, you can get the medications and do all this and some of them are great. And but I was surprised how much that was kind of popping out with the social media, especially actually, with the antibiotic thing. I had two kids. And when I heard it, I must have Googled it a few times, because then all of a sudden, my feed was going where go to hear it go to here, we'll give it to you go to here. Um, how do you knowing that? I mean, just getting that information out that it's 95% of them are not legitimate? How do patients or their family members really, like? How do they kind of determine that, like, what should we be looking for? You talked about red flags, like, what are


you doing, there are a couple things, they're really, there's some big things that you should know, first. So if you go into one of these sites, and they are seeing that no prescription is needed, or they're going to, you know, dispense your medication without prescription, that should be a huge red flag, because nowhere in the United States are you able to get a prescription medication without a prescription. So that's, that's your first red flag. Second, if there's no access to a pharmacist, you should always be able to have access to a pharmacist to provide counseling, to talk to you about your condition or the medication that you're taking. And whether it's the right medication for you, or whether they need to talk to your prescriber to get a different medication for you. If you don't have access to pharmacists, that should be another red flag. The third thing that we always say is just make sure that you're talking to your health care team. So whether it is your, your your provider, whoever's prescribing a medication, or whether it's your pharmacist, just make sure that you verify the medication before you buy it. And there are many ways to do that. But going through these sites that aren't credentialed or are asking for isn't saying, Hey, you can get this medication from Canada for for $100 less than what you can get it for United States or from this website, wherever it is even have to be from Canada, but wherever it is, and you know, we're going to sell this medication to you for $1 a pill, when you went to your pharmacy, you know that that medication was like $400, that should be a huge concern when there's that big of a discrepancy and pricing for that as well. And so I always recommend that you either reach out to your pharmacist or you talk make sure that you talk to a pharmacist before you start taking any medication that is dispensed to you either online or, or at your local mom and pop store. Right. And I thought that was interesting, because I didn't even know that you could do that, that you could literally take any medication that you have to a pharmacist and be like, What is this? Tell me what this is, and this is healthy to take, which isn't even necessarily been online. But even if you have older parents or somebody that that you're wanting to make sure it's healthy, like, you know, checking to make sure things are, you know, all good. I didn't know you could just go and be like, hey, helped me like what is this? Pharmacists can do that poison control, you can always call the you know, the one 800 Number for poison control. Of course, the control can also help you with that. And it's usually housed by pharmacists and other healthcare professionals that can help identify specific medications based off inscriptions on pills and what have you. And so either one of those, because I know some it may be difficult to to access to pharmacies more readily. But nowadays, you can just call a pharmacy and tell them what what's on it and they can help you to determine whether it is but I'll tell you this, though, the bad actors are getting really good at what is counterfeit medicine and what is real. And so you still need to be cautious in where you're buying medications and make sure that it's from a known site. Nowhere on social media from a guy or girl who's


you know, some person who's saying that they'll meet you at this spot and to give you your oxycontin or your Percocet or your Adderall. Those are sites that I just wouldn't trust. We've seen too many people die, both young and old, over the last you know, several years due to overdoses from from some type of social media contact, where they buy


If this medication was laced with illicit fentanyl, and then they died within minutes, and you know, just hearing so many of these sad stories, day in and day out,


it's one thing that we say is like, just make sure you know, where you're getting your medication from, that you're verifying that, and that you're talking to a trusted healthcare professional, before you're ingesting anything that you're putting in your mouth or putting into your body. Because it can likely be very lethal and kill you.


With one dose,


which is so scary, and that's, and that's even to where you also talked a little bit about,


like self diagnosis, and like, kind of being like, oh, I need this, but maybe, you know, like, where a lot of these you can get it so easy. And if there's not a medic,


medication reconciliation, you know, you could really be causing a lot of harm to yourself with stuff that, oh, I can just take, I don't know, depression medicine, or our all or whatever, and I need it, but not really seeing, you can't self medicate on some of this stuff, especially not taking a prescription and reconciling with your prescriptions that you are maybe taking so talk even a little bit about that. Right. And we're you know, again, we're in this digital age, and we're all we're all you know, have have done it and can say that we have done it is, is when you have some or you're not feeling well, or when you're you know, or when when your friends comes, like I'm not feeling this, or I feel this, the first thing you're doing is you're going to Google and then on Google, you're gonna see all these different indications and diagnosis is, and then after, like, Alright, how can I get some this medication without going to a prescriber, or a physician or you know, or healthcare professional to get it. And so it goes back to that living in a digital age. And I always say, and I know, like, even when I'm talking to for instance, like, oh, well, I have this and say, You need to get checked out. And you need to go to a doctor and see what you really have. Because there may be underlying conditions that you don't think that you may not be experiencing, but you don't really know. And so to get the appropriate diagnosis, and to get the appropriate care that you need, you should go see a trusted healthcare professional to be able to do so. And that depend on internet and, and what you see or what you read and Google or what have you know, and absolutely, and it's interesting, you know, our app medical memory, it allows providers to video record parts of consultations or information they're wanting to provide to patients. And it's interesting, because we just started, like working more with pharmacy pharmacists and pharmacies where they're even will say, hey, go to our hospital, pharmacy, it's right downstairs, like check and make sure so that you are gonna stay on your medication, making sure that you have it go right there are but a lot of them are even a lot with that information is you really need to have a reconciliation, we really need to make sure that everything is working, like, you know, come and see us like I know, it's a hassle, but let's make sure that everything's lined up. And that's all of the messages they're even sending to patients just to make sure that you know, everyone's Lighten up, and it is needed to have that next next step, especially when it's something you're just going to continuously be adjusting, you don't think a little thing is gonna have that much power. But you know, it really, really, you know,


hey, one dose can be lethal of many different medications, depending on what it is. And so


the appropriate diagnosis will go a very long way. And it's you shouldn't shouldn't put your health in the hands of the internet, you should put your health in the hands of a trusted health care professional to be able to provide you the appropriate diagnosis and treatment for for what you need. Absolutely. Awesome. Well, I think that what you're doing is awesome, as far as with making sure that you're protecting people and putting these programs in place and digging into things that are in place to say, you know, how can we how can we make these sites go away? How can we make sure that we're, you know, making sure that everyone's not over, you know, prescribing, overtaking all that stuff? I think you're doing really, really awesome work. Is there anything else that you guys kind of have,


or anything kind of that you're seeing in the next few years of pharmacy and the things that we need, you know, to be aware of or any of that there is in first before I do that I would be remiss if I didn't say this, and my team would kill me if I didn't say this, but that we have a tool for patients and for the general public to go and check on internet pharmacies. It's called Safe dot pharmacy. It's free to everyone, anybody who was looked at it, and what you do is you can go into this website, say again, safety FMCSA F e dot pharmacy, and you can type in the website of the internet pharmacy. And what it will tell you is whether or not that website is is a is a valid pharmacy or is it not recommended pharmacy? And in addition to that, on this website, it will give you tools on different red flags you should check and what have you so we've been we've been on a huge edge


occasion campaign to just make make the public aware, make patients aware, make sure healthcare providers are aware of this tool so that they can provide it to their patient. And it's being updated on a weekly basis. Because again, as our team is finding those 200 websites each week, they're populating those websites into this into into this website, so that they can have so that patients can have a directory of those pharmacies that are acting legitimately. And then those that are acting illegitimate and that are not recommended. Because there is still a process. And this is like, you know, it's illegitimate shutdown, but you were just even saying, we then send the information to the authorities, then they're the ones that kind of go through it. And so kind of it sounds like until that process happens, where they verify it, this is a great place to check, especially with how fast they're popping up. Sounds like getting them shut down isn't as fast and also has to be handed over. So that's a great kind of media, just to make sure is that a lot of times, a lot of times when they do get shut down. Because these, these act, these legal actors are so good at doing this, they're able to pop up another site within minutes or hours, or within days of the site getting shut down.


And so that's why we continue to have teams work on us to continue to educate and to continue to update this, you know, our directory, because these sites are appearing on a daily basis. And as long as we're gonna continue to have drug shortages, you know, the shortage, the huge shortage, right now is Adderall. And along with antibiotics, as long as you're gonna continue to have these shortages, you know, these rogue internet pharmacies, and these bad actors are gonna continue to take advantage of this system and, and take advantage of patients, you know, friends, family, whoever else. And so that's why we've, we've been very passionate about this, we've been very active in trying to provide this tool and continue to provide this tool for free to everyone and just to continue to educate the general public on different ways to make sure that they verify the medication that they're taking. Absolutely. And that's really important even for, you know, because a lot of people that listen to our podcast, we talk about patient communication, so a lot of times it's nurses and providers and, and whatnot is, you know, even if you're prescribing something as a doctor or discharging a patient is almost that one line of reminder, Hey, make sure you're getting this filled at a licensed pharmacists. And if you need to go online, because whatever, like make sure like just one extra line of just make sure you know where you're getting this can be a lifesaver, and truly, like, you know, for someone that you know, especially patients that are doing, you know, have diabetes or heart challenges that are consistently having it or concerned about the cost, that one more line of just I understand it's expensive, but you gotta go where you know, it's going to be safe, and making sure that they have that one extra voice of making the patient aware of it. Because I would care to say, most of you even I talked to you a lot of which were providers, and I was like it's 95%. And they're like, what that's crazy, like they were blown away by it these high end some of these pharmacies, some of these, you know, bad pharmacies, rogue internet pharmacies, looks so good, that even pharmacists and health care professionals can't tell like if they're good, bad without, you know. So don't be fooled by just the deception of the appearance of the internet website. Like make sure you're doing your due diligence when you're doing that. Because, yeah, and I would say this. The other thing I would say is, is not only focusing on internet pharmacies, but be very careful of social media, and inviting medications from social media, because you're basically buying medication from a drug dealer. Yeah, yeah. No, absolutely. It's yeah, it may not be illegal, but it is like, I mean, you know, I mean, it's not illegal substance, but you're like, you're still not buying someone licensed to provide it to you. And I bet that's coming. More and more, especially


in those days, you look at the age population between 18 and 49.


And, yeah, and most of those that you're hearing from that, that are that have died from taking illicit fentanyl laced products. It's all I mean, a lot of it's coming from social media. I won't say the majority, but a lot of it's coming from social media. And just I mean, hearing the stories of like, these kids that are like, oh, I need was one pill because I just have so anxious I need to get some sleep. And so my friend refer me to this person on social media. I contacted in the show at their door, gave me medication and that, you know, this college student is dead the next day, like it's, it's sad. So for all the parents and you and I are both parents too, as well. For all the parents listen, be careful with social media and make sure that you you educate your kids or teenagers or your college students or just adults as well about just you know the dangers of bio medications from social media.


Are some of these pharmacies? Yeah, absolutely. Well, thank you so much for your education and your influence and your time. It was incredibly informative. And thank you for letting us be a platform to also help you know, get this information out. Well, I really appreciate you having me and allowing me to, to sit here and talk about this. Again. It's something we're very passionate about. And I really appreciate you and your time and anytime your team Julie for allowing us to be able to be able to do this as well. Awesome. Well keep fighting the good fight.


get this message out there to everyone. Yeah. All right. Thank you so much. Thank you

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