Three percent. If you’re ordering prescription medicines online, those are the chances that you are buying from a legitimate, accredited internet pharmacy. With odds that slim, is it really worth it to risk your safety for savings that are nearly always too good to be true?

Unfortunately, the answer for many American patients is still yes. Drug counterfeiting, aided by the explosion of Internet pharmacies and the ease of online purchasing, is a multibillion dollar industry. And although our government has taken steps to make patients aware of the risks of purchasing medicines from illegal online pharmacies, it’s clear that we still have a long way to go in our education efforts.

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Two years ago, America was shocked by counterfeit versions of the cancer drug Avastin that had infiltrated our secure supply chain and found their way to patients. That’s because for the first time, it became clear to many U.S. policymakers, patients, and the media that counterfeit medicines weren’t just a problem restricted to what many considered to be “lifestyle” drugs, like diet pills or erectile dysfunction treatments. This was cancer, and the fact that someone actually went to the trouble to produce, advertise and sell fake cancer medicine should leave no doubt about the types of criminals we’re dealing with.

The Avastin incidents happened to a large extent because healthcare professionals like doctors and purchasing managers for oncology clinics bought and administered the counterfeit medicines to their patients. If people who should clearly know better can behave in this way, the average American doesn’t stand much of a chance against professional scammers who stand to get rich by preying on innocent patients over the internet.  

The magnitude of the problem that we can actually quantify is staggering. Earlier this year, the United States was one of 111 countries participating in INTERPOL’s Pangea sting operation, which led to nearly 11,000 illegal online pharmacies being shut down, the removal 19,000 ads for fake drugs on social media sites, the seizure of 9.4 million doses of phony medicines. And last month, Google agreed to spend $50 million annually over the next five years to crack down on advertising for illegal online pharmacies. The sheer size of these numbers means that although incremental progress is certainly being made to protect patients, much more work remains before we can eradicate the threat of counterfeits.

Congress and our federal government must take a more serious look at the problem, and work toward solutions that can drastically reduce, if not eliminate, the menace of counterfeit drugs. First and foremost, patient awareness isn’t anywhere near the level it needs to be to ensure people can make informed decisions when purchasing medicines over the internet. Agencies like the FDA should be given the resources to better educate Americans about the health and safety dangers from purchasing from rogue online pharmacies.

And in order to get to the root of the problem, stopping those who are manufacturing and selling potentially lethal fake medicines, law enforcement agencies should have appropriate funding to more aggressively pursue counterfeiters and put them behind bars. This is especially true for the overtasked, underfunded and very small Office of Criminal Investigations (OCI) within the FDA.  Lastly, legislation should be enacted to give FDA/OCI administrative authority to require production of documents to assist in their Internet and related investigations, and increase penalties for trafficking in counterfeit, substandard, unapproved, and misbranded drugs.

In this era of federal budget cuts, resources are understandably scarce. However, with new illegal and fake internet pharmacies popping up far faster than regulators and law enforcement can ever shut them down, more needs to be done. The FDA and other agencies are doing the best with what they have, but Congress and the Obama Administration must get more involved. The risks to patients are simply too great to merely hope that another Avastin incident doesn’t happen again.

Dahl is a board member of the Partnership for Safe Medicines, an advocacy organization dedicated to stopping the spread of counterfeit drugs. He is a former assistant director of the FDA’s Office of Criminal Investigations (OCI).