Published July 17, 2014 MEDICATION MANAGEMENT Black Is the New Gray in Pharmaceuticals Harold E. Cohen, RPhEditor-in-Chief US Pharm . 2014;39(7):1. For generations, many greedy, scheming businessmen in this country have been buying and then selling goods from the so-called gray market to unsuspecting consumers. While the notion of a gray market may vary from person to person, it is defined basically as a market created by selling legal goods outside of a manufacturer’s authorized trading channels. Let’s say a legitimate jewelry store wants to sell a certain premium brand of watches. It would not be unreasonable for the premium watch manufacturer to conduct an analysis of the store’s business volume and credit history before allowing it to become an authorized dealer of its brand. Another, less reputable store might like to sell the same watches, but instead of buying them directly from the prestigious watch manufacturer, it purchases them through a “middleman” who likely obtained the watches through more corrupt means. This constitutes the beginnings of a gray market for these watches. And because the store selling gray market watches does not have to abide by the manufacturer’s strict sales policies, it can usually sell the watches at much-discounted prices compared to those the authorized dealer must charge. A gray market for pharmaceuticals has also existed over the years, wherein diverters sell legitimate drugs at lower prices to retailers who might be having trouble making ends meet. Unfortunately, with prescription drugs the gray market has evolved into a more serious black market, consisting typically of controlled and counterfeit drugs. While the FDA has been proactive about prosecuting pharmacists who are caught purchasing and distributing black market medications, only the more sensational arrests make headlines. Once such case involved a compounding pharmacist in San Diego who purchased injectable cancer medications such as Avastin, Eloxatin, Gemzar, Neupogen, Rituxin, Taxotere, and Zometa from a supplier in Canada. The versions of the drugs so purchased and mixed as infusions were not approved by the FDA. And in Brooklyn, New York, a pharmacist defrauded Medicaid by improperly billing for prescription medications that he purchased on the street. According to an article published online by MintPress News on May 5, James Harris, PhD, a former FDA staffer and a trained toxicologist, expressed his disappointment that physicians “were cited as being the number one direct source of prescription drugs [contributing to the drug abuse crisis in the U.S.].” He was amazed that little was mentioned about how the black market is largely responsible for the relentless drug abuse problem in this country. He claims that “prescription pills are easier for teenagers to obtain than beer.” This was underscored by Marine Corps Gen. John F. Kelly, head of the U.S. Southern Command, in testimony before the Senate Armed Services Committee on March 13. “The majority of heroin sold in the United States comes from either Colombia or Mexico, and we are seeing a significant increase in heroin-related overdoses and deaths in our country.” Pharmacists can and should play a key role in helping to control drug abuse and the spread of black market medications. I have always believed that pharmacists have a sixth sense when it comes to spotting suspicious drug abuse activity by their patients, and that they should always remain vigilant and report anything they feel puts their profession in jeopardy. The war on drugs is real, and pharmacists are on the front lines. To comment on this article, contact editor@uspharmacist.com.