Americans continue to struggle to pay the highest prices in the world for prescription medications, while Congress continues to dither on whether or not to legalize the re-importation of cheaper drugs from outside the country – something that is currently illegal. That hasn’t stopped millions from simply hopping across the border to Mexico or Canada, or even ordering from online pharmacies at huge discounts.

But isn’t there a risk of arrest and prosecution, even if lives depend on those illegally-obtained drugs?

Practically speaking, the answer is no. Yes, crossing the border in order to buy prescriptions is officially illegal, but the fact is that the law is almost never enforced. Under guidelines from the FDA, federal border agents are allowed to turn a blind eye “when the quantity and purpose are clearly for personal use, and the product does not present an unreasonable risk to the user.”

In this case, the term “personal use” means a maximum of a three-month supply. According to people who have purchased prescriptions in Mexico or Canada, as long as it is no more than a 90-day quantity, it is as simple as declaring it to customs and showing a doctor’s prescription and contact info. Even if a border agent has been having a bad day, the worst thing that may happen is that the drugs will be confiscated – but you won’t be arrested. (Attempting to bring more than a 3-month supply could raise suspicions that you’re planning to re-sell them, however – and that will get you in trouble.)

And what of ordering online from overseas pharmacies? Again, this is technically illegal, and the FDA does have the power to block entry of such shipments at international mail centers – but again, this rarely happens. Instead, these packages are often detained for inspection, which can delay delivery by several days, creating a problem for those who require daily medication.

The real risk – and ostensibly, the reason for the law in the first place – is that imported medications may not be safe or genuine. Dr. Ken Croen, a general practitioner in Harrison, New York who assists patients in shopping for prescriptions in Canada, warns, “There is a lot of junk in the pharmaceutical world.”

There is an appalling number of scam operations masquerading as online pharmacies, so it is important to do some homework before ordering over the Internet. This means making certain that the country in which the pharmacy is operating has strong regulations and that it is properly licensed. The pharmacy website should include contact information (i.e., a phone number and physical address). If an online pharmacy does not require a doctor’s prescription, that is a red flag. Avoid ordering from such a source.

Fortunately, there are a few websites that can assist customers in the vetting process, including the Canadian International Pharmacy Association (CIPA) and PharmacyChecker.com. These sites require valid prescriptions and medical profiles in order to protect patients from possible drug interactions. They also keep listings of “rogue” pharmacies operating on the World Wide Web.

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K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.