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[citation needed] Today, many consumers head to online pharmacies in India, South Africa and other countries where drug prices are often lower than in Canada. Most US consumers and some legislators favor accessing foreign-made prescription drugs to lower Americans’ health costs. According to a Wall Street Journal/Harris Online poll in 2006, 80 percent of Americans favor importing drugs from Canada and other countries. [5]President Obama’s budget supports a plan to allow people to buy cheaper drugs from other countries. [6]A report in the journal Clinical Therapeutics found that U.S. consumers face a risk of getting counterfeit drugs because of the rising Internet sales of drugs, projected to reach $75 billion by 2010. Legality and risks of purchasing drugs online depend on the specific kind and amount of drug being purchased. While rarely enforced, it is usually illegal to purchase controlled substances from an overseas pharmacy. Generally speaking, a person purchasing a controlled substance from such a pharmacy may be violating two federal laws which can carry stiff penalties.

The act of importation of the drug from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). Note that FDA does not recognize online prescriptions; in order for the prescription to be valid, there has to be a face-to-face relationship between the patient and the health care professional prescribing the drug. What exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition which would allow them to operate as an adjunct to the patient's own physician if the patient submits medical records documenting a condition for which the requested medication is deemed appropriate for treatment. Sections 956 and 1301 provide exemptions for travellers who bring small quantities of controlled substances in or out of the country in person, but these exemptions do not cover delivery via a mail carrier. Importation of any prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), unless the following conditions are met (as listed in Section 804). The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a significant threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual. According to Department of Homeland Security Appropriations Act, Section 535, Customs and Border Patrol are not allowed to prevent people from importing FDA-approved prescription drugs. Although originally the law was worded to cover all prescription drugs, countries of origin, and methods of delivery, its final edition specifies that it only applies to importation from Canada, and to ".individuals transporting on their person a personal-use quantity of the prescription drug, not to exceed a 90-day supply".

Controlled substances are also explicitly excluded. Therefore, it does not disallow Customs to screen and intercept drugs sent by mail. It is also technically illegal to import "non-approved" drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, the patients may be allowed to keep these drugs. Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances. For several years, the states of Nevada, Minnesota, Illinois and Wisconsin have run official state programs to help their residents order lower-cost drugs from abroad to save money. Most online pharmacies worldwide will send consumers a free replacement order if their order is not received for any reason, including customs seizure (some do require the customer to submit a copy of the seizure letter they received from customs, in order to prevent fraudulent claims of non-receipt). Normally, consumers should wait about 30 days after placing their order before considering this option. When considering an order, a prospective customer should read the rules regarding reships on the pharmacy's website.