Drug compounding — the custom-mixing of drugs for specific patients — predates the industrial production of pharmaceuticals, which started in the late 1800s. Government regulators have let the practice persist for a few reasons. The most often cited is the need for some patients to use medicines free of dyes, binders and other additives
In the last two decades, industrial-scale compounding has emerged as a big — and in some eyes essential — source of drugs.
Companies such as New England Compounding Center, the now-closed company at the heart of the fatal meningitis outbreak, make products that are virtual copies of ones produced by drug companies.
In some cases, these “compounding pharmacies” start with raw materials. Sometimes they repackage finished drugs they get from drug companies. Either way, the product is hard to visually distinguish from what one might buy from Merck, Pfizer or GlaxoSmithKline.
NECC’s steroids were sold in stoppered glass vials, just like a drug company’s. Many clinics bought compounded drugs in bulk, as they do from drug manufacturers. Until the latest outbreak — which has sickened 696 people and killed 45 — many physicians considered the products to be interchangeable with manufactured drugs.