Online Pharmacies: Authentic or Illegitimate?

September 20, 2007

Due to the high cost of pharmaceutical drugs, some patients are turning to the Internet (eg, online pharmacies) to purchase their medications at a much cheaper rate, or so they think.

Due to the high cost of pharmaceutical drugs, some patients are turning to the Internet (eg, online pharmacies) to purchase their medications at a much cheaper rate, or so they think. Over the past couple of years, the number of online pharmacies has drastically increased, attracting customers by making it easier for them to fill new prescriptions and get refills without having to wait in line. Hundreds of online pharmacies are popping up all over the Internet including the online divisions of retail pharmacy giants such as Wal-Mart, CVS, and Walgreens, yet how many of them are legitimate?

Danger, Will Robinson!

If you receive spam e-mails from online pharmacies advertising the inexpensive costs of drugs like Viagra, consider how many of your patients receive them. Every year, hundreds of thousands of patients succumb to this kind of advertising and purchase their prescription medications online—often without a valid prescription from a healthcare professional—putting themselves at risk. Some of these online pharmacies only require patients to fill out a brief questionnaire, which is then viewed by a paid physician who has no relationship with the patient and bypasses the physical exam. “This practice undermines the safeguards of direct medical supervision and a physical evaluation performed by a licensed health professional,” says Jeffrey Shuren, MD, medical officer in the Food and Drug Administration’s (FDA) Office of Policy, Planning and Legislation. “The Internet makes it easy to bypass this safety net.”

These “rogue sites,” either “sell unapproved products, or if they deal in approved ones, often sidestep established procedures meant to protect consumers.” Patients who purchase medications from these sites run the risk of receiving contaminated, counterfeit, or outdated drugs; or lethal combinations of medications. Victims have included “women in Argentina who died after taking a bogus anemia treatment, deaths in Cambodia due to fake malaria drugs, and children in Haiti and India killed by paracetemol made with antifreeze.” In fact, the World Health Organization has found that “more than 30 percent of medicines on sales may be counterfeit” in African, Asian, and Latin American countries.

The Government Does Care

Senator Dianne Feinstein (D-CA) and Representative Jeff Sessions (R-AL) have collaborated to propose amendments to the Controlled Substances Act and introduced The Online Pharmacy Consumer Protection Act of 2007. The goal of this legislation is to “ban the sale of drugs online without an original written prescription.” It would “require doctors to meet with patients in person before prescribing medication.” A press release issued by her office quotes Feinstein as saying, “Today controlled substances are just a click away on the Internet. This is dangerous and it should be stopped. This legislation bans the dangerous practices of rogue pharmacies and requires all controlled substances purchased on the Internet to be done with a legitimate prescription and a medical examination.”

Additionally, the Food and Drug Administration (FDA) is working with the National Association of Boards of Pharmacy and the Federation of State Medical Boards to enforce federal and state laws to stop the illegal buying and selling of medications over the Internet. The FDA has also taken steps to alert consumers about the dangers associated with this practice and provide them with the necessary tools with which to make informed decisions when purchasing medications online. The Verified Internet Pharmacy Practice Sites™ (VIPPS®) initiative is a voluntary certification program that “provides consumers valuable information about the credentials of online pharmacies.”

To demonstrate the effectiveness of the VIPPS program, research was conducted by the brand protection firm MarkMonitor, who monitored approximately 3,200 online pharmacies, only four of which were accredited by VIPPS. “The data shows brandjackers are profoundly exploiting brands, using increasingly sophisticated tactics, and, in the case of the pharmaceutical industry, posing an outright danger to consumers through questionable practices that indicate counterfeiting and gray markets,” said MarkMonitor President and CEO Irfan Salim. (All of the firm’s research can be viewed in their Brandjacking Index™.)

Consider Yourself Warned

Healthcare professionals must warn their patients who regularly use online pharmacies to purchase prescription medications about the risks they are taking, and provide them with helpful tips they can use to determine whether an online pharmacy site is legitimate. Here are some suggestions offered by FDA:

1. Check with the National Association of Boards of Pharmacy to determine if the site is a licensed pharmacy in good standing.

2. Don’t buy from sites that offer to prescribe a prescription drug for the first time without a physical exam, selling a prescription drug without a prescription, or sell drugs not approved by FDA.

3. Don’t do business with sites that do not provide access to a registered pharmacist to answer questions.

4. Avoid sites that do not identify with whom you are dealing and do not provide a US address and phone number to contact if there’s a problem.

5. Beware of sites that advertise a “new cure” for a serious disorder or a quick cure-all for a wide range of ailments.

6. Be careful of sites that use impressive-sounding terminology to disguise a lack of good science or those that claim the government, the medical profession, or research scientists have conspired to suppress a product.

7. Steer clear of sites that include undocumented case histories claiming “amazing” results.

8. Talk to a healthcare professional before using any medication for the first time.

The bottom line: patients should remain cautious when purchasing medications over the Internet, and healthcare professionals should be proactive when discussing the risks associated with this practice.

ADDITIONAL RESOURCES

Buying Drugs Online—It’s Convenient and Private, but Beware of Rogue Sites

Docs Busted in Online Pharmacy Racket

Narcotics on the Net: The Availability of Web Sites Selling Controlled Substances

Online Pharmacy Bill, a Good Start but Needs More

Rogue Sites Deal Dangerous Rx

“You’ve Got Drugs!” IV: Prescription Drug Pushers on the Internet