According to NABP President Gary A. Schnabel, RN, RPh, "There is a common misconception that prescription medications purchased from any website calling itself a pharmacy are safe." However, patients fail to realize that when buying medications from unknown sources online, established safeguards vanish, and the odds of getting counterfeit or substandard medication rise substantially.
Of the more than 5,200 Internet drug outlets NABP has assessed since May 2008, greater than 5,000 (96%) were found to be out of compliance with basic criteria for legitimate pharmacy practice and were posted as “Not Recommended” on the NABP website. Here are some of the infractions:
- More than 75% dispense drugs, including opioids and other analgesics, without a valid prescription being required, with most Internet outlets accepting a brief online questionnaire in place of a prescription.
- Nearly 25% post a physical address located outside the US, and roughly half do not provide any physical address at all. According to the World Health Organization, more than 50% of medicines purchased over the Internet from sites that conceal their physical address are counterfeit.
- Nearly half offer foreign-made or unapproved drugs. Because these drugs are not subject to the quality and safety requirements of those approved for sale in the U.S. — or even of those approved for sale in other developed countries — their safety and efficacy are unknown.
- Nearly 20% of the online operations do not have secure sites that protect patients' personal and financial information.
PRACTICE POINTERS: Patients eager to save money may be tempted to patronize online drug outlets, which advertise widely on the Internet and flood personal e-mail with their spam. Healthcare providers need to remind patients about purchasing medications only from legitimate local pharmacies or mail-order sources that have been approved by the medical practice or healthcare insurance plan. This is particularly essential for prescribed opioids, which always should be acquired from a single legitimate source known to the healthcare provider.
Since practically any pharmaceutical product can be purchased via the Internet for licit or illicit use, pain practitioners need to question patients not only about what they have been taking for their pain, or other purposes, but where they purchased the products. Many of those, if bought online, may be of inferior quality and potency or completely bogus; ie, not containing the advertised ingredients at all. And, with such ease of accessibility, a patient can “self-prescribe” practically any product that they believe might be helpful for their condition, which makes an accurate medication history-taking of each patient a challenging but critical clinical practice.
SIDE NOTE: Most parts of the United States, as well as other countries, have implemented Prescription Drug Monitoring Programs (PDMPs) in efforts to track where people are obtaining prescribed medications, to stem unauthorized drug purchases or practices such as “doctor shopping.” However, it must be recognized that the availability of drugs, including opioids, via unscrupulous Internet outlets completely circumvents PDMPs and, unless these rogue online purveyors are somehow brought under control, the reliability of PDMPs as a risk mitigation measure may be questionable.
MORE INFO: In addition to the NABP, LegitScript and the FDA provide helpful information and guidance regarding safely buying medicines online. Of the 60,845 pharmacy websites in the LegitScript database, only 348 (0.6%) are currently rated as legitimate. Further information and access to these sources are available at the Pain-Topics.org website [click here].
REFERENCE: NABP. 5,000 Web Sites Selling Prescription Drugs Outside of Pharmacy Laws and Practice Standards. News Release, 12/28/2009.