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What to Avoid When Buying Drugs Online

Not all online pharmacies are equal. Here's what to look for and what to avoid when buying drugs online.

By Martin Downs
WebMD Feature

Reviewed By Brunilda Nazario

Not all online pharmacies are equal. Some adhere to the same standards that brick-and-mortar drugstores do. But many other sites operate in the margins of the law, or well outside of it, and authorities are keen to pull the plug on them.

"We don't have any concerns with a legitimate Internet pharmacy," says Kristina Lunner, director of federal government affairs for the American Pharmacists Association.

But the few trustworthy pharmacy sites share a marketplace crowded with dealers who, if their practices were made plain, you might not trust to sell you a newspaper, let alone fill your prescriptions.

"There's been a proliferation of illegitimate or rogue drug sellers who are using the Internet," Lunner says, being careful not to call them pharmacies per se.

You can buy prescription drugs online in basically one of three ways.

First, a site may fill your order the traditional way -- only after you present a doctor's prescription. You either have to send the prescription to them by fax or mail, or have the doctor call it in.

Moving into murkier territory, there are so-called "prescribing sites." They will take your order after you fill out an online questionnaire detailing your medical history, or after a brief phone consultation. Either way, a doctor working for the site reviews your information and writes the prescription for you (or not, depending on details you've provided and what drug you're ordering). You pay for this service, generally in the form of an additional "consultation fee."

Some sites will fill any order, no questions asked, no prescription required. This is simply illegal in the U.S., so such sites are likely to be foreign.

Problems With Online Prescribing

While the practice is marginally legal, there is wide opposition to online prescribing within the medical community. In 1999, the American Medical Association took the stance that online prescribing "falls well below a minimum standard of medical care."

The FDA agrees with the AMA, and the Federation of State Medical Boards in 2000 came to the conclusion that prescribing drugs solely on the basis of an online questionnaire amounts to "unprofessional conduct."

The argument against Internet prescribing boils down to this: Online questionnaires or phone consultations are inferior to a physical exam and face-to-face interview. You can easily lie or forget relevant information, and your actual physical condition isn't apparent to the doctor writing the prescription.

"Do you have high blood pressure?" a form may ask. Maybe last time you saw a doctor you didn't, but the remote doctor reviewing your form cannot put a cuff on your arm to find out.

"Online questionnaires do not address all of the potential dangers of taking medication," Lunner says.

Although a form may catch an obvious conflict between your medical history and a given drug, you are essentially prescribing it to yourself. You can't guarantee that you'll hear from a doctor or pharmacist if there may be a better choice for you or if you should try another treatment approach.

"It's extremely important to remember that the whole process of patients getting access to prescription pharmaceuticals is deliberately mediated by professionals with a significant amount of experience," says Caroline Loew, PhD, vice president of scientific and regulatory affairs at the Pharmaceutical Research and Manufacturers of America.

Lawmakers have recently moved to ban online prescribing. Earlier this year, Sen. Norm Coleman, R-Minn., put forward a bill to that effect, known as the "Ryan Haight Act," named after a California teen who died from an overdose of prescription narcotics that he ordered from online pharmacies.

The bill was referred to a Senate committee headed by Sen. Judd Gregg, R-N.H. Gayle Osterberg, a spokeswoman for Gregg's office, said the Senate probably won't vote on it this year, and that the bill's provisions will likely end up wrapped into broader legislation on importing prescription drugs from Canada.

"To the extent that people want to talk about allowing importation, we can't do that without also addressing the question of the Internet," she says. "Most Americans do not live within a short bus ride to Canada, so we have to assume that they will continue to turn to the Internet."

What's Out There?