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
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.
Quick GuidePrescription Drug Abuse: Know The Warning Signs
"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?
A recent government investigation hints at what you may get by ordering drugs online.
During the first half of 2004, U.S. Government Accountability Office (GAO) investigators ordered 68 samples of 11 different drugs from online pharmacies located in the U.S., Canada, and other countries. The drugs they bought included popular drugs like Lipitor, Viagra, Zoloft, and Celebrex, as well as two addictive narcotics, OxyContin and Vicodin. (All the sites claiming to sell brand-name Vicodin actually shipped the drug's generic equivalent, hydrocodone.)
The GAO study found problems with many of the drugs they ordered, including four counterfeit samples.
Two orders from U.S.-based online pharmacies came with no instructions for use; two came with no warning information, and one was not shipped properly. Four of the Canadian samples came with no warning information, and 16 of the samples were Canadian versions not approved for sale in the U.S. market.
The worst offenses were found with the drugs ordered from online pharmacies operating out of Argentina, Costa Rica, Fiji, India, Mexico, Pakistan, the Philippines, Spain, Thailand, and Turkey.
When the GAO investigators ordered Accutane from outside the U.S. and Canada, they received "Roaccutan," a foreign version of the drug with Spanish-language packaging. The FDA warns consumers never to buy Accutane online because its use must be closely monitored, and only doctors on a special registry may prescribe it.
An order of Crixivan, an HIV/AIDS drug, came packaged in an aluminum can inside a box of "Gold Dye & Stain Remover Wax." Investigators were able to get one sample of OxyContin from a foreign site, and it was determined to be counterfeit. The pills came in a plastic baggie stuffed inside a CD case that was wrapped in packing tape.
What's more, some of the drug samples came from places that stretch our definition of "pharmacy." Two return addresses were traced to private homes in Lahore, Pakistan. One return address was a business in Cozumel, Mexico, but that business claimed to have no connection to an online pharmacy. Another shipment apparently came from a shopping mall in Buenos Aires, Argentina, but investigators weren't able to find out which store in the mall had sent it.
Finally, six orders that GAO investigators placed and paid for never arrived.
Safe Online Shopping
There are benefits to filling your prescriptions online. For people who are house-bound and those who live out in the far reaches of rural America, Internet pharmacies provide an invaluable service.
Many of us don't know the actual price of our prescriptions because we pay a flat co-pay to our insurance companies. Shopping online, however, allows those without prescription drug benefits to see, for example, that Walgreens.com sells a 30-day supply of 10 mg Lipitor for $77.99, and Drugstore.com has it for $64.99.
The FDA points consumers to the Verified Internet Pharmacy Practice Sites (VIPPS) program, run by the National Association of Boards of Pharmacy.
Web sites that carry the VIPPS seal are assured to be legitimate pharmacies located in the U.S. Some are online services offered by chain drug stores, but those that only fill prescriptions online abide by the same regulations that traditional U.S. drug stores follow.
"That seal needs to be well understood," says the American Pharmacists Association's Kristina Lunner.
At present only 14 online pharmacies are authorized to carry it. You can check to see if an online pharmacy is part of the VIPPS program at the VIPPS web site.
In general, the FDA offers the following advice to online shoppers:
- Do not buy from sites that don't require a valid prescription.
- Make sure the site has a licensed pharmacist you can contact to ask questions.
- Don't buy from foreign online pharmacies.
- Ask your doctor before you use any medicines for the first time.
Quick GuidePrescription Drug Abuse: Know The Warning Signs
Published Nov. 17, 2004.
SOURCES: Kristina Lunner, director of federal government affairs, American Pharmacists Association. Gayle Osterberg, director of communications, Senate Committee on Health, Education, Labor and Pensions. Caroline Loew, PhD, vice president of scientific and regulatory affairs, Pharmaceutical Research and Manufacturers of America. Federation of State Medical Boards of the United States, Inc., Special Committee on Professional Conduct and Ethics, April 2000. American Medical Association, Report of the Board of Trustees, Internet Prescribing, 1999. United States General Accounting Office, Report to the Chairman, Permanent Subcommittee on Investigations, Committee on Governmental Affairs, U.S. Senate, "Internet Pharmacies: Some Pose Safety Risks for Consumers," June 2004. Prepared Statement of the Federal Trade Commission on "The Internet Sale of Prescription Drugs From Domestic Websites" Before Committee on Government Reform, U.S. House of Representatives, March 2003. 108th Congress 2nd Session Bill S. 2464, "Ryan Haight Act." FDA.
©1996-2005 WebMD Inc. All rights reserved.
Daily Health News
Drugs and Treatment Resources
Subscribe to MedicineNet's General Health Newsletter