As the cost of medications continues to rise and health insurance plans encourage home delivery of maintenance medications, pharmacists are in a unique position to inform patients of the potential dangers of ordering prescription medications online. About 97% of more than 10,000 online pharmacies reviewed by the National Association of Boards of Pharmacy (NABP) are unlicensed or fraudulent operations that peddle contaminated, expired, or counterfeit medications and do not comply with U.S. pharmacy laws, according to a January 2013 report.
Patients who take these medications may get sicker, develop resistance to medicines, or experience new adverse effects. The drugs can also cancel out the effects of other medicines, cause harmful interactions, or lead to misdiagnosis.
Lower-income patients and those with no or inadequate prescription coverage may be tempted by the cheap prices of online pharmacies. Older patients who need long-term maintenance medicine as well as patients seeking drugs for baldness, impotence, wrinkles, and acne may also use or consider using the sites, according to FDA’s BeSafeRx campaign (www.fda.gov/besaferx).
Be alert to the signs that a patient may be buying products from an online pharmacy. “Patients who are not responding to treatment, who are experiencing unexpected adverse effects or new symptoms, or who are changing medications frequently” may be ordering drugs online, said NABP Executive Director Carmen Catizone, MS, BSPharm. “If a patient seems uncomfortable—or if there’s anything unexplained—open the door to further conversation by asking, ‘Are you getting any of your medications off the Internet?’”
Warn patients that inexpensive medications offered by these rogue websites often are produced by unknown sources in other countries “where quality standards are more lax and counterfeit medications more widespread,” according to NABP. Because FDA does not have jurisdiction over prescription medications from other countries, it cannot guarantee the drugs’ safety or effectiveness. The medications may have slight variations or different ingredients from those approved by FDA for use in the United States.
These rogue websites may also misuse patients’ personal and financial information, infect their computers with viruses, sell their information to other illicit websites and Internet scams, and charge them for products they never ordered or received.
Advise patients to avoid online pharmacies that
Explain that legitimate online pharmacies always require a doctor’s prescription, have a pharmacist available who can answer questions, are licensed with the pharmacy board in the state where they operate, and have privacy and security policies that are easy to find and understand.
Refer patients to NABP’s list of 50 online pharmacies accredited through the Verified Internet Pharmacy Practice Sites (VIPPS) program and to their list of not-recommended sites that appear to be out of compliance with state and federal laws or NABP patient safety and pharmacy practice standards. Patients who have concerns about a site can report it to their state board of pharmacy, NABP, or FDA.
The National Council for Patient Information and Education offers a number of resources, including the brochure Buying Prescription Medicine Online: A Consumer Safety Guide.