Online Pharmacies
Lauren Howell, PharmD
On October 2, 2024, CDC released a statement to inform public health officials, clinicians, and affected patients, their families, and caregivers about a potential public health risk for individuals who order what they believe to be prescription medications from online pharmacies.
A few days earlier, in September 2024, the U.S. Department of Justice announced an indictment against those who run illegal online pharmacies. The Department of Justice stated that these individuals advertise, sell, manufacture, and ship millions of unregulated counterfeit pills to tens of thousands of people in the United States. These pills often contain fentanyl, putting patients who believe they are taking completely legit and legal prescription medications at risk of an overdose.
The National Association of Boards of Pharmacy (NABP) has estimated that nearly 95% of websites that offer prescription medications are operating illegally. Often offering prescription drugs at deeply discounted prices without a prescription, the convenience and cost-effectiveness of these online pharmacies can seem appealing to patients. However, patients may be unaware that the medications they obtain from these pharmacies may be unapproved, counterfeit, or otherwise unsafe medications that are obtained outside the safeguards that a regular pharmacy would provide.
How to know if an online pharmacy is legitimate
Pharmacists can help protect the public from counterfeit medications by educating their patients on how to identify a safe, verified, online pharmacy. Legitimate pharmacies will be licensed by regulators and accept only valid prescriptions. Additionally, they will comply with drug and professional practice laws as well as privacy laws and ensure patient confidentiality. Patients can also look for contact information, as safe and verified pharmacies should make this information readily available for patient care inquiries. ■
How to talk to patients who have already obtained medications from an online pharmacy
Pharmacists should inform patients of the dangers of using online pharmacies. When a patient has already used an online pharmacy to obtain medication, there are several counseling points that the pharmacist can use to educate the patient on the best next steps to take.
1. Check to see if the pharmacy is U.S. state-licensed. If the pharmacy is not, do not consume the medication.
2. If you suspect that the medication you received is counterfeit, you should dispose of it immediately. There are several ways to safely dispose of medications.
- Check with local law enforcement officials to find out if there is a DEA-authorized collector in the community that participates in a take back drug program.
- Check with your pharmacy to see if they offer on-site medication drop-off boxes, mail-back programs, or other ways to help you dispose of unused medications.
- Check the FDA’s list of medicines that are recommended for flushing when a take back option is not available. Do not flush medicine unless it is on the flush list.
- Medications that are not on the flush list can be removed from their original container and mixed with coffee grounds, dirt, or cat litter. This makes the pills less appealing and recognizable to others. Put the mixture in something that you can close such as a sealable zipper storage bag or empty can and throw the container in the garbage.
3. Always have naloxone with you in case of the need for administration in response to any person who shows signs of an opioid overdose. Always have someone nearby whenever you ingest any unknown substance or medication.
4. If a poisoning emergency occurs, call 911 and seek medical attention immediately.
For questions about unknown substances, contact Poison Control by calling 1-800-222-1222. ■