Internet chemists are becoming more popular, but there are concerns about bogus sites, writes Karlin Lillington
The package that arrives in the post is a plain grey envelope marked "healthcare products". It gives no indication that it holds a month's supply of a prescription-only painkiller.
But then again, what it could actually hold is unprescribed counterfeit medicine. These are rife on the internet, according to the World Health Organisation: "In industrialised countries, internet-based sales of pharmaceuticals remain a major source of counterfeit medicines, threatening those who seek cheaper, stigmatised or unauthorised treatments."
Yet there is a growing, regulated internet pharmacy trade, attractive to many consumers because of good prices and the anonymity of the transaction. Countries such as Canada, the US and the UK all have a legal framework in which perfectly respectable pharmacies offer prescription drugs online.
In the Republic, the situation is less clear cut. Prescriptions cannot be filled online by any pharmacy based in the Republic - neither to Irish customers nor to those abroad - and the Irish Medicines Board (IMB) works with the Revenue to ensure this is strictly observed. But Irish consumers can buy prescription drugs online and have them sent into the State, apart from some controlled drugs such as methadone or OxyContin (both, however, are easily available on internet sites abroad).
Internet pharmacies fall into three general categories. First are the pharmacies that operate much like a local chemist. In places such as Canada, the UK and US, there are often online divisions of major chain pharmacies. They sell a wide range of products as well as prescription drugs, which require a doctor's prescription.
The second type of internet pharmacy tends to be lifestyle-related, selling a narrower range of pharmaceuticals based on categories such as weight loss or sexual dysfunction. These require the customer to fill out an assessment form, which is examined by a physician working with the pharmacy who approves a prescription filled by the pharmacy.
The third type of pharmacy, often based in Asia, India or the South Pacific, will fill orders without a prescription or assessment. This type in particular worries regulators. It also makes up the bulk of online pharmacy sites, including those featured in e-mail spam messages. A new study from the US National Centre on Addiction and Substance Abuse (Casa) reveals that 89 per cent of websites selling controlled prescription drugs do not demand prescriptions.
However, in the US, the pharmacy industry itself has moved to create ways of letting consumers know whether a given pharmacy is legitimate. The National Association of Boards of Pharmacy (www.nabp.net) runs a service called Vipps (verified internet pharmacy practice sites) which accredits online pharmacies that adhere to their state's licensing requirements. The sites can then show a Vipps seal.
In the UK, the Royal Pharmaceutical Society of Great Britain (RPSGB) offers guidelines for internet pharmacies, which it terms "an area of rapid growth". The legal requirements for such pharmacies are that they must be registered with the RPSGB, must operate from a physical rather than "virtual" premises, must be under the physical control of a registered pharmacist, and can fill orders for valid prescriptions only.
By contrast, while forthcoming legislation will allow pharmacies here to sell over-the-counter medications online, Irish professional medicines and pharmacists' organisations remain opposed to having prescription drugs available at a mouse click.
"The Irish Medicines Board takes the view that internet sales are not in the best interests of public health as they do not often require prescriptions, or if they do involve a genuine medical practitioner and pharmacist, neither the purchaser nor the supplier has any proper knowledge or confirmation that either the patient's medical and personal information supplied by the purchaser or the product by the supplier are actually genuine," says a spokeswoman.
The IMB is the regulatory body for the control and dispensing of medicines.
"There is a strong body of evidence that a significant amount of products offered by internet sites are counterfeit, and as such, pose a danger to patients and consumers," the spokeswoman adds.
The Pharmaceutical Society of Ireland (PSI), the industry's regulatory body, is similarly critical. "Pharmacists have a key role to play in the safe, effective and rational use of medicines and to remove the pharmacist from the supply chain when dispensing medicines is dangerous for the health of consumers," says a spokesman. "The PSI is concerned about the range of medicines being sourced over the internet for use by people without consulting either their pharmacist or doctor and the growing problem of counterfeit medicines being illegally manufactured and supplied."
Pam Logan, professional and business manager with the Irish Pharmaceutical Union, which represents pharmacists, agrees with this stance. "Internet pharmacies can't tell who diagnosed the patient in the first place, or if they self-diagnosed and diagnosed incorrectly. There are no checks and balances there between the prescribing and the dispensing."
But surely if countries as cautious as the US and UK allow online pharmacies to operate, there's an argument for introducing more competition and better prices here? "It is a matter for the UK and US competition authorities to regulate their own markets," is the response of the IMB.
Health insurer the VHI says online pharmacies could prove beneficial if they offered drugs at a reduced price.
"However, there are issues around regulation," a spokeswoman says. "We would encourage those with responsibility for the regulation of drug use in this country to come to a view as to whether the benefits of online pharmacies outweigh the risks."
And the Irish Patients' Organisation remains cautious, warning patients to "be very, very careful buying drugs online". It doesn't mince words: "You can die from one click of your mouse!"
Unlike a prescription scribble, the writing here is clear: don't expect to see prescriptions filled online in the Republic any time soon.