'I am amazed but I foud this site where you can bye great meds like Valium and Vicoden. Its not easy to find but here it is have a look and have a happy weekend god knows i will." No prescription? No doctor? No problem, say a growing number of online pharmacies. But there are many problems, writes Conor Pope.
'I am amazed but I foud this site where you can bye great meds like Valium and Vicoden. Its not easy to find but here it is have a look and have a happy weekend god knows i will."
And so arrives another badly written e-mail, light on grammar but heavy with the promise of prescription drugs without a prescription. Such e-mails are becoming more frequent, as a growing number ofwebsites offer to ship prescription drugs anywhere in the world within 48 hours. All you need is a credit card and
the will to self-diagnose and self-medicate.
Most are so obviously bogus that you can discount them. Could anybody be foolish enough to put their health and
credit-card details into the hands of people who can't even spell "found" and "buy"? But then there are the other sites,
sites that are plausible and apparently legitimate and offer to prescribe hundreds of drugs to anyone after the most cursory of checks. No data is available for Ireland, but the National Audit Office in Britain
found that up to 600,000 Britons have bought prescription medicines over the Internet. In the US the estimate is a conservative million.
The dangers of self-prescription were made clear last month when a London inquest was told how a 24-year-old musician, Liam Brackell, committed suicide by jumping in front of a train after becoming addicted to prescription drugs he bought online. The inquest heard that Brackell was so dependent on opiates and antidepressants that he was buying up to 300 pills a day. By the time of his death he had used 23 types of prescription drugs, some of which even GPs would have been reluctant to prescribe.
Concern is growing here about the increasing popularity of online pharmacies. Although it is illegal to establish an
e-pharmacy in the Republic and a crime to buy prescription drugs online and import them into the State, there is a widespread recognition of the impossibility of policing the issue and an acknowledgment of the threat e-pharmacies pose.
Tim O'Malley, a Minister of State at the Department of Health and Children, has warned of the dangers of buying medicine over the Internet. "It is," he said, "shocking to think that consumers can simply log on and purchase [drugs] with a credit card."
Although O'Malley, a former pharmacist, accepted that the Internet was "notoriously difficult to regulate" he urged people "to be very wary of medical sites that offer an almost instant diagnosis and to avoid buying prescriptive
drugs online."
One US-based site makes a virtue of shipping low-cost drugs worldwide, many of them of dubious legality in the US and illegal here. The site promises to ship orders discreetly "right to your door! No waiting, no hassle, no doctor visit needed! Your [sic] only a click away!
So what are you waiting for? Join now and take control of your life today!"
Apart from the crass breathlessness of the blurb and the irresponsibility of its promises, there is another side to the promotional spiel: the cost. Drugs bought online, it claims, are much cheaper than those bought over the counter. But this is not true, according to Olive Stephens of the Irish Pharmaceutical Union (IPU).
"Internet pharmacies provide nothing to the patient in terms of value for money. US e-pharmacies providemedicines at triple what you can buy them for in Irish pharmacies." Price is not the IPU's primary concern, however. "E-pharmacies are illegal in Ireland for good public health reasons.
Pharmacists, as healthcare professionals, believe it is critical that the sale of medicines is carefully monitored in the interests of patient safety," says Stephens. "When a patient comes into a pharmacy with a prescription a pharmacist
checks for problems such as therapeutic duplication, drug-drug interactions, incorrect drug dosage or duration of drug
treatment, drug-allergy interactions and clinical abuse or misuse. In e-pharmacies this kind of face-to-face contact and
professional monitoring of patients is impossible."
As Stephens points out, many of the people who would be inclined to use e-pharmacies are the most vulnerable.
Prescription-drug addicts, who cannot get access to medicines through traditional routes, "need considerably more
professional advice than your average patient, not less, as would be the case were they to access medicines through
an e-pharmacy".
In the US, where e-pharmacies are common, major problems are being reported to do with self-medication, counterfeits and illegal purchases. The US spends more than ¤160 billion a year on "drug misadventures" such as overdoses, adverse drug reactions, drug interactions and improper drug selection.
Dr John Hillery, a psychiatrist and vice-president of the Medical Council, is also concerned about the proliferation of
online pharmacies. Antidepressants are among the commonest drugs sold online; as Dr Hillery points out, "one of the risks of depression is suicide, so we very closely monitor the amount of these medications we give scripts for. It seems tome that if someone goes online they can actually get one or two months' supply" with no controls in place.
The abuse and misuse of drugs – and of people taking drugs for the wrong reasons or taking dosages that are too high – are some of the problems Dr Hillery sees developing as a result of e-pharmacies. He believes self-medication is never justified.
The Medical Council is drawing up guidelines for the problem that should appear before Christmas. One of the more obvious reasons people turn to the Web for prescriptions is that many of the drugs available on it reflect people's insecurities about their appearance and play on their fears of growing old. There are anti-ageing creams, anti-baldness pills, treatments for obesity, acne and erectile dysfunction and aids for people desperate to quit smoking. Anti-anxiety medications and drugs to combat depression and pain are also extremely popular.
Sites keen to exploit these fears seem to behave astonishingly cavalierly. I tried buying the antidepressant Seroxat from
one UK-based website. The medical questionnaire the site relies on in place of a visit to a doctor asks me no more than six cursory questions about my health. The site helps me to give the right answers by using them as the default
option. It has already selected Yes as my answer when it asks if I agree to monitor my blood pressure at least once a fortnight and stop taking the drug if my blood pressure rises above 140/90. "Do you have high blood pressure?" offers the default option of No. Several more questions follow, then I am led to the checkout, to be charged ¤50 for the drugs plus an annual subscription of ¤15 and ¤5 for delivery. The same drugs in a Dublin pharmacy cost just over ¤40.
"With the introduction of the Internet everything is going virtual and the field of medicine is no exception," the site declares.
"As long as you have recently had a physical examination it is not necessary to have a full examination again to determine
need of medication."
Most doctors and pharmacists would disagree.