Is It Safe To Order Drugs From Overseas Pharmacies?

Darrell T. Hulisz, RPh, PharmD

Disclosures

January 02, 2009

Question

Some of my patients obtain prescription medications from outside of the United States via the Internet. What are the risks of this practice, and how can any problems be avoided?

Response

Darrell T. Hulisz, RPh, PharmD
Associate Professor, Department of Family Medicine, Case Western Reserve University School of Medicine, University Hospitals, Case Medical Center, Cleveland, Ohio

A growing number of US consumers are engaging in the potentially risky practice of purchasing medications from unregulated Websites that ship drugs from foreign countries. The Food and Drug Administration (FDA) has cautioned consumers about this practice, especially about ordering prescription drugs without a valid prescription.[1] Many drugs that are available from overseas pharmacies should be monitored by a health professional for effectiveness and for potential adverse events, FDA officials have said.

There are several different types of Internet pharmacy portals, and some of them do follow safe medication practices. In the best-case scenario, a valid, legal prescription from a licensed prescriber is transmitted to the Internet pharmacy, which then fills the prescription and mails it to the patient. Pharmacies meeting quality standards of care are designated as Verified Internet Pharmacy Practice Sites (VIPPS) by the National Association of Boards of Pharmacy.[2]

In contrast, legitimate prescriptions may be transmitted to pharmacies outside the United States, and may be filled with counterfeit drugs, expired drugs, illegally diverted drugs, or adulterated drugs.[2] Even worse, consumers may order prescription medications online without first acquiring a legitimate prescription, giving them access to potentially toxic or addictive medications without seeing a healthcare provider.

Some online pharmacies routinely sell and ship medications such as zolpidem, methylphenidate, sildenafil, fluoxetine, oxycodone, and various opiates to US customers without prescriptions.[3,4] In fact, large quantities can be purchased with few or no screening questions asked about the patient's medical history. Even when screening questions are asked, these pharmacies are unable to verify the patient's responses. In countries that do require valid prescriptions, physicians may approve the orders without knowing anything about the patient. In this case, the patient does not know anything about the physician's qualifications, either.

On occasion, parcels are confiscated by US Customs and Border Protection if officials suspect they contain pharmaceuticals. While this may protect the consumer from harm, they probably will not recover their prepaid charges.

The dangers of bypassing a licensed US prescriber and obtaining medications overseas are myriad. Perhaps the most troubling is the lack of a valid prescription, because the consumer may be self-diagnosing and self-treating. Purchased medications may be addictive, be potentially toxic, or require special monitoring. There is often no assurance that the dosage is correct, nor is there screening for drug-drug or drug-disease interactions.

Some overseas Internet sites sell drugs that have not been approved by the FDA. One example is rimonabant, a drug used in other countries for weight loss. Rimonabant was denied FDA approval in 2007 amidst concerns regarding its neuropsychiatric side effect profile. Other concerns about drugs obtained overseas include inadequate or inaccurate labeling, inappropriate packaging, and questionable storage and handling.

Online pharmacies are subject only to the laws and regulations of the countries where they are based.[5] For example, in Canada and Australia, a valid prescription must be supplied before the medication is dispensed. However, in Mexico, many prescription drugs are sold over the counter and can be ordered over the Internet without a prescription.[5]

Pharmacists and other health professionals should discourage patients from buying medications from online overseas pharmacies. Likewise, patients should not order any medication that was not prescribed by a licensed US health professional. If patients are insistent about using Internet pharmacies, they should be counseled to use only pharmacies that have received the VIPPS designation and require a legal prescription before dispensing any medication. However, healthcare professionals should be aware that many consumers are using online pharmacies simply to bypass the prescription process, and not to save money.[1]

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