COMMENTARY

The Very Real Risks Behind the $400 Billion Illegal Online Pharmacy Industry

Gayle N. Scott, PharmD

Disclosures

December 30, 2016

Illegal and Abundant

Face-to-face interaction with a pharmacist is the most desirable situation for obtaining medication, but legitimate online pharmacies may offer greater convenience and sometimes lower costs, especially for chronic medications. However, only a fraction of the 35,000 active online drug sellers are legitimate.[1]

A recent survey of more than 11,000 websites selling prescription medications online to US consumers found that only 1 in 25 appear to comply with US laws and pharmacy practice standards.[2] Furthermore, about one half of medicines sold online are fake or counterfeit.[3]

Illegal pharmacies are big business. According to the World Health Organization, counterfeit, contaminated, and fake medicines, along with substandard formulations and active ingredient substitutions, are a $431 billion market.[4] Products obtained from illegal online pharmacies have been found to contain potentially toxic substances, including floor wax, mercury, concrete, chalk, boric acid, road tar, paint, antifreeze, and in some cases unlabeled drugs.[5] The health risks posed by using substandard treatments for such conditions as tuberculosis and malaria have a direct impact on public health in developing countries as well.[4]

Most illegal online pharmacies that claim to be Canadian are located in a different country. About one half of websites for illegal pharmacies list no precise location, and those that do often use a bogus location that does not match the information on their domain name registration.[6]

Many of these illegal online pharmacies do not commonly require a valid prescription. Some offer a questionnaire in lieu of a prescription in order to portray legitimacy, whereas others ask no questions whatsoever. The risk of self-diagnosis and self-medicating with unnecessary, inappropriate, or excessive treatment is obvious, as is the risk of following the often fraudulent or misleading heath claims these sites use.[6]

The array of medicines available from illegal online pharmacies is nearly as expansive as their legal counterparts, ranging from opioids to antibiotics, but also includes recalled drugs, investigational drugs, and drugs that have been reported to be in critical shortage in legitimate pharmacies.[6]

Illegal online pharmacies, like reputable businesses, want repeat customers, so most do appear to deliver (usually by US mail) what is ordered, rather than simply taking money and not fulfilling the purchase.[6] The purchase of prescription drugs, particularly scheduled drugs, is further facilitated by online technologies such as Tor, software that enables anonymous communication, and BitCoin, which allows untraceable payment.[7] However, the use of these unsanctioned sites leaves purchasers vulnerable to identity theft, fraud, and hacking.

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