High Price of Insulin, Albuterol Leads Some to Craigslist

Miriam E. Tucker

February 18, 2020

The high price of pharmaceuticals such as insulin has driven some Americans to buy and sell those medications illegally on the classified advertisement website Craigslist, new research finds.

Results from a cross-sectional analysis of 432 Craigslist ads during the summer of 2019 were published online February 17 as a research letter in JAMA Internal Medicine. The study was conducted by Akram Ahamed, of the College of Engineering, University of Delaware, Newark, and colleagues.

Although there was no way to determine whether the ads resulted in sales, the study "provides evidence that patients are seeking and likely finding medication, in particular analog insulin, in unregulated and unmonitored online marketplaces," the authors write.

They also found a number of advertisements for albuterol.

The new findings align with the results of an online survey reported in December 2019 that showed that in the United States, patients with diabetes are engaging in a variety of "underground" methods, including donating, trading, borrowing, or buying diabetes drugs ― in particular, insulin ― as well as supplies.

"Unregulated resale of prescription medications is illegal and in the case of insulin, may be dangerous because improper storage can lead to loss of potency or contamination of the product," Ahamed and colleagues note. They point out that such ads are prohibited by Craigslist policy.

Insulin Costs Prohibitive in US: Cheaper on Craigslist

US prices for insulin have come under great scrutiny. Around a quarter of diabetes patients are said to ration use of this medication ― which, for those with type 1 diabetes, is essential for life ― because of high costs.

Patients and parents of children with diabetes have long protested, and some states have started to cap prices ― most recently, Illinois, which has said that no person covered by state-regulated commercial health insurance plans should pay more than $100 per month for insulin.

Ahamed and colleagues searched Craigslist ads in all 50 US states. They identified 105 ads for albuterol and 327 for insulin in 31 states. They also searched for ads for EpiPens – autoinjectable devices for delivering epinephrine – but didn't find any.

Analog insulin was the most commonly advertised product of the three, accounting for 72% of the posts. Of those, most ads were for Lantus (Sanofi Aventis) (28%), Humalog (Lilly) (27.5%), or Novolog (Novo Nordisk) (21%).

Compared to the prices listed on Drugs.com, the Craigslist prices per vial of analog and human synthetic insulin were $372.30 and $123.19 less expensive, respectively.

In contrast, the Craiglist price for an albuterol inhaler was on average $18.77 more expensive than retail.

An analysis of the content of the ads revealed several dominant themes. Some sellers had altruistic motives, for example: " 'I have an extra boxes [sic] of insulin I hope somebody can use them.' "

Others were hoping to make some money, such as one who said that they " '…need to sell to be able to buy new ones.' "

Other advertisers had changed medications and hoped to either sell or give away the old ones to avoid waste.

Some ads included additional supplies, such as " 'free hypodermic needles with purchase.' "

Delivery options in the ads included FedEx and priority shipping. At least one mentioned that they would "ship insulin with ice packs to keep it cool."

Several ads acknowledged concerns about safety. One assured, " 'You will receive an inhaler, new in the box and in sealed factor wrapper,' " and another, " 'New in sealed boxes.... These boxes have been refrigerated since new and have been in my possession since leaving the pharmacy.' "

Other persons who placed ads were less careful; one explained, " 'Two 1000ml viles on Humalog. One unopened, one opened.' "

Another was particularly honest in providing additional details: " 'I have a bottle of Lantus Gargine Insulin for sale. I purchased this for a diabetic (pet- details withheld).... It was opened about 30 days ago. It was always used with a new needle. It is 75% full.' "

The authors were unable to obtain details of Craigslist's regulatory mechanisms.

However, Craigslist notes that the site allows users to report or "flag" inappropriate or illegal posts, which are subsequently considered for removal by site administrators.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online February 17, 2020. Abstract

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