Online pharmacies: No prescription necessary

Thanks to Elizabeth Dillon of Cognitive Therapy Associates for this guest post.

The unregulated sale of controlled drugs through online pharmacies is growing in the United States. In a society heavily influenced by the sultry lure of prescription medications for biological and behavioral problems, the rise of online pharmaceutical retailers is unsurprising. There are many benefits to this type of drug distribution. The disabled or homebound population can have their medications conveniently delivered to their homes, shoppers enjoy a certain level of discretion and anonymity, and the selection of products is vast. Item information can be easily researched and compared through the use of websites, and computers can quickly catch potentially dangerous prescription errors.  However, there are also significant drawbacks associated with the online sale of prescription drugs.

A study released this week by the National Center on Addiction and Substance Abuse at Columbia University, under the leadership of Joseph Califano, demonstrated that most websites selling prescription opioids, stimulants, and depressants will sell to customers who lack legitimate prescriptions. This rise in illegitimate drug activity has also been linked to the growing abuse of prescription drugs especially by college students. At least 365 sites are devoted to selling controlled medications by mail. Controlled drugs commonly purchased without a prescription included Oxycontin, methadone, Vicodin, Xanax, and Valium. In a society where prescription drugs have become the norm rather than psychotherapy, counseling, or cognitive behavioral therapy, this online market flourishes.

According to a 2005 study completed by Christopher Littlejohn and his associates, online merchants can be categorized into four basic types–“legitimate,” “subscription,” “lifestyle” and “no-prescription.” Legitimate pharmacies operate similarly to traditional pharmacies. Customers must have a prescription from a licensed medical practitioner, and in general these websites do not offer the types of controlled prescription drugs that are most commonly obtained illegally and abused. Users of subscription pharmacies are granted access to a full range of drugs without a prescription once they sign up for a program and pay a membership fee. These subscription websites are furtively maintained in hard-to-regulate areas of the world like Mexico and parts of Asia. Lifestyle pharmacies ask customers to fill out a medical questionnaire in lieu of a prescription. They commonly provide more elective or luxury drugs that treat conditions such as alopecia, obesity, and impotence. No-Prescription pharmacies are just that. These are sites that are willing to mail controlled drugs to online customers without a prescription. Littlejohn’s study also contended that the people who most commonly ordered drugs illegally from these websites were literate, credit card owning individuals with Internet access. These three factors also lead to the inference that the abusers of online pharmacies are of a relatively high socioeconomic status.

There are many distressing consequences associated with the sale of prescription drugs online. Unlike conventional pharmacies, there is little to no consumer protection over the Internet. Products can be advertised with false claims and the sale of unapproved trial drugs goes unchecked. The administrators of illegal websites often remain anonymous and can quickly disable and create new sites that make it difficult for any regulatory agency to keep track of their activities. Operations are also commonly run outside of the U.S., making law enforcement officials scramble to put together international cooperation efforts.

This lack of effective online pharmacy regulation can lead to disastrous consequences. Francine Haight of La Mesa, CA lost her son Ryan to an overdose of the generic form of Vicodin, which he ordered without her permission online with a debit card.  “The Internet made it easy for the drug dealers to sneak into your living room,” she said. The sale of online drugs has led to drug and substance abuse, and death related to drug interactions, incorrect dosage or administration, and impure drugs. Illegal prescriptions can end up in the hands of children or others who are incapable of using them responsibly.

As the sale of controlled drugs without a prescription is a recent phenomenon, means of combating the trend are still in development. The FDA has vowed to increase public outreach and awareness, expand enforcement, and develop tighter bonds of international cooperation. In April the “Ryan Haight Online Pharmacy Consumer Protection Act” was approved by the Senate and is currently being reviewed in House committee meetings. If passed, the legislation would require online pharmacies to be properly certified and for doctors to meet in person with patients before prescribing a controlled drug. Some state governments have already passed laws that regulate the online drug trade but many advocates are pushing for stricter federal regulation. Some search engine companies have begun to fight back against online sellers by employing a program called, “Pharmacy Checker.” The device filters out unlawful advertisers and forces them to provide verification.

The sale of controlled drugs over the Internet is proliferating quickly and as is commonly seen with progress in technology, there is a gap between action and regulation. According to the Drug Enforcement Agency, 85 percent of Internet drugs sales are controlled drugs compared to 11 percent at traditional pharmacies. These statistics display the obvious potential for drug abuse and need for greater online pharmaceutical quality control.

Eckholm, Eirk. (2008, July 9). Abuses Found in Online Sales of Medication. New York
, Retrieved July 10, 2008.

Henney, Jane. (2001). Cyberpharmacies and the role of the US Food and Drug
Administration. Journal of Medical Internet Research, 3(1), Retrieved July 10,
2008 from the PubMed database.

Littlejohn,C., Baldacchino, A., Schifano, F., & Deluca, P. (2005). Internet Pharmacies
And Online Prescription Drug Sales: a cross-sectional study. Drugs: education
Prevention and policy
, 12, 75-80. Retrieved July 10, 2008, from the Academic
Search Premier database.

For more information about Cognitive Behavioral Therapy, Dr. Allison Conner can be contacted through her website or at (212) 258-2577.

July 10, 2008

4 thoughts on “Online pharmacies: No prescription necessary”

  1. Thank you for the article. As one who works in the rehabilitation field, I can tell you from experience that prescription drug abuse and addiction is soaring to almost epidemic proportions.

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  3. Thanks David & Elizabeth. This is a very interesting issue – particularly since the DEA proposed rules to allow on-line prescribing of controlled substances last week, and Bush just vetoed the Medicare bill which contained increased incentives for e-prescribing…. It makes it look like the right and left hands don’t know what each other are doing – or in this case, the right hand and the right hand. Anyway – I wrote about the intersection of these things at I think this issue is just beginning to get the attention it deserves.

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