For anyone--dealers, addicts and children included--purchasing these and other drugs online and prescription-free is as easy as point and click.
Online pharmacies offer customers a convenient, private and oftentimes cheaper alternative to the typical corner drugstore.
The elderly or disabled can order their medicines 24 hours a day without leaving the cozy confines of their homes. Customers who are too embarrassed to order certain medications can do so without coming face to face with a pharmacist.
While the perks might convince some customers to make their purchases online, buyers should beware. According to government agencies, buying drugs from some online pharmacies can pose serious threats to your health.
The dangers include the following:
Drug information, side effects, dosage and warnings are often not included. When they are, they can be in a different language.
Online sites don't always ask for a patient's medical history.
Many sites don't offer a pharmacist for consultation.
Some sites don't package or handle drugs properly, which can render them ineffective.
The prescription you get might not be the real thing, or you might not get it at all.
"A drug could be codeine but it could also be sugar," Ukrop's pharmacist Lori Milton said.
The typical e-mail inbox likely contains an overflow of offers for cheap prescription drugs, and a Google or Yahoo search can produce thousands of hits on a single drug name. A Google search for "Vicodin" yields nearly 1.5 million hits; one for "Vicodin without a prescription" produces more than 150,000.
Officials from the pharmaceutical industry and the Food and Drug Administration refer to sites offering drugs without a prescription as rogue e-pharmacies. The number of rogue pharmacy Web sites is reaching epidemic proportions, as is the selection of drugs they offer.
Rogue e-pharmacies are the most potentially dangerous, according to the FDA and Drug Enforcement Administration. These sites offer an extensive stock of prescription drugs--including narcotics, mood-altering drugs and drugs for sexual dysfunction, acne and weight loss--with no questions asked.
Although laws prohibit the sale of drugs online without a prescription, the vastness of the Internet has made regulation nearly impossible.
The state boards of pharmacy regulate online pharmacies in the United States. The FDA and DEA are partners in regulating foreign-based sites and practitioners.
A five-month investigation of online pharmacies conducted earlier this year by the U.S. General Accounting Office identified two types of e-pharmacies: the legal and the illegal.
The legal ones require a patient to present a valid prescription written by a licensed physician. Many, but not all, of these sites are listed by the National Association of Boards of Pharmacy as Verified Internet Pharmacy Practice Sites. Participation in the VIPPS program is voluntary but gives an online establishment legitimacy.
The illegal sites are those that either do not require a prescription or offer one after a customer completes an online medical questionnaire.
The questionnaire--which, on most sites, is said to be reviewed by a licensed practitioner--replaces the traditional face-to-face examination between patient and doctor. But, in Virginia at least, it is not an accepted substitution for a visit with a doctor. For a prescription drug to be legally dispensed, Virginia board officials said, a licensed pharmacist working in a licensed pharmacy must receive a valid prescription from a licensed physician.
"Virginia law basically says that to have a valid physician-patient relationship, there usually must be a face-to-face visit," said Elizabeth Scott Russell, the executive director of the Virginia State Board of Pharmacy.
The law describes four requirements of a bona fide physician-patient relationship. The practitioner must obtain the patient's medical or drug history. He or she also must inform the patient of the risks and benefits of the drug being prescribed, perform a physical examination and offer follow-up care if necessary.
A valid online site should display a toll-free phone number and street address and should be avoided if it "does not advertise the availability of pharmacists for medication consultation," according to the pharmacy board's Web site.
Take 247-drugstore.com, a Sweden-based online distributor, for example. Though it offers a Swedish street address, it does not provide a number for customer assistance. Instead, it offers customer communication solely via e-mail, a practice deemed suspect by the board.
The GAO reported that eight of 21 samples it received from foreign pharmacies came from senders with questionable return addresses. They tracked down the locations of the addresses and found that one was a shopping mall in Buenos Aires, Argentina, and two others came from private residences in Pakistan.
In March, FDA official William K. Hubbard testified about Internet drug sales before the House Committee on Government Reform.
The FDA's report cited the Internet as a tool used to bypass its regulation, saying "individuals not licensed to sell prescription drugs can easily create Web sites that appear to represent legitimate pharmacies. The fact that operators can quickly change the location and appearance of their Internet site makes the enforcement all the more difficult."
Regulators also question the safety, handling and authenticity of drugs dispensed by online pharmacies.
The GAO received 68 drug samples from across the globe in its study, 45 of which were obtained without a prescription. Twenty-nine were from U.S. pharmacies, 18 were from Canadian pharmacies and 21 from other foreign pharmacies. Among those pharmacies, five of the U.S. and all 18 Canadian pharmacies required a prescription, but the remaining 24 U.S. and all 21 other foreign establishments either issued prescriptions based on questionnaires, or didn't require a prescription at all.
According to the report, all the drugs from non-Canadian foreign pharmacies were received with little or no labeling or drug information. Some also exhibited problems with handling or chemical composition.
And that's if the drugs were received at all.
Six of the orders that were placed and paid for by the GAO were never delivered--five from other foreign pharmacies and one from an unknown location.
When the drugs were received, it was impossible to determine their authenticity without performing extensive laboratory testing.
After testing, the GAO reported that four of the 21 samples from other foreign pharmacies were either counterfeit or not comparable to the product ordered.
None included labeling with instructions for use, few provided warning information and 13 were shipped improperly or arrived damaged.
That's not to say that drugs from Canada and the U.S. are always the real thing. The FDA released a report in July uncovering one Canadian pharmacy that distributed fake generic versions of Viagra, Lipitor and Ambien.
The GAO also cited other problems with American and Canadian sources--namely that the drugs are not FDA-approved for the U.S. market--but not as many problems as overseas. All the samples it received from within the continent came with dispensing information, most included warnings and only one was mishandled.
An investigation conducted by Prevention magazine and published in February produced results similar to the GAO report, namely that for a price, anyone can get any drug at any time without a prescription.
The magazine cited cases of various buys, including one for Ritalin made by a 13-year-old, and another for painkillers resulting in the overdose death of the 38-year-old buyer.
"The real problem here," Milton of Ukrop's said, "is that these drugs often display no strength or identifiable markers. There's no [National Drug Code] number. They're unrecognizable to a pharmacist."
Milton added the potential language barrier to the list of dangers. Medications in other countries often go by different names than in the states, a factor that could compromise a distributor's ability to decipher orders and a consumer's ability to read labels and drug-information sheets.
Most sites don't offer customers the opportunity to consult a pharmacist, either. Unsupervised use of some drugs could have fatal consequences.
Prevention magazine reported the case of a 52-year-old Illinois man who had incidents of chest pain and a family history of heart problems. He ignored his doctor's orders and purchased Viagra online. The man had intercourse and then died of a heart attack.
Although Viagra was not directly blamed for his death, the man likely would not have been able get a prescription for the drug through a face-to-face doctor visit because of his symptoms, the magazine said.
When a customer uses a walk-in pharmacy, some sort of list is kept of his or her medical conditions, drug allergies and other drugs being used.
Some online sources don't require customers to provide that information, an omission that could lead to severe interactions, allergic reactions or other health complications.
In addition, when drugs come by mail, children could get into the package when it is delivered, or someone could steal it on arrival.
Becky Snead, executive director of the Virginia Pharmacists Association, said she hopes for more federal oversight over online drug distribution. She cited assistance from financial institutions as a good first step.
"Before they start processing credit transactions for drugs," she said, "they should make sure that they're really coming from a pharmacy."
The association tells pharmacists to talk to their patients about where their medications come from and encourage them to use diligence in choosing a provider, Snead said.
Russell of the state board said that most Verified Internet Pharmacy Practice Sites have a corresponding brick-and-mortar pharmacy in the state. Those that don't must be certified with the state board of pharmacy, she said.
Legitimate sites could exist outside of the VIPPS list because the program is voluntary. Snead recommends that customers ordering drugs online in Virginia find out the name and address of the pharmacy and verify with the state board that it has a license. The small amount of time it takes to verify a a distributor's legitimacy could be the difference between life and death.
"The majority of individuals seek [the online] route because they think they can get a better deal that way," Snead said. "The challenge is that unless you're very diligent, that good deal can hurt you."
To reach BECKY PIEDEL 540/374-5000, ext. 5558