Buying medications online is a risky business. According to the National Association of Boards of Pharmacy (NABP), 97 percent of the more than 10,900 Internet pharmacies, or 10,573 online drug sellers, reviewed by the board are operating in conflict with pharmacy laws and practice standards. Violations have included stolen personal and financial information, virus-laden spam e-mails and even online pharmacies selling pills that contain drywall or rat poison.
Some of the issues surrounding Internet pharmacies were highlighted by a case in 2012 involving a couple of Canadian businessmen who sold counterfeit Avastin, a cancer drug developed by Roche Holding AG, to Americans patients. Some of these counterfeit medications even showed up in medical clinics. In 2014, FedEx received an indictment from a federal grand jury for drug trafficking charges after delivering drugs for nearly a decade from Internet pharmacies operating illegally. As recently as early March, there was a $2 million settlement paid by one Missouri pharmacist who distributed painkillers like Fioricet online to patients he had never seen for an in-person consultation.
It’s easy to understand why someone would want to cut corners and make a quick buck in pharmaceuticals; at the time of the Avastin incident, the U.S. prescription pharmaceutical industry was a $300 billion per year business. Unfortunately, the high cost of pharmaceutical medications is why about 50 million adults between the ages of 19 and 64 do not fill out a prescription every year. Medications purchased over the Internet can cost up to 90 percent less than the same medication purchased in a brick-and-mortar pharmacy. It is also easy to understand those cost savings given the ingredients found in online pharmaceuticals. Consumers obviously need better protections to make sure that the medication they’re purchasing is the medication are ordering and not drywall or rat poison.
In order to curtail the online selling of counterfeit medications and ensure that online medication purchases can happen with at least some consumer safeguards, the NABP and other organizations have called for the development of the .pharmacy Top Level Domain public health initiative, which is designed to help consumers better distinguish between legitimate pharmacists and rogue drug sellers. The program allows legitimate pharmacies to obtain pharmacy domain names instead of a “.com” or “.net” domain name, which is much easier to get. The program would address the public risk factors of illegal medication sales involving the drug transactions without a prescription as well as the sale of foreign or unapproved drugs. General availability for eligibility into the program will be available to applying pharmacies beginning on June 3rd.
There has been plenty of action taken by government agencies on behalf of the public to stem the threat of counterfeit or illegal drugs from being sold over the Internet. In the early stages of 2014, the United States was one of 111 countries taking part in a global effort to shut down the activities of nearly 11,000 online pharmacies which were operating illegally. There were 9.4 million doses of counterfeit medication that was seized during that sting. While participating in Operation Pangea VII, sponsored by Interpol, the Food and Drug Administration found thousands of mislabeled medications through the examination of mail packages at U.S.-based international mail facilities.
It’s important to note that organizations like the NABP are not necessarily calling for the end of online pharmacy sales, but they are seeking a way to regulate those sales to save lives. Many medications are sold online that contain chemicals which could interact dangerously with other prescriptions or just damage the human body, and this could be overlooked without the oversight of a physician.
There are some areas of the country where the executive branch of governments in some states are stepping in to try and solve the problem. For example, the state of Maine had passed the Maine Pharmacy Law in February two years ago, the first of its kind in the entire country. The law enabled the purchase of prescription drugs from sources outside of the United States; business leaders in the state pushed for the regulation based on their belief that it would help control employee health care costs. However, the law was invalidated in a 19-page decision by Judge Nancy Torresen of the U.S. District Court for the District of Maine who decided that the federal government and not Maine has the discretion to enable such a measure regarding the importation of goods from foreign countries.
Inactivity at the federal level, however, is proving to be a little troubling. The FDA’s 2014 involvement in the Interpol operation helped uncover medications being sold under false labeling but proactive approaches like the NABP’s .pharmacy Top Level Domain program seem to be needed to enable consumers to make smarter shopping decisions on a platform as ubiquitous as the Internet. Main Street America has nothing on the amount of commerce and commercial space that can be packed into a gigabyte of server space so policing the new e-commerce frontier should be a little more rigorous.
Interestingly, this need to more effectively control the Internet and digital communication pathways for a safer economy is something we’ve heard before from the federal level of our government. Last November, we profiled a cybersecurity framework developed by the National Institute of Standards and Technology (NIST) for organizations to protect themselves from and respond to cybersecurity risks. At a meeting hosted by the U.S. Patent and Trademark Office at that time, San Jose State University President Mohammed K. Qayoumi had some opening remarks mentioning the importance of roads to the Roman Empire or seaway control to the British Empire. “Today, in the digital revolution, we have a similar issue with cybersecurity. Whoever controls that role and can be masterful at it, that is the nation that will really have major influence globally,” Qayoumi said.
The issue of Internet pharmacies presents a different kind of cybersecurity issue, one that could actually impact public health because of misrepresented medications. In early March, a report released by the U.S. Trade Representative said that inaction on online sellers of illegal goods like counterfeit medicines is a public safety risk. The USTR can list domain name registrars on its annual list of notorious markets but that office asked for greater efforts by trade partners and the International Corporation for Assigned Names and Numbers (ICANN), which is responsible for the maintenance and methodology of databases related to Internet namespaces.
Other than the .pharmacy Top Level Domain program, there have been some efforts to ensure that those who engage in online purchases of medication can do so as safely as possible. The NABP itself coordinates the Verified Internet Pharmacy Practice Sites (VIPPS) program, which provides a list of accredited online pharmacies which have been vetted by NABP staff. The NABP also recommends those using online pharmacies to contact the board of pharmacy for the state within which an Internet drug seller is situated.