In recent years, the advent of the Internet has culminated in a vast transformation of the pharmacy industry, with products and services becoming increasingly accessible through this borderless virtual space. The key concern lies in the proliferation of illegitimate overseas-­based online pharmacies, offering a supply of unregulated health products and even medications without valid prescriptions to uninitiated consumers. The US Government Accountability Office (GAO) estimated a total of over 36,000 rogue online pharmacies in operation as of February 2014.

Online pharmacy shopping poses significant risks to consumers and these include:

Adulterated or counterfeit medications

According to a report by the European Alliance for Access to Safe Medicines, three in five medications sold online may be counterfeit – that is, the medication may contain an incorrect or even harmful ingredient. Counterfeit drugs pose significant concerns to public health, not only because their safety and therapeutic effects are unknown, but also because they preclude patients from obtaining the right treatment that could be potentially life­-saving. Often, consumers have no means of keeping track of the online dealers when problems arise as the Internet allows these perpetrators to remain anonymous while running their illegal enterprises. According to Douglas Stearn, director of the FDA’s Office of Enforcement and Import Operations, “Consumers have little or no legal recourse if they experience a reaction to the unregulated medication or if they receive no therapeutic benefit at all.”

Non-­compliance to supply chain and storage protocols

Medicinal products require strict compliance to storage protocols throughout the supply cycle, beginning from the raw materials to the manufacture, transit and distribution stage. Failure in compliance at any point of the supply chain continuum not only adversely affects the quality of the medication, but may also result in fatal health outcomes for consumers.

Unlicensed products without approval from local health authorities

Regulatory requirements for drug approval may vary in different countries. Hence, a medication that may be approved for sale in its country of origin may not necessarily have the local health authorities’ approval to use them. In essence, even if the medication is purchased from a legitimate overseas online pharmacy, chances are local import restrictions may prohibit its entry into the country.

Lack of supervision by a health professional

The GAO revealed that differentiating a rogue online pharmacy from a legitimate one is becoming a challenge due to sophisticated marketing methods employed by these fraudulent sites.According to Bill Kelly, Australia’s Pharmacy Board chairman, “These [online] pharmacies generally supply drugs without a prescription and may or may not employ pharmacists. They are rarely licensed in the jurisdiction where they are located. To all intents and purposes they are not pharmacies and may not even have a shopfront.” A recent analysis in the United Kingdom revealed that 80 out of the 113 online pharmacies

being studied were willing to sell Diazepam, Fluoxetine and Simvastatin without a prescription. The figure is worrisome as prescription medicines are available freely over the Internet even though some of them either have potential for dependency or serious drug interaction. Without proper consultation with a health professional, consumers run the risk of getting the wrong treatment from fraudulent online pharmacies as they may be inappropriately diagnosed or provided inaccurate clinical information over the Internet.

Curbing the proliferation of fraudulent online pharmacies remains as a challenge because of its wide span of operations around the world and the complexity involved in their prosecution. It is therefore imperative that health consumers are educated to practice vigilance and advised against compromising their health over the purported cost and convenience of dubious online pharmacies. MIMS