Journalist and producer based in Spain working for UK press. My focus here is safe travel and tourism in Spain. I also cover current affairs, business, architecture and rural regeneration, and work / have worked for The Guardian, BBC, FT, The Times, Conde Nast Traveller, Business Life, Reader's Digest, Evening Standard.
It took me three minutes to drop 180 Xanax, 180 Ambien, 90 Zocor and 160 Soma into my shopping basket and proceed to checkout. Like most of the online pharmacies that bombard e-mail inboxes daily, this one – “the narcotics professionals” – has dollar pricing and appears to be US-based so it will take 12 days for my shipment (in its “discreet packaging”) to arrive.
But I didn’t need a check-up or a prescription. I didn’t even need to be over 16. I shouldn’t have been surprised. Investigations carried out under the aegis of the UN’s International Narcotics Control Board in Asia and Europe confirm that about 90 per cent of online sales of internationally controlled narcotics and psychotropics take place illicitly, without the required prescription. Legitimate online pharmacies that dispense medicines only on receipt of a prescription issued by a registered doctor, following a face-to-face consultation, account for a tiny fraction of this multibillion-dollar industry. Meanwhile, No Record Online Pharmacies (NROPs), based mainly in Mexico and Canada, flout the law, openly selling drugs for cash, no questions asked. One applicant was approved for Viagra after entering the details of her neutered cat.
In spite of this, there’s a misconception that online pharmacies are legal. “Regulating online pharmacies is an international headache,” says Mandie Lavin, the Royal Pharmaceutical Society of Great Britain’s director of fitness to practise and legal affairs. “There is a code of ethics that registered pharmacists – whether bricks and mortar or operating online – have to abide by but then registered pharmacists are the least likely to contravene the law and we are unable to regulate what lies outside our jurisdiction. “Our legislation dates back to before this level of technology could be envisaged; we’ve entered entirely new realms,” says Lavin. “This is an issue the health select committee needs to urgently address and I only hope it doesn’t take another Harold Shipman accumulating large amounts [of drugs] to make that happen.” Until laws are updated we in the UK are free to browse and purchase with impunity potentially lethal doses of prescription-only medicine for personal use. So why do increasing numbers of people risk cutting their doctors out of the loop?
The government’s concerted efforts to make us better informed and more involved in healthcare decisions may have backfired. Services such as Pharmacy in the Future and NHS Direct, used in conjunction with symptom checkers, self-help guides and detailed information on medicines, dosage and effects, have given the public a greater degree of autonomy and the belief they can do without doctors. Dr George Rae, member of the prescribing committee of the British Medical Association, says: “Patients are now incredibly well-informed. That’s a good thing but the corollary to that is they also need to be well-informed of the significant risks associated with buying from online pharmacies.”
For a friend who juggles long hours in PR, raising children and a 90-minute commute, convenience just about outweighs risk. “I’m 39. For 20 years when I’ve had a sore throat I’ve made an appointment, seen the doctor and been prescribed erythromycin,” she says. “Why waste his time and mine when I know he’ll say I need antibiotics and I can get them online? So I’m tempted, despite the fact it would work out more expensive. I don’t have any concerns from a health perspective when it’s for treating something ordinary.” However, uninformed self-diagnosis and the misuse of antibiotics – the wrong type, the wrong dose, incomplete courses – is resulting in widespread bacterial resistance, contributing to the rise of the superbug. Poor decisions made by individuals have potential repercussions for all.
It’s not only the time-poor that are taking health into their own hands but also children trying to deal with issues they don’t want to discuss with the family doctor. A couple in California sued an online pharmacy in February for sending – without checks or consultation – 90 capsules of fluoxetine (Prozac) to their teenage son who had completed an online questionnaire describing himself as being “mildly depressed” and then used the pills to kill himself. US high school students are prescribing themselves “study drugs”, Adderall and Ritalin being among the most popular. Unchecked access to online pharmacies has also led to a massive rise in the recreational use of prescription drugs.
According to the US National Institute on Drug Abuse, about 5 per cent of 12th graders reported using Oxycontin for non-medical purposes last year, and nearly one in 10 reported similar use of Vicodin.
And there is nothing that can prevent that trend – and the “pharming parties” spreading in the UK. We are increasingly willing to trust in the layman expertise of friends and relatives. A former colleague “borrowed” Lorazepam from his girlfriend on the day of a new business pitch to calm his nerves and then again a few times afterwards because it seemed to work; and a relative, prescribed Zomig for migraines, has frequently administered to the hungover. Of course in medicine a little knowledge can be a dangerous thing. Lifestyle drugs that feature high on the list of online pharmacy top-sellers are regarded as harmless but, as with any drugs, shouldn’t be self-prescribed.
Sara Coakley of the Medicines and Healthcare Products Regulatory Agency, uses the example of Viagra. “On a basic level Viagra increases blood flow. If any part of your body fails to cope with this the consequences can be serious or at worst fatal.” It is easy to miss underlying health problems or ignore family history that might indicate a patient’s suitability to the product.
“Interactions with other medications or even foods can cause problems,” says Coakley. “For instance, patients prescribed nitrates for angina should never take Viagra as the interaction can cause a life-threatening drop in blood pressure and has resulted in deaths in clinical trials.”
Lifestyle drugs are popular with UK buyers but top-sellers internationally include amphetamines, opoids such as oxycodone, benzodiazepines, even fentanyl and secobarbital, all of which are potentially lethal to self-prescribers. Online forums are full of discussion on adverse reactions – including seizures – to self-prescribed drugs and debates over what doses parents should give their children. Escalating dosages is a fast track to addiction, although ironically there is no guarantee that prescription drugs bought online contain the right amount of active ingredient anyway – intercepted deliveries have revealed a wide, almost random, variation.
There is no guarantee they are genuine either. Rogue pharmacies cost-cut by distributing counterfeit drugs manufactured overseas, predominantly in Pakistan and China – a trade that is predicted to exceed $75bn in value by 2010. “You could be getting anything” says Coakley, citing examples mixed with cement or other prescription only medicines.
With health organisations and government bodies around the world wondering impotently at the rise of online pharmacies, and billions of dollars worth of pharmaceuticals being traded openly and illegally, it is difficult not to think wistfully back to the days of a paternalist health service, when we weren’t expected to be empowered, discerning and ultimately vulnerable consumers but could just be our GP’s patients. Unfortunately progress dictates otherwise.
SORREL DOWNER / FINANCIAL TIMES