Sunday 20 February 2011

Online pharmacy

Online pharmacies, or Internet pharmacies, are pharmacies that operate over the Internet. Many such pharmacies are, in some ways, similar to community pharmacies; the primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient than traveling to a community drugstore, in the same way as ordering goods online rather than going to a shop.[1]

While many internet pharmacies sell prescription drugs only with a prescription, some do not require a pre-written prescription. In some countries, this is because prescriptions are not required. Some customers order drugs from such pharmacies to avoid the inconvenience of visiting a doctor or to obtain medications their doctors were unwilling to prescribe. People living in the United States and other countries where prescription medications are very expensive may turn to online pharmacies to save money. Many of these websites employ their own in-house physicians to review the medication request and write a prescription accordingly. Some websites offer medications without a prescription or a doctor review. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and the suitability of a medication for a specific individual.[2] Pharmacies offering medication without requiring a prescription and doctor review or supervision are sometimes fraudulent and may supply counterfeit—and ineffective and possibly dangerous—medicines.

In the United States, there has been a push to legalize importation of medications from Canada and several European countries to reduce consumer costs. Although importation of prescription medication usually violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. Often Americans purchase lower-cost foreign drugs by driving to Canadian or Mexican pharmacies, buying their medications when traveling abroad on vacation, or, buying by mail from foreign pharmacies.

International consumers

International consumers who must pay higher prices for their medications often purchase drugs online from online pharmacies in their own countries, or those located in other nations such as India, Pakistan and the Philippines. Some of these pharmacies require prescriptions, while others do not. Of those that do not require prescriptions, some ask the customer to fill in a health questionnaire with their order. Many drugs available online are produced by well-known manufacturers such as Pfizer, Wyeth, Roche, and generic drugmakers Cipla and Ranbaxy of India and Teva Pharmaceutical Industries of Israel.

U.S. consumers

To save money, millions of people in the U.S. who do not have insurance to cover the full cost of medicines purchase drugs by mail from online pharmacies abroad. A major attraction of online pharmacies abroad is that nearly every country, except the U.S., controls its drug prices. Shoppers can easily obtain 50 to 80 percent or more savings on U.S. prices at foreign pharmacies.[3]

Very rarely are these orders investigated because U.S. authorities are much more worried about controlling illegal pharmacies in the U.S., not consumers themselves.[citation needed] The Washington Post reported that "...millions of Americans have turned to Mexico and other countries in search of bargain drugs...U.S. Customs estimates 10 million U.S. citizens bring in medications at land borders each year. An additional 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points. Still more packages come from online pharmacies in Canada."[4]

Until about 2004 American consumers looking abroad most commonly turned to Canadian pharmacies for affordable medications.[citation needed] Since then many use online pharmacies in India, South Africa and other countries where drug prices are lower than in Canada.[5]

Most people in the US, including some legislators, favor accessing foreign-made prescription drugs to lower Americans’ health costs. According to a Wall Street Journal/Harris Online poll in 2006, 80 percent of Americans favor importing drugs from Canada and other countries.[6] President Obama’s budget supports a plan to allow people to buy cheaper drugs from other countries.[7] A report in the journal Clinical Therapeutics found that U.S. consumers face a risk of getting counterfeit drugs because of the rising Internet sales of drugs, projected to reach $75 billion by 2010.[8]

In the United States, there are two verification programs for online pharmacies that are recognized by the National Association of Boards of Pharmacy (NABP). One is the Verified Internet Pharmacy Practice Sites Program (VIPPS), which is operated by the NABP and was created in 1999.[9] The Food and Drug Administration refers Internet users interested in using an online pharmacy to the VIPPS program.[10] The other is LegitScript, which as of September 2010 had approved over 340 Internet pharmacies as legitimate and identified over 47,000 "rogue" Internet pharmacies

Overseas online pharmacies and U.S. law

Legality and risks of purchasing drugs online depend on the specific kind and amount of drug being purchased.

    * It is illegal to purchase controlled substances from an overseas pharmacy. A person purchasing a controlled substance from such a pharmacy may be violating two federal laws that carry stiff penalties. The act of importation of the drug from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). FDA does not recognize online prescriptions; for a prescription to be valid there must be a face-to-face relationship between the patient and the health-care professional prescribing the drug. What exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition that would allow them to operate as an adjunct to the patient's own physician if the patient submits medical records documenting a condition for which the requested medication is deemed appropriate for treatment. Sections 956 and 1301 provide exemptions for travellers who bring small quantities of controlled substances in or out of the country in person, but not by mail.
    * Importation of any prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), even for personal use.[12] The Food, Drug, and Cosmetic Act does allow for the importation of drug products for unapproved new drugs for which there is no approved American version. However, this allowance does not allow for the importation of foreign-made versions of U.S. approved drugs.
    * The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual.[13]
    * It is also illegal to import non-approved drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, patients may be allowed to keep these drugs.[14]
    * Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances.
    * For several years, the states of Nevada, Minnesota, Illinois and Wisconsin have run official state programs to help their residents order lower-cost drugs from abroad to save money.
    * Most online pharmacies worldwide send consumers a free replacement order if their order is not received for any reason, including customs seizure (some require the customer to submit a copy of the seizure letter from customs, to prevent fraudulent claims).

Enforcement

Enforcement of the laws listed in the previous section can be difficult. Among other reasons, strict drug law enforcement is politically unpopular because many customers of online pharmacies are seniors and the uninsured who cannot afford to buy their prescription drugs in the United States.[citation needed]

    * Any package containing prescription drugs may, in principle, be seized by US Customs and Border Protection. The package may be held and eventually returned to the sender if the addressee does not respond and provide proof that they are allowed to receive these drugs (e.g., a valid prescription).[15] In practice, the number of packages containing prescription drugs sent to United States on a daily basis far exceeds CBP's capabilities to inspect them.[16] In the past, packages often passed through customs even if they were not sent from Canada or otherwise didn't meet the requirements of section 804 of 21 USC. Until recently, about 5 percent of prescription drug packages sent from Canada were being seized.[17]
    * At the present time, CBP does not seize packages from Canada.[citation needed]
    * DEA and FDA[18] generally do not target consumers unless drugs are imported in large quantities (suggesting intent to distribute) or represent a perceived danger to public health (opiates, amphetamines).[citation needed]
    * Rarely, drug importation laws are enforced on the local level. For example, in June 2005 in Baton Rouge, Louisiana, a number of customers of online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without prescription

UK consumers

In the UK more than 2m people buy drugs regularly over the internet from legitimate online pharmacies.[20] In 2008, the RPSGB introduced a green cross to identify accredited online pharmacies.[21]

The first internet pharmacy in the UK was Pharmacy2U, which started operating in November 1999, after being backed from the British government.[22]

Drugs supplied in this way tend to be non-prescription medications (e.g. "for common gut complaints such as constipation, diarrhoea, colic and abdominal pain"),[20] or medicines which doctors refuse to prescribe for patients, as all patients treated under the National Health Service pay either a low flat price or nothing for prescribed medicine and medical equipment.

In the UK online pharmacies often link up with online clinic doctors. In the UK it is legal for doctors to carry out online consultations and issue presctiptions.[23] The doctors must be registered with the Care Quality Commission. Online clinics only prescribe a limited number of medicines and do not replace regular doctors working from offices. There are various ways the doctors carry out the online consultations; sometimes it is done almost entirely by questionnaire. Customers usually pay one fee which includes the price of the consultation, prescription and the price of the medicine.

Internet Fraud and Organized Crime

For years, and especially more so since about 2006, there has been a major surge in emailed spam for so-called 'Canadian Pharmacies'. According to reports, this has also caused significant harm to the legitimate pharmacies in Canada according to their industry associations.

Several gangs exist, primarily Yambo Financials, and a Russia-mafia group that is headed by Leo Kuvayev and Alex Polyakov, and possibly other criminal gangs. Leo Kuvayev was arrested in the United States and while awaiting trial on charges of selling prescription drugs online, was granted bail, upon release on bail left the country, and soon was sending large quantities of email spam for pharmaceuticals, largely prescription drugs.

Many spammers use identifiable domain names. One gang uses domains with two words run together, such as prizechange, always followed by .com, and the other uses nonsense words, like qiyidevoh, always followed by .cn (domain extension for China). Most of the sites look very similar, although at times there are differences, or new versions of the pages appear.

Most of the offerings of the spam gang sites are for anti-impotence drugs such as Viagra and Cialis, or opioid painkillers such as Vicodin or Oxycontin. Most of the medicines shipped are counterfeits with little or no active ingredient.