Campaign Provides Education on Unsafe, Online Medication Sources

Aislinn Antrim: Hi, I'm Aislinn Antrim with Pharmacy Times, and I'm speaking with Al Carter, executive director of the National Association of Boards of Pharmacy, about their buying medication safely campaign. This campaign aims to educate clinicians and consumers on the dangers of buying medicine from unsafe sources, particularly online. Can you discuss what those sources are?

Al Carter, MS, PharmD, RPh: Sure, and thank you for having me, it's great to be here. So, with online pharmacies, nearly 95% of websites offering prescriptions online are operating illegally. And in recent years, specifically as it pertains to COVID-19, we've seen an alarming increase in thes number of sites that are that are doing so, whether it's offering prescription medications, opioids, or even offering COVID so-called treatments. It's basically skyrocketed with the pandemic in the last couple of years.

Also, with many of these sites, they don't go through the rigorous FDA requirements for making sure that a drug is safe and efficacious. And so, we don't have those same safety protections in place to make sure that they're going through the same process that all the drugs go through within our supply chain.

Finally, many of these sites are purported to be from Canada, or Canadian sites, but honestly and truly, they're shipping these medications from all over the world. And many of these flights have not even been approved by Canadian regulators. And so, the campaign we're doing right now is truly to educate and inform patients and the general public on some of the concerns and risks with purchasing from these sites.

Aislinn Antrim: Absolutely, that's really concerning. And you touched on this, but can you explain the legality of these sites? And how are they allowed to function?

Al Carter, MS, PharmD, RPh: It's very hard to regulate something you can't see or touch, correct? And many of these sites—again, it's around 95%—they're operating illegally, because many of them will dispense medication without a prescription. And that should be a first red flag, when you see an online pharmacy, that is saying that they can dispense to you, you know, let's go with Viagra or what have you, or an opioid. When you can get your pain medications without a prescription, that should be alarming. And that's what many of these sites do. And they're often selling medications that are not approved by the FDA.

And so, it's very difficult for a regulator, per se, to find these pharmacies, because once they have been discovered or there's some type of investigation or what have you on that specific pharmacy, then they close that website and open up another and open up a different domain. And so, we're working with with Congress and trying to look at different regulations and laws to provide further liabilities to these websites. But right now, there isn't that restriction. So, it makes it very difficult.

Aislinn Antrim: Definitely. And as you said before, the COVID-19 pandemic resulted in an increase of sourcing these medications from these websites. And can you discuss that a little bit more? Do you have any numbers or kind of what was that increase? What did that look like?

Al Carter, MS, PharmD, RPh: I don't necessarily have any numbers, but I do know that it was significant. And really, the pandemic provided online activity for everyone as we couldn't go out to our pharmacies or pharmacies were closed. Due to the pandemic, a lot of people went to online pharmacies, or you had mail orders. And so, the pandemic provided these illegal online drug sellers with this opportunity. And it's an excellent marketing opportunity, I must add, to prey on fearful customers and consumers. And you know, these websites were offering falsified, substandard drugs, they're offering treatments for COVID-19. You know, we're seeing full marketing campaigns that focus on hydroxychloroquine. And, you know, now ivermectin and really, it's unfortunate that this is the case, but there really isn't a reliable way to ensure prosecution if the criminal networks benefited from the pandemic or not. But all assumptions and all signs lead to that they heavily benefited from the pandemic and just the fear factor of being able to offer a solution to consumers or patients that otherwise didn't have that, you know, or who have a delayed access to the appropriate meds.

Aislinn Antrim: Yeah, absolutely. And now that you've kind of explained what these sources are, what dangers do they really present to patients?

Al Carter, MS, PharmD, RPh: There's a lot of dangers. And one is that patients often choose to buy medications online because they're cost effective, and they're easy. But what you see with illegal websites and with social media accounts selling fake, substandard, and counterfeit medications, is that it continues to be a growing public health risk. You're getting these medications that are fake, or substandard, and you don't know what's in them, you don't know if it is the full amount of the drug product or chemical substance that you're supposed to have, or if it's less potent or more potent, so those leads to different risks. You take diabetes, for example. If you're receiving a medication online for diabetes that doesn't have the appropriate dosage your doctor prescribed, then that can alter your diabetes to where you can no longer maintain your appropriate glucose levels, or whatever the case may be. So those are health risks.

In addition, you know, what we're seeing is you're starting to see medications that are laced with synthetic fentanyl. And so, the potential for an overdose or death due to these synthetic drug products is also a huge risk from a health standpoint. But the product that you get from the community pharmacy is almost guaranteed to be legitimate. There are no concerns with the products you are receiving from your community pharmacy, because it goes through appropriate channels, it goes through the appropriate US supply chain. And there are measures and regulations in place to protect the patient and protect public safety.

Aislinn Antrim: Definitely. And just to clarify and make sure that it's clearly stated in here, these are entirely separate from your licensed regulated mail order pharmacies.

Al Carter, MS, PharmD, RPh: That's correct. Your licensed mail-order pharmacies have to go through the appropriate regulations, just like your community pharmacy down the street.

Aislinn Antrim: And how does the campaign really work to address these concerns and kind of what is it doing about these issues?

Al Carter, MS, PharmD, RPh: It's really all about education. So, this campaign is focused on alerting patients to the facts of these dangerous websites and social media accounts that exist. It also provides them with an easy-to-use search tool, to see if the online pharmacy that they are going to use is validated and if it has done so through the appropriate requirements and regulations and licensure that all other pharmacies have gone through. And you know, so we can make sure that they're verifying that the sites that they're using are legitimate. And it also helps patients with tips on finding out what are the signs of a rogue pharmacy that is not taking steps or saying that you do not need a prescription. You know that 10 times out of 10, that that pharmacy is going to be a rogue pharmacy, especially if you have a prescription that you're not receiving, or that you're getting without a prescription. And so, it helps provide education and affiliates a risk associated with buying medications online.

Aislinn Antrim: Wonderful. Well, finally, how can pharmacists work to educate their patients on these issues and these sites?

Al Carter, MS, PharmD, RPh: There's two things. One, pharmacists are definitely the first point of access for a patient to educate them on, you know, tools that they can use to recognize pharmacies, is one. Second, providing them with questions to purchasing online. And that, you know, it's really if something seems too good to be true, it probably is. And so, making, you know, making sure that they recognize legitimate pharmacies, how to understand those and you know, and what are some of the different signs to do so. And then also, you know, again, telling them to visit a pharmacy and verify that their site is a good place to buy and purchase the prescription meds.

Aislinn Antrim: Wonderful. Well, thank you so much for talking with me about this.

Al Carter, MS, PharmD, RPh: Thank you so much, as well, Aislinn. I appreciate the opportunity to do so.