Health Outcomes in Patients Using No-Prescription Online Pharmacies to Purchase Prescription Drugs

Abstract

BackgroundMany prescription drugs are freely available for purchase on the Internet without a legitimate prescription from a physician.ObjectiveThis study focused on the motivations for using no-prescription online pharmacies (NPOPs) to purchase prescription drugs rather than using the traditional doctor-patient-pharmacy model. We also studied whether users of NPOP-purchased drugs had poorer health outcomes than those who obtain the same drug through legitimate health care channels.MethodsWe selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. Using search engine marketing (SEM), we placed advertisements on search result pages stemming from the keyword “tramadol” and related terms and phrases. Participants, who either used the traditional doctor-patient-pharmacy model to obtain tramadol (traditional users, n=349) or purchased it on the Web without a prescription from their local doctor (ie, nontraditional users, n=96), were then asked to complete an online survey.ResultsRespondents in both groups were primarily white, female, and in their mid-forties (nontraditional users) to upper forties (traditional users). Nearly all nontraditional users indicated that their tramadol use was motivated by a need to treat pain (95%, 91/96) that they perceived was not managed appropriately through legitimate health care channels. A majority of nontraditional users (55%, 41/75) indicated they used NPOPs because they did not have access to sufficient doses of tramadol to relieve pain. In addition, 29% (22/75) of nontraditional users indicated that the NPOPs were a far cheaper alternative than seeing a physician, paying for an office visit, and filling a prescription at a local pharmacy, which is often at noninsured rates for those who lack medical insurance (37%, 35/96, of NPOP users). The remainder of participants (16%, 12/96) cited other motivations (eg, anonymity) for using NPOPs. In terms of health outcomes, nontraditional users experienced a significantly (P<.01) greater number and severity of adverse events, including life-threatening seizures: 7% (7/96) of nontraditional users reported seizures, while none of the traditional users reported seizures.ConclusionsAlthough online pharmacies can offer distinct advantages in terms of convenience and cost, users of these “rogue” pharmacies that offer drugs with no prescription or doctor supervision do so at great risk to their health, as evidenced by much higher rates of adverse events. The most logical explanation for these findings is that the lack of physician oversight of dosage schedules, contraindicated conditions, and concomitant medications, were responsible for the increased intensity and frequency of adverse events in the nontraditional users. Although we only examined tramadol, it is logical to postulate that similar results would be observed with dozens of equally accessible prescription drugs. As such, the geometric growth in the use of online pharm...

Evaluating Aspects of Online Medication Safety in Long-Term Follow-Up of 136 Internet Pharmacies: Illegal Rogue Online Pharmacies Flourish and Are Long-Lived

“…These rogue online vendors enable the sale of prescription drugs or other medicinal products (either directly on the website or indirectly by directing patients to another website) and violate applicable laws or regulations [24]. Those websites that provide drugs without a legitimate prescription from a physician are often titled “no-prescription online pharmacies” [25]. It is most likely that individuals who may be behind rogue websites are licensed neither as pharmacies nor as pharmacists [26].…”

Profiling online recreational/prescription drugs' customers and overview of drug vending virtual marketplaces

“…Overall, however, most online pharmacies' customers were here reported to be young, Caucasian (Menon et al, ; Pew/Internet, ; Pew/Internet, ; Inciardi et al, ; Cicero and Ellis, ; Chiauzzi et al, ), and men (Gurau, ; Rajamma and Pelton, ; Inciardi et al, ; Chiauzzi et al, ). Conversely, women seemed to be more likely to search the web for health‐related information (Kaskowitz et al, ; Atkinson et al, ; Fittler et al, ; Wiedmann et al, ; Svorc, ; Thackeray et al, ).…”

“…Overall, apart from purchasing medicines, subjects may regularly use the web for both social/working purposes and to acquire a range of not health‐related items as well (Lenhart et al, ; CASA, ; Drug Strategy, ; Cicero et al, ; Ivanitskaya et al, ; Cicero et al, ; Cicero and Ellis, ; McDonald et al, ). People without any health insurance seemed to look at the web as a source of more affordable prescription drugs (Fung et al, ; Pew/Internet, ; Pew/Internet, ), including tramadol (Cicero and Ellis, ). Conversely, online acquisition of contraceptives was made by female subjects properly covered by health insurance schemes (Kaskowitz et al, ).…”

“…There are variations in gender/age according to the type of drug purchased ((Kaskowitz et al, ; Pew/Internet, ; Atkinson et al, ; Fittler et al, ; Fittler et al, ; Inciardi et al, ; Schnetzler et al, ; Wiedmann et al, ; Mazer et al, ; Thackeray et al, )), with men most typically interested in purchasing sexual performance‐enhancing drugs (Trissler, ; Jones, ; Orizio et al, ). Overall, apart from purchasing medicines, subjects may regularly use the web for both social/working purposes and to acquire a range of not health‐related items as well (Lenhart et al, ; CASA, ; Drug Strategy, ; Cicero et al, ; Ivanitskaya et al, ; Cicero et al, ; Cicero and Ellis, ; McDonald et al, ). People without any health insurance seemed to look at the web as a source of more affordable prescription drugs (Fung et al, ; Pew/Internet, ; Pew/Internet, ), including tramadol (Cicero and Ellis, ).…”

Availability of prescription drugs for bipolar disorder at online pharmacies

“…Little information is available about the people who purchase prescription drugs online without a prescription. In a study of 96 people who purchased tramadol online without a prescription, the primary reasons were dissatisfaction with their care, and saving money including the cost of doctor visits (Cicero and Ellis, 2012). Notably, 7% of the 96 online purchasers of tramadol experienced serious adverse events (life-threatening seizures) versus no seizures in the 349 who purchased tramadol with a prescription at a local pharmacy.…”