Get ready for online sales of prescription drugs

Michael OReilly

CMAJ 1999;161:557

And the thing they are most interested in, according to another survey done by BioInformatics (www.bioinfoinc.com/news.html), is information about drugs.

Using services like the Internet Drug Index (www.rxlist.com/), anyone can get the same information once reserved for physicians or pharmacists. Users can find out what drugs to use, what they do, their side effects and possible interactions. There are even online discussions groups dedicated to specific drugs.

Helping patients turn this information into useful knowledge is an ever-growing challenge for physicians, but it pales in comparison to a quandary that's on the horizon: online sales of prescription drugs.

Until recently online drug sales have been limited to bulk vitamins, herbs and the range of products from the "alternative medicine" field. Places like Mothernature.com (www.mothernature.com), GreenTree Nutrition (www.greentree.com) and eNutrition (www.enutrition.com) have been selling various concoctions for years. But with all the hype over ecommerce, drug companies and drug retailers are getting in on the game by offering their wares for sale directly online.

Americans can now order prescription drugs online at places like Soma.com (www.soma.com/) or Drugstore.com (www.drugstore.com/). Drugstore.com, funded in part by the owners of Amazon.com and a former Microsoft executive, opened its cyber-doors last February. The owners hope to capture part of the $150-billion US pharmaceutical market. The site offers a complete range of drugstore services, up to and including the filling of prescriptions.

Like the other services offering prescription drugs, Drugstore.com asks users to create a "health profile." In much the same way that a doctor takes a patient's history, this online system takes visitors through a series of questions and fill-in forms. It asks about existing medical conditions, known drug allergies and current medications. The information is then kept on a secure server. Next, the system asks new users to provide a payment method and the prescription. This can either be a transfer of an ongoing doctor's order from another drugstore, or the cyber consumer can mail in the original prescription.

Drugstore.com accepts faxed prescriptions from physicians and the company will even contact a patient's doctor to arrange things. Once proper authorization is received the prescription is filled and delivered by courier, arriving at the recipient's home without that person ever seeing a pharmacist face to face.

Many people have been ringing alarm bells about the potential dangers posed by this type of activity. Online pharmacies are now setting up in less-regulated countries and selling prescription drugs without prescriptions. For example, the Online Mexican Pharmacy (mexicanpharmacy.com.mx/) offers a guide to drug stores in that country that will sell pharmaceuticals without a prescription. It also sells drugs directly.

As that Web site states: "Yes it's legal, and you don't need prescriptions for most medicines." This service targets Americans, and it must be popular. On Aug. 6, it had no "membership" openings available. The lists of available drugs were longest under the antidepressant and painkiller categories.

At SafeWeb Medical (www.safewebmedical.com/) visitors can order prescription medications ranging from Xenical to Viagra. For US$75 this site will take a medical history online and send it to a "licensed medical doctor." This unknown person will decide, based on this information, whether this drug is appropriate.

"If appropriate, the doctor will write a prescription which will be sent to a qualified pharmacy. The pharmacy will then fill and ship the medication to you."

"Consumers are taking a huge risk," William Hubbard of the US Food and Drug Administration warned in a recent Associated Press article. "They may be risking their lives. We're very concerned about this."

They may be concerned, but stopping the growing practice of online drug sales is difficult. However, some headway is being made in the US. Recently, the state of Kansas sued 5 edrugstores after a 16-year-old boy purchased Viagra online. And a family physician in Ohio is facing criminal charges over a similar case.

So far no Canadian-based service is offering to fill prescriptions over the Net. Hasslefield Drugs (www.hassdrugs.com/ ) is online, but is only selling nonprescription drugs and other retail items.

But as American authorities are finding out, it is hard to stop this snowball once it starts rolling. And the ball is probably on its way to Canada. —Michael OReilly, moreilly@cancom.net

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© 1999 Michael OReilly