Internet pharmacies: Convenience vs. safety

Lorain E. Ogden

Consumers weigh convenience, safety when shopping for medications online

Spam e-mails flooding in boxes show the ease of online pharmacies but skip the downsides of ordering drugs from who-knows-where over the Internet.

Credit: Andrew popik

“Depression is a common and serious disorder.” You can “stop suffering” and “get relief now.”

“Anxiety brand meds are available without a prescription now!”

So “DON’T feel down anymore” and, “don’t miss your chance to save money!”

These advertisements are some of the millions Internet users encounter each day, either populating the inbox of their e-mail or popping up on the monitor while surfing the Web.

Sales pitches for prescription drugs are indicative of a growing trend as millions of people are turning to the Internet for their health-care needs. All that is required is a computer and a credit card, and consumers can research, diagnose and treat themselves all from the comfort of their own homes. For everything from baldness to cancer and AIDS, every prescription medicine can be found and ordered — with or without a prescription — with relative ease over the Internet. Pharmaceutical relief can then be delivered overnight to your door via FedEx.

Seems like another triumph of convenience for the Information Age, but is relief really only a mouse click away?

Pros and Cons

Proponents of getting prescriptions filled online may cite the ease and privacy of ordering medications from Internet pharmacies, but the real reason most people go online is price.

And thanks to socialized medicine and prescription drug price controls in Canada’s health care system, making a run to the border is starting to make a lot of sense — particularly for American senior citizens.

David MacKay, executive director of Canada International Pharmacy Association, said the average age of Canadian pharmacies’ 2 million American customers is 70 years old. Plus ordering online from Canada can save American consumers an average of 50 percent on brand-name drugs.

At, consumers will pay $95.99 for a 60-count prescription of 100 mg Celebrex. But patients who fill the same prescription at Canadian online pharmacy only pay $45.98.

While these appear to be impressive savings, the bargains found at Canadian or international pharmacies don’t extend to every product.

“Americans could save more by purchasing generic versions of drugs in the United States,” MacKay said. “But it appears that’s not what they want. “

While accessibility and affordability is the driving force behind those who support unrestricted access to international online pharmacies, safety and quality are concerns. Probably the most pressing concern of U.S. regulatory entities, such as the Food and Drug Administration, is the infiltration of counterfeit prescription medications in the American drug supply.

Pharmacies and drug manufacturers in other countries are not held to the same standards as those in the United States. Some drugs that have not been approved by the FDA are available on international online pharmacies, and some drugs that come from international sources might be fake. In 2003, a U.S. wholesale distributor recalled more than 130,000 bottles of counterfeit Lipitor, a cholesterol-reducing drug, because they were fake.

In addition to concerns over the quality of the medications bought online is the quality of the pharmacies that sell them.

Pharmacies operating without accreditation, dispensing medications to customers without a prescription and offering unsafe or non-FDA-approved drugs are some potential violations in this difficult-to-regulate, emerging online market.

Without a license

Carmen Catizone, executive director of National Boards of Pharmacy, estimates between 400 and 800 licensed and around 500 unlicensed online pharmacies operate in the United States.

But shutting down the pharmacies that operate without Boards of Pharmacy accreditation, dispense meds without a prescription or sell products that have not been FDA approved is nearly impossible, Catizone said.

“As soon as we identify Web sites tied to these unlicensed pharmacies, they close down operations and move out,” he said.

Other vocal opponents of international online pharmacies are those being affected financially by the availability of cheaper medications over the Internet — the pharmaceutical companies.

Earlier this year, pharmaceutical giant Pfizer released a statement that outlined conditions of the sale of its products to Canadian pharmacies that prohibits them from selling to customers in the United States.

“It’s called blacklisting,” MacKay said. “Six or seven pharmaceutical companies are threatening to cut off supply to Canadian wholesale distributors. It’s not going to affect Canadian citizens. It’s going to affect the underinsured and uninsured American seniors who we serve.”

The Industry

Despite opposition from federal regulators and pharmaceutical companies, the prevalence of Internet pharmacies doesn’t appear to be diminishing. Retail sales on the Web show no sign of slowing down.

The Census Bureau of the Department of Commerce reported that “retail e-commerce sales” for the second quarter of 2004 increased by more than 23 percent from the second quarter of 2003.

MacKay said the 35 pharmacies that are certified by the association and adhere to the U.S. pharmacy standards account for about 80 to 85 percent of the cross-border sales of pharmaceuticals to American consumers.

Winners and Losers

Catizone said the patients have the most to lose in this continuing controversy about how to deal with purchasing pharmaceuticals online.

“They’re seeking affordable medications through, really, an unsafe route,” Catizone said. “Unless something is done to make importation safe, we’re going to have some patients that are going to be significantly injured because the people entering the re-importation market are not the most honorable or ethical.”

Daniel Hines of senior citizen advocacy group Today’s Senior Network said he is also not hopeful for consumers.

“My advice is to stay well,” Hines said. “The Bush administration has no concept of the needs of an aging population.”

Catizone said the issue is complex with many different groups having conflicting interests.

“Each of these factors is continuing to add to the confusion and even some of the dangers to patients,” he said. “Throw in the politicians that have advanced the issue for political purposes and ignored the public safety, and it’s just contributing more to confusion than resolution at this point.”

It appears to be too early to foresee any changes in the federal government’s approach to online pharmacies — and many are not optimistic.

MacKay said Americans should probably prepare for “more of the status quo.”

“The Bush administration has four more years of impunity. There will be some veiled attempts to appease American citizens,” MacKay said.

If the prices of drugs do not go down, Catizone said, there has to be “an importation system that can guarantee the product integrity and that also requires the online pharmacies and their pharmacists to be licensed with the individual states in the U.S.

“Otherwise, there’s just no safety net.”

Contact features reporter Lorain E. Ogden at [email protected].