Illegal pharmacies are setting up shop on your computer, offering discounted prescription medicines. But there's much more at stake here than Viagra for sale in your inbox.
By ROBERT WHITAKER
Hands up if this doesn't happen to you: most mornings when you open your e-mail, your inbox has been flooded with offers of how to get 75% off Viagra. Or off all your prescription medication.
While this kind of spam is a pest and usually you delete it while wondering how to get rid of the irritation once and for all, if you delved deeper you'd uncover a far bigger, more serious problem. The internet is turning into the drug dealer of the 21st century.
From pills that boost your sex drive or cure acne to highly scheduled drugs such as ketamine, opioid-derivatives like methadone and the date-rape drug Rohypnol; you can buy them all online.
All it takes is a credit card and you can take your pick of an A to Z of powerful prescription drugs with just a few clicks. And without a prescription.
Desmond* (28), a Centurion bodybuilder, admits that he often orders anabolic steroids via the internet for muscle-building purposes. He knows it may contain horse hormones, but doesn't care.
Erik* (53) of Pietermaritzburg has ordered Viagra countless times. He says no-one warned him of the risks before accepting his order.
In 2002 Liam Brackell, a 24-year-old British man with a history of depression, killed himself with the drugs he'd bought from an online pharmacy. According to his mother, at one point Liam was taking delivery of 300 anti-depressant tablets at his home every day. By the time he died, he had bought 23 different types of anti-depressants online.
Matter of convenience
In developed nations – even in South Africa – millions of people have been turning to the internet to buy prescription drugs online. It's convenient (you don't have to leave home), often quite cheaper (you can shop around for the best price) and private. Sounds too good to be true? Like so many things in cyberspace, what you see is not necessarily what you get . . .
Buying on the net is booming. Last year consumers spent around R106 billion on prescription medications online. If experts are to be believed, most of those purchases were without a script. During the past three years tracking studies of these online pharmacies selling controlled medicines have shown a steady increase.
There are no face-to-face consultations or medical examinations. Medical records are not required and there are no follow-ups.
Is it legal?
In the brick-and-mortar world it most certainly isn't. Just as it's illegal for doctors to prescribe medicines to patients they've never seen, so it is for a pharmacy to dispense a behind-the-counter drug without a valid prescription. The pharmacist would lose his licence and the customer would probably be arrested for possession.
According to Marc Blockman, professor of clinical pharmacology at the University of Cape Town and Groote Schuur Hospital, you would also be guilty of something else. "It's highly illegal for someone to import drugs into South Africa [without an import licence], which is effectively what you're doing if you order them online.”
Dr Vanessa Steenkamp, secretary-general of the SA Society of Basic and Clinical Pharmacology and lecturer at the department of clinical pharmacology at the University of Pretoria, expresses deep concern: "Not only is it illegal, it's also unethical and potentially life-threatening."
But things just aren't cut and dried on the net, although numerous pharmaceutical bodies have been lobbying for some sort of control and punitive action to be taken to stem the tide of online pharmacies of ill repute. To say the authorities haven't had much success regulating these suppliers is an understatement. When it happens in cyberspace – be it gambling, pornography or drug dealing – it's difficult to control and amounts to a legislative minefield.
For the most part and depending on the country of origin, there's nothing to say an online pharmacy cannot operate. Legally it should dispense drugs only if a valid prescription is presented and only if the consumer is in the same country as the pharmacy. In that sense, these are the same regulations that apply to your local pharmacy.
The loop-hole exploited by illegal online pharmacies is these laws don't necessarily apply in cyberspace. Online pharmacies can bypass many of the laws by registering their website in a country that has lax pharmaceutical policies, even if the business isn't based there.
The other stumbling block for authorities is that rogue pharmacies aren't exactly up-front when it comes to providing contact persons or a physical address. And it's so easy to close down one site and start up another under a different address . . .
There are many valid reasons why you should get a prescription only after a face-to-face consultation with a healthcare practitioner. Take medications like the appetite suppressant Reductil, Viagra for erectile dysfunction or Zyban for smoking. Your doctor will give you a prescription after a thorough consultation during which he will review your medical history, consider how the drug may interact with other medications you're taking, and discuss whether or not you should complete the regimen. These are the considerations a doctor has to weigh up.
Doctors also have to inform patients about any possible adverse side-effects and advise which particular precautions should be taken. The widespread availability of medicines on the internet circumvents all these important checks.
No fool-proof system
That's why – probably because they are trying to appear more scrupulous or credible – some online pharmacies require the completion of an online customer questionnaire before dispensing any prescription medications. Some websites also offer an online "consultation" free of charge or refer patients to their own medical consultants.
But experts suspect in most cases there are no medical consultants at all. Rather it's a computer program measuring consumers' responses to questions based on a matrix and making the medications available based on those criteria. It's hardly a fool-proof system. In one experiment, an online pharmacy dispensed Viagra after an online "consultation" despite the fact the patient was taking nitrates for a heart condition – potentially lethal when combined with Viagra.
The stage seems set for dangerous drug interactions and contaminated, counterfeit or outdated drugs.
Gambling with your health
Consumers who buy prescription medications online are gambling with their health and have no clue as to what they are buying or the risks involved, Professor Blockman says.
"Besides the fact people may be buying drugs off the black market, there's no way to tell if the drugs are counterfeit or not," he warns. "Even if they are genuine, they could have expired or not have been manufactured properly or handled correctly. If a drug hasn't been stored or packaged properly, the active ingredients may lose their effectiveness and could even be toxic."
What’s in a name?
What you order may be completely different to what arrives on your doorstep. Confusion with brand names could lead to consumers inadvertently taking the wrong medication.
Many foreign medications, although marketed under the same or similar names, may contain significant differences, Dr Steenkamp warns. Even though the name of a drug bought from another country may be identical or similar to the name on a prescription, "the active ingredients in the medicine may be completely different or it may require a different dosage and therefore not provide the right treatment".
In the United States, Flomax, for example, is the brand name of medication used for an enlarged prostate. In Italy, the product called Flomax is an antiinflammatory drug. In Spain, Norpramin is used to treat stomach ulcers while in the United States it's an antidepressant.
Then there's the British drug Amyben, used in the treatment of abnormal heart rhythms. It could easily be mistaken for Ambien, an American brand name for a sleeping pill – and one of the prescription drugs thought to have played a role in actor Heath Ledger's premature death.
A Food and Drug Administration (FDA) investigation found as many as 105 American brand names have foreign counterparts that look or sound so similar consumers who have such prescriptions filled abroad may receive a drug with the wrong active ingredient.
For sale: miracle cure (untested)
Still not convinced? What about the online pharmacies that blatantly capitalise off the illnesses of their customers by promising them "miracle cures" and "guaranteed results"? It seems miracle cures, once thought to be laughed out of existence, have found a new medium.
Millions of people are now falling into the trap of buying deceptively marketed products online. What's worse, many of these socalled miracle drugs have yet to be proven or tested.
Just recently the BBC reported on an experimental cancer drug being sold on the internet. While animal studies in rats have shown the drug can shrink tumours more research needs to be done and human trials are still years away. But as many as 200 terminally ill patients bought the drug online. Not only are the potential adverse effects of using this drug unknown but experts are also concerned any possible promise of a cure could be quashed be cause the bad press may undermine their efforts to conduct clinical trials.
So what's being done to stop this?
Little legislation exists to regulate what happens in cyberspace. That hasn't stopped the FDA and the Drug Enforcement Agency (DEA) in the United States from collaborating to shut down the more nefarious online cartels and seize millions in cash, bank accounts and assets – a small drop in the ocean in what is already a multibillion dollar industry.
The DEA has also formed an initiative with search engines such as Google and Yahoo to warn people of the dangers of buying medication online. Last year alone the warning popped up nearly 80 million times when people visited illegal online pharmacies.
It would be naïve to think that online pharmacies will disappear. In fairness, there are a few that are properly accredited by professional pharmaceutical organisations and issue prescription medications by the book.
Although they remain inaccessible to South African consumers and it remains illegal to purchase from them, it may not be long before we have our own reputable online pharmacy.
Until that happens though, it’s best to follow the advice of the experts: just click no to online drugs.
* Not their real names.
(This is an edited version of a story that originally appeared in YOU Pulse / Huisgenoot-POLS magazine, Spring 2008. Buy the latest copy, on newsstands now, for more fascinating stories from the world of health and wellness.)