Since 1998, there has been explosive growth in the number of Web sites offering to fill prescriptions or sell medications. But the proliferation of Internet prescriptions is sounding alarm bells for doctors, pharmacists and health authorities nationwide because of a lack of standards -- even illegal practices -- at some Web sites.
The National Association of Boards of Pharmacy (NABP) estimates there are at least 400 Web sites dispensing prescriptions in the United States. No one knows how many of these online pharmacies exist worldwide.
More Regulation Needed
The advantage of Internet prescriptions is convenience. With a few keystrokes on the computer, prescriptions are filled and delivered by mail or can be picked up at a local pharmacy. Internet prescriptions are especially useful for seniors and people with disabilities who may have difficulty leaving the house.
But Web sites have offered the impotence drug Viagra, the allergy medicine Claritin and the anti-baldness pill Propecia without patients ever seeing a doctor, says Carmen Catizone, executive director of the NABP.
For example, a California Web site was dispensing hundreds of Viagra prescriptions per week to people who filled out brief medical questionnaires but never saw a doctor. The patients' responses were supposedly forwarded to a doctor for prescription approval, but health authorities later discovered the "doctor" was actually a retired veterinarian in Mexico. The site has since been closed.
"For us, that's a very dangerous situation," says Catizone, whose association members are state agencies that regulate pharmacies and pharmacists.
The American Medical Association (AMA) recommends that before prescribing medication, doctors should take a patient's medical history and discuss the benefits, risks and side effects of the treatment. In most cases the AMA suggests that doctors physically examine a patient. Without a thorough consultation with a physician, taking a prescription drug like Viagra can be risky if a patient has heart problems or other medical risks, or is taking a medication with potentially harmful interactions.
Research before Purchase
If you want to get a prescription through the Internet, use a Web site affiliated with a pharmacy, Catizone suggests. Stay away from sites that offer to prescribe medicine if you just have to answer a few questions or undergo what he calls a "cyberspace consultation."
"If a site makes claims or promises that you don't need a prescription or that their doctors will view your comments or questionnaire, that's a definite warning sign to avoid those sites," Catizone says. "Some of these medications, especially from overseas, are from dubious sites. We're not sure if they're counterfeit medications or outdated or expired drugs."
Legitimate Web sites will ask for a valid prescription and verify it with your doctor, Catizone notes. Look for sites that call customers to provide advice whenever filling new prescriptions.
Find out whether the site's pharmacy, physicians and pharmacists are licensed in the state where you live. It is illegal for doctors to prescribe medications for patients in a state where they are not licensed to practice. Not all prescriptions bought over the Internet will be covered by your insurance, so check beforehand. Do not buy prescriptions over the Internet unless the company lists its phone number and address to contact if there are any problems.
If your medication arrives by mail, check the packaging to make sure it's not damaged. Read the accompanying material describing possible side effects and how to take the medicine.
"If there is no accompanying material, that's a warning sign that it's probably not a good site," says Catizone.
Patients' privacy is a potential problem with Internet prescriptions, too. Before giving out any personal health information, find out as much as you can about whether a Web site is reputable. The site should include information about its security and confidentiality policies.
In April 1999 the NABP began certifying Web sites that dispense medications. By August, qualified sites should be able to start posting a Verified Internet Pharmacy Practice Site (VIPPS) seal. The association's seal of approval means a site has appropriate federal and state licensing to operate a pharmacy and adheres to VIPPS criteria for professional conduct, such as compliance with a recognized quality assurance policy, security of prescription orders, and consultation between patients and pharmacists.