Online prescribing for sexually transmitted infections – what’s on offer? An evaluation of internet pharmacies based in the United Kingdom

BackgroundOnline pharmacies offer an alternative approach for patients to manage their sexual health. Our aim was to determine the type of antimicrobials sold as treatment for sexually transmitted infections (STIs) by UK internet pharmacies and if providers were adhering to national guidelines.MethodsA search engine results page (SERP) generated a list of registered UK online pharmacies offering treatment for the following infections: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex and Trichomonas vaginalis. An initial audit in 2017 benchmarked each provider against the British Association of Sexual Health & HIV (BASHH guidelines. Results were fed back to each provider before re-audit in 2020. Websites selling antibiotics for non-gonococcal urethritis (NGU) and Mycoplasma genitalium were included at re-audit.ResultsThere were 30 pharmacies identified in 2017 of which, five were excluded. Treatment could be obtained for Neisseria gonorrhoeae from five pharmacies without providing a culture result; three (60%) pharmacies sold BASHH approved antibiotics for Neisseria gonorrhoeae. All 25 pharmacies sold Chlamydia trachomatis treatment; 22 (88%) offered first line treatment options but no website assessed for proctitis. Herpes simplex treatment was sold on 22 websites of which, 13 (59%) offered treatment recommended by BASHH. Trichomonas vaginalis treatment was sold by four websites in line with BASHH. Results at re-audit showed an improvement in standards, although advice before, during and after treatment remained variable.DiscussionOur work has allowed us to engage with providers to improve prescribing within the UK online pharmacy industry. However, tougher regulation is needed in order to embed sustainable change for patients who choose to access treatment online.

ILLEGAL INTERNET PHARMACIES AS A THREAT TO PUBLIC HEALTH IN EUROPE

The aim: This article aims to raise awareness and stimulate serious discussion about the dangers of illegal Internet pharmacies for patient safety and public health, the necessity to improve legal instruments, and unite the efforts of governments, professional organizations, and civil society for combating this activity. Materials and methods: This study is based on the Medicrime Convention, empirical and analytical data of the WHO, Interpol, Europol, NABF, Directive 2011/62/EU of the European Parliament and of the Council of June 8, 2011, the regulatory acts and juridical practice of Ukraine, experts interview of pharmacy practicians, analysis of websites. Totally 18 laws and papers, 34 court judgments, 50 websites were analyzed, six experts were interviewed. Dialectical, comparative, analytic, synthetic, system analyses and sociological research methods were used. Results: Illegal Internet pharmacies are widespread in Europe, especially during the COVID-19 pandemic. This black market poses a severe threat to patient safety and public health as falsifying, substandard, and smuggled medicines are sold through these channels. Without any exception, all illegal pharmacies sell prescription drugs without any prescriptions. Regulatory and protective legal instruments at the national and international levels are insufficient to counter the Internet trade in medicines. Conclusions: The widespread proliferation of illegal Internet pharmacies in Europe requires European states to work together to protect patient safety and public health. A legal mechanism needs to be established to exchange information and combat illegal pharmaceutical activities on the Internet at the international level. At the national level, it is necessary to strengthen control over the wholesale of prescription medications to prevent them from entering the black market.

Digital Marketing: Problems of Internet Pharmacies Legal Regulation

Digitalisation of pharmaceutical activities is creating a new type of pharmaceutical market, a more flexible and less costly; yet it has become more dangerous for patients and the economic stability. The reason is the imperfection of the legal regulation and online sales of pharmaceutical products, in particular. It is necessary to clarify that digitalisation of pharmaceutical activities is not only about online sales of pharmaceutical products. It is also digital marketing, which includes promoting pharmaceutical products via the Internet, including advertising such products. Research shows that prescription drugs are sold to such patients by both illegal online pharmacies and legal ones. Most counterfeit medicines are sold through illegal online pharmacies. The purpose of the article is to draw attention to the need for legal support for the activities of Internet pharmacies using more efficient technologies, including limiting their activities. Carrying out the research, several scientific methods were used. The methods of system-structural analysis, induction and deduction were used at all stages of the research in the study of the legal regulation of the sale of medicines in various countries through Internet pharmacies, the practice of its use, the state of illegal behavior in this area, analytical materials and scientific sources. The formal-logical method was used to study regulatory acts and international documents, the comparative-legal method was used to perform comparative analysis of the legal regulation of Internet pharmacies’ activity, as well as the practice of its application in the countries of the European Union, the USA, Turkey, Ukraine, and some Arab states. It should be noted that in the EU member countries, due to single European economic and customs area and general regulation, the problems of Internet pharmacies are of the same nature. The content analysis method was implemented for studying journalistic materials and researching websites that offer distance selling, online ordering, and delivery of pharmaceutical products to a consumer in various ways. Keywords: online pharmacies, digital marketing, digitalisation of pharmacy.

USABILITY INTERNET-PHARMACIES SITES

The modern development of information technology provides the opportunity to use them in many areas of life, which also include medicine and pharmacy. The introduction of technologies such as an electronic prescription system, drug labeling, creates the prereq-uisites for the remote provision of services. Recently, legislative changes have legalized the distance trad-ing of OTC drugs. In this regard, soon the supply chain of the drug to the end user may include a mini-mum number of professionals. Thus, in these condi-tions, the role of information that users can receive via the Internet is significantly increasing. Such a term as the "usability" of the site, or its ease of use, appeared back in 1998 and every year is of increasing importance. In relation to online pharmacies, the usa-bility assessment is especially relevant in terms of both general functionality, which is typical for all services selling products via the Internet, and features specific to Internet pharmacies only. On May 8, 2020, an anal-ysis of the "usability" of 20 sites of pharmacy organi-zations was conducted. Some advantages were high-lighted (putting information on the quality of goods (declarations, certificates), warnings, contraindica-tions and storage conditions in a separate block), as well as disadvantages (some clutter of the site with elements, the presence of blank pages and a fuzzy warning about prescription drugs).

The Emergent Business of Internet Pharmacies: Convenience, Risks, Regulatory Policies and Future

Healthcare is a core issue for all individuals, societies and states. There are continuous and aggressive efforts everywhere to improve healthcare conditions for people. With the rise of the World Wide Web, every sphere of life has gone through a huge revolution and so has the field of medicine. As people get more and more access to the internet, the trend to search for information related to health has also gone high. According to web data, almost 4.5% of all internet search is related to healthcare. 72% of the US and 71% of the European internet users have searched for information related to health during the past year. This is overwhelming. Mobile phone devices have further pushed this trend to new heights. But the point of caution is that internet users have started to get self-diagnosis online. Not only that, but the tendency to order medicine online has also gone up. ‘Pharmaceuticals’ is a huge part of the medicine industry. Just like any other business going online during the recent decades, the pharmacies have also gone online and against any apprehensions, they have met an overwhelming success there. There is an ever-growing number of online customers for internet pharmacies. The convenience of home delivery is always alluring and comparatively, the economical cost is an added benefit. But along this success came some serious issues forcing the authorities to enact regulations. This paper expounds on the historical development of internet pharmacies, their rapid growth during recent times, their advantages, concerns and regulatory actions to keep them under control. It also contains a bit of advice to the customers to avoid monetary and physical harm from illegal pharmacies online.

Consumers Turning to the Internet Pharmacy Market: Cross-Sectional Study on the Frequency and Attitudes of Hungarian Patients Purchasing Medications Online (Preprint)

BACKGROUND During the past two decades, the internet has become an accepted way to purchase products and services. Buying medications online are no exception. Besides its benefits, several patient safety risks are linked to the purchase of medicines outside the traditional supply chain. Although thousands of internet pharmacies are accessible on the web, the actual size of the market is unknown. Currently, there is limited data available on the use of internet pharmacies, the number, and attitude of people obtaining medications and other health products from the internet. OBJECTIVE This study aims to gather information on the frequency and attitudes of patients purchasing medications online in a nationally representative sample of outpatients. Attitudes towards main supply chain channels, perceived benefits, and disadvantages of influencing online medication purchase are evaluated. METHODS A cross-sectional explorative study using a personally administered survey was conducted in a representative sample of Hungarian outpatients in 2018. RESULTS A total of 1055 outpatients completed the survey (response rate 77.23%). The mean age was 45 years, and 456 (43.22%) reported having chronic health conditions. The majority (872/1055, 82.65%) of the respondents were aware that medications could be obtained online, but only 44 (4.17%) used the internet for previous medication purchases. Attitudes towards the different pharmaceutical supply chain retail channels showed significant differences (P<.001), respondents accepted retail pharmacy units as the most appropriate source of medications while rejected internet pharmacies. Respondents were asked to evaluate 9 statements regarding the potential benefits and disadvantages about the online medicine purchase, and based on the computed relative attitude rate there is a weak still significant tendency toward rejection (P<.001). Correspondence of demographic factors, internet usage behavior, and prospective online drug purchase attitude was evaluated. Respondents who use the internet more and purchase goods online will be more likely to buy medications online. Furthermore, youth and education will determine the medication purchase behavior. CONCLUSIONS Many patients will purchase medications on the internet in the future. Currently, there is an increased risk of patients buying products from illegal sites because these dominate the global online pharmacy market. Consequently, improved patient-provider communication and promotion campaigns are needed to inform the public about the safe use of internet pharmacies, as these initiatives can directly prevent patient safety threats.

Internet Pharmacy Cybercrime

Internet pharmacy social gains are efficiency, improving pharmaceutical access for isolates, and less cost. Alongside gains, illegal Internet pharmacies and unscrupulous pharmacy practices have made online purchasing a cyber risk for consumers. Industry self-regulation has failed, giving way to U.S. government and transnational intervention. The U.S. assumes “responsible domestic governance” in disrupting Internet crime by passing modern day drug policies (White House, 2011; 2016), and having transnational cooperation. States have joined the federal to pass laws generally on licensed in-state entities processing orders for rogue Internet pharmacies (GAO, 2013) but not uniformly. However, online pharmacy sites continue to dispense without “valid” prescriptions, unapproved drugs are sold online, and illegal pharmacies continue to operate. This chapter explores why some American states have adopted laws regulating Internet pharmacies from 2000 through 2015, using Cox proportional hazards regression.