What happens when drugs are purchased on line or from another country? As drug costs get more and more expensive, people are looking for less expensive ways to purchase their drugs. This is a very hot subject that has been debated and discussed in the media, in the doctor's waiting room and amongst patients both in and out of the pharmacy or doctor's office. Internet purchasing is becoming a powerful tool for purchasing drugs. Is this safe? There has been a proliferation of Internet sites devoted to filling prescriptions on line for everything from Viagra to anti-inflammatory agents. Many sites legitimately dispense drugs, however, the Food and Drug Administration (FDA) is concerned that the "Internet has created a marketplace for the sale of unapproved new drugs, prescription drugs dispensed without a valid prescription or products that are marketed with fraudulent claims" ⁽¹⁾.

Due to the media blitz of direct-to consumer advertising, patients frequently request drugs that may or may not be what is best for them. The days of the physician initiating discussion with the patient or family member about the medical problem and the most appropriate drug to treat that problem has shifted. We are now faced with the patient requesting a specific medication based on what they saw on television, read in a magazine, or heard from their friends.

In the past, and now, many people have visited Canada and brought back drugs for personal use in the United States. Mexico has been another source of obtaining drugs at a reduced price. Many drugs are illegal in the US, but are readily available in Mexico. Retin-A is markedly less money in Mexico, compared with the US, but is it the same drug? The problem that many fail to realize is that despite the drug bearing a familiar name, it is possible that the drug in question might be a counterfeit version and might be unsafe or completely ineffective. Quality assurance is another factor to be considered when purchasing drugs outside the United States.

When purchasing drugs on line, where are these drugs coming from? In many instances, it is IMPOSSIBLE to identify where the online pharmacy is operating (country of origin).

The FDA has issued the following warning statement for people who buy their products online ⁽²⁾:

• You are put at risk when buying from an illegal website. You may receive counterfeit products, contaminated products, the wrong drug, or an incorrect dose.
• You are at risk taking an unsafe or inappropriate medication.
• Getting a prescription drug on line WITHOUT seeing a doctor (only by filling out a form) puts the consumer at great risk. Do you honestly believe that a short questionnaire takes the place of a history and physical done by a physician who knows you?

If you MUST buy your products online, please consider these guidelines:

• check out www.nabp.net This is the national association of boards of pharmacy and will help you determine if the pharmacy is a licensed pharmacy in good standing.
• do not purchase drugs from a site that offers to sell you your prescription drug the first time without a physical examination.
• do not do business with a pharmacy that does not have a registered pharmacist available to answer questions.

This information is made available to help all of us buy quality drugs at affordable prices. Much of this information came from Norcal Mutual Insurance Company. Consult with your doctor or pharmacist if you have additional concerns.

(1) Statement of William K. Hubbard, Associate Commissioner for Policy, Planning and Legislation, before the Committee on Government Reform, Subcommittee on Human Rights and Wellness, US House of Representatives on April 3, 2003 (from www.fda.gov/ola/2003/internetsales0403.html)
(2) FDA. Buying Medicines and Medical Products Online:Tips and Warnings for Consumers. (from www.fda.gov/oc/buyonline/default.htm.)