The sale of counterfeit medications has long been a problem around the world, beginning in lower income countries and expanding to wealthier nations—like the United States—through the rise of online pharmacies. Now, with the emerging prevalence of drug availability on social media and an increase in demand due to COVID-19, a new study finds the threat of illegal medication sales via online sources is intensifying. 

A collaboration between Butler University and Michigan State University, the survey evaluated U.S. participants’ rate of using internet platforms to purchase prescription medicines, as well as their risk perceptions and motivations for doing so. Nearly 18 percent of respondents said they buy medications online, with the top reasons being to get “legitimate medicine” or “a good deal.” 

In a list of 20 specific platforms—including online pharmacies, e-retailers, social media platforms, and instant messaging services—even those that participants perceived as least trustworthy for purchasing meds (Kik and TikTok) trended generally toward being considered safe. Online pharmacies and Amazon were seen as the safest. Wickr was the most used platform to purchase sedatives, stimulants, and narcotic medicines, followed by Tumblr, QQ, Pinterest, eBay, Kik, Alibaba, Weibo, and WeChat.

John Hertig, Butler University
Dr. John Hertig

“Especially recently, people order everything online—from toilet paper, to Oreos, and now prescription medicines,” says Dr. John Hertig, Associate Professor of Pharmacy Practice at Butler and a lead researcher for the study. “When more people are comfortable going online, there are more opportunities for illegal actors to take advantage of consumers.”  

Given previous findings that nearly 96 percent of websites selling prescription meds are operating illegally, and that half of the products sold through these platforms are counterfeit, Americans are clearly overconfident in their ability to safely obtain medications over the internet. 

Hertig explains that counterfeit medications either don’t work at all, don’t work as well as they should, or contain toxic chemicals such as brick dust, chalk, rat poison, or ethylene glycol (which is commonly used in antifreeze). But even when online platforms sell authentic drugs, ease of access creates potential for harm: Nearly 55 percent of survey respondents had purchased narcotics online, 52 percent had bought stimulants, and about 30 percent had bought sedatives. 

“We are looking at medicines that have high addictive properties that are known to be public health concerns,” Hertig says. “If you put this in the context of the opioid epidemic, this represents a major gap in our patient safety safeguards. Online, people can bypass a visit and diagnosis from a physician, verification of the prescription and counseling by a pharmacist, and government regulators who make sure the medicine you’re getting is approved. People have a lot of confidence that what they’re getting is real, even though they have no way of knowing.”

The pandemic has driven more people to online platforms, with 36 percent of participants purchasing (likely falsified) medications or vaccines related to COVID-19. Typically, the higher a consumer’s perceived risk of online platforms, the less likely they were to purchase medicines using those channels. That was not the case for COVID-19 products.

“Researchers had already seen this perfect storm approaching,” Hertig says. “We have a population who uses the internet for everything, and now they are reaching the age where they are increasingly consumers of healthcare. Then, in 2020 that perfect storm we’ve been predicting rushed upon us because of the pandemic, where fear of the virus has overridden perceived risk of web-based drug sales, and many of us have been restricted to our homes. The surge of people going online for medications has created an exponential problem.”

Hertig also points out that all the sources included in the survey are major websites, social media platforms, or messaging services open to anyone on the web—not part of the dark or grey web. He says many consumers buying meds online do so through visual platforms like Instagram, specifically so they can see the product for themselves and feel like they can verify that it’s authentic. But that would be tricky even for professionals: One of Hertig’s previous studies found that only half of pharmacists could correctly identify an illegal online pharmacy.

So, what’s the solution? Hertig says it starts with education.

“We as a society, and we as a healthcare community, need to continue to educate our consumers on the risk of social media as a mechanism by which to get prescription drugs,” he says. “We also need to educate ourselves, within the healthcare community, that this is occurring here in the United States every day—it’s not just a problem in lower-income countries.”

Social media, search engines, and ecommerce platforms also must do more to take accountability for what’s being distributed illegally on their platforms.

“There needs to be a better balance between protecting the freedom of the internet while also making sure we are properly regulating it, especially when it relates to public health and patient safety,” Hertig says.

Other authors on the paper included Dr. Charlotte Moureaud, who completed part of a Medication Safety Fellowship at Butler and worked on this research alongside Hertig. Researchers Yao Dong, Iago S. Muraro, and Dr. Saleem Alhabash were part of the team at Michigan State.

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