Last week, I focused on the ways that GPs' role in prescribing is constantly evolving (click here). Prescribing is an everyday activity and yet is also a critical skill that the vast majority of doctors need to continuously update. The article looked at the traditional approach, how pharmacists can contribute to safe prescribing and the potential prescribing of health apps. Well, modern technology has also thrown up a prescribing problem that it is possibly more widespread than we realise.
The univadis GP News service reported last week: "Counterfeit medication use is a growing problem in the UK, warn researchers. They say patients should be advised against buying drugs from internet pharmacies offering cheap medications without a prescription." (click here to read the article.)
Astonishingly, the researchers found that "in a survey of over 2000 UK adults, one in seven respondents admitted to buying prescription-only medications without a prescription". Furthermore, some of these pharmaceuticals are not what they are claimed to be, being either diluted or containing other substances that could be harmful. They lack the quality control we associate with legitimately supplied pharmaceuticals.
It is very difficult for regulators to bring these websites on the world "wild" web under control. Such sites may be based outside their jurisdiction, and even if shut down are likely to spring up from servers based outside the control of the traditional regulatory and law enforcement agencies.
So why do people buy these drugs? I am sure there are reasons of cost and gaining access to medications that doctors would normally not prescribe, as well as avoidance of other barriers to healthcare. If this figure of one in seven can be substantiated, many of our patients are taking counterfeit drugs and I suspect that many will not own up to it. It could be due to a combination of embarrassment and not wanting to upset their doctor or receive an ear-bashing about buying illegal drugs.
Even worse, what problems are these counterfeit drugs causing? We have no idea. Currently this is a black hole of unknowns but it is a worrying phenomenon - a problem we cannot even quantify. Perhaps we should be asking our patients if they are obtaining drugs from online sources. Even if we do, I suspect many will deny it, but it is an issue we cannot ignore. Maybe the next step in the research process is to ask people why they buy from an internet-based pharmacy in the first place?
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown