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Background

Internet-sourced drugs are often considered suspect. The World Health Organization reports that drugs from websites that conceal their physical address are counterfeit in over 50 percent of cases; the U.S. Food and Drug Administration (FDA) works with the National Association of Boards of Pharmacy (NABP) to regularly update a list of websites likely to sell drugs that are illegal or of questionable quality. Some pressure groups and politicians have called for banning Internet drug purchasing--even while others laud it as a convenient, cost-effective way for consumers to access drugs.

Methods and Findings

This study examines drug purchasing over the Internet, by comparing the sales of five popular drugs from a selection of websites stratified by NABP or other ratings. The drugs were assessed for price, conditions of purchase, and basic quality.

Prices and conditions of purchase varied widely. Some websites advertised single pills while others only permitted the purchase of large quantities. Not all websites delivered the exact drugs ordered, some delivered no drugs at all; many websites shipped from multiple international locations, and from locations that were different from those advertised on the websites.

All drug samples were tested against approved U.S. brand formulations using Raman spectrometry. Many (13) websites substituted drugs, often in different formulations from the brands requested. These drugs, some of which were probably generics or copy versions, could not be assessed accurately. Of those drugs which could be assessed, failures ranged from 0% (0 out of 24) at "approved" websites to 8% (1 out of 12) at websites "highly not recommended" by the NABP. One of the two drugs received from "not recommended" and "highly not recommended" websites that could not be linked directly to a website for purchase because the packaging lacked appropriate labeling failed spectrometry testing.

Conclusions

Some websites did not comply with purchaser requests for brand-name drugs, which limited the ability to assess quality. Of those which could be assessed, most drugs (except Viagra) passed spectrometry testing. Of those which failed, few could be identified either by a country of manufacture listed on the packaging, or by the physical location of the website pharmacy. If confirmed by future studies on other drug samples, then U.S. consumers may be able to reduce their risk by relying on tools like the NABP "recommended" and "not recommended" lists and by using common sense when examining packaging and pills. Future studies should assess drugs from unapproved websites in a linear fashion--orders should be staggered over several months to ensure provenance of each drug received. With few identifiable marks on packages received from these websites one cannot be sure of the source if multiple orders are made within a few weeks.

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Roger Bate is a resident fellow at AEI. Kimberly Hess is a researcher and editor at Africa Fighting Malaria. Robert Brush is an application scientist at Ahura Scientific, Inc.