Following the recent death of a young woman in the United Kingdom after consumption of diet pills bought online, the investigating police officer urged the public to be incredibly careful when purchasing medicine or supplements over the internet. These weight loss pills are found to have a toxic substance called di-nitro phenol not permissible for human use, though available in black market as weight reducing drug. Just two pills are lethal. There have been some awakening activities in our country too on online medicine sale. Maharashtra Drugs Control Authority filed a First Information Report (FIR) against an e-commerce major ‘snapdeal.com’ for alleged sale of prescription drugs ranging from emergency contraceptive pills to erectile dysfunction pills to abusive cough syrups. Telangana Government’s Drugs Control Administration ordered to stop online sale of all medicines. Karnataka Government has recently cancelled the licence of two wholesalers involved in online pharmacy activities directly delivering medicines at patients’ doorsteps. These emphasize the seriousness of the issues of online sale of medicines.
The sale of medicines outside the regular retail pharmacy is not new. It has just flourished in this internet age. In late 1980s, pharmacies began selling prescription medications via mail order in the Unites States. More than 120 years later this mail order business transformed into first internet-based pharmacy, soma.com, in January 1999. Shortly after that the internet pharmacy was launched in United Kingdom. Estimates showed that there were more than 1000 websites selling medicines as of early 2004. Now the number of websites involved in online selling of medicines is of anybody’s guess. Online pharmacy business offers several advantages to the consumers ranging from convenience to maintaining privacy to discounts on price. It is really a boon for the aged patients who have difficulty coming to pharmacy for buying medicines. Some online traders argued in favour of providing this philanthropic service benefiting the senior citizens and disabled patients and patients living in remote areas.
Ever since the operation of online pharmacy started, the people and the authorities have time and again raised concern on various issues. The prime concerns are: Are the medicines supplied safe? Is there an assurance of safety and effectiveness of medicines and health products? Is it legal to buy medicines online and so on. The US FDA studies have shown the quality and counterfeiting issues in products available in internet pharmacies. One of the products of Tamiflu (oseltamivir) found to have no active ingredient but the tablets made of talc and paracetamol. The patients were supplied with haloperidol when they ordered some other anti-psychotics. The patients get deceived with either poor quality or wrong medicines.
The countries like USA and UK have legalised the sale of medicines online. These online pharmacies are recognised and regulated. US FDA issued guidelines for the consumers to identify the legal internet pharmacies and how to buy medicines online. The criteria for trust worthy websites are: located in USA, licensed by state board of pharmacy, licensed pharmacist is available to advise the patients, requires prescription to supply prescription medicines, and have contact information for the patient to talk to the person if need arises. The Council of Royal Pharmaceutical Society of UK has standards of good professional practice for online pharmacy services ensuring confidentiality and integrity of patient information and opportunities of advising patients as needed. In India, sale of medicines are regulated by the Drugs and Cosmetics Act and the Rules; and Pharmacy Act. The licenses for sale of medicines are issued under Drugs and Cosmetics Act and the Rules. The licensed premises are monitored too. There are basically three categories of medicines: Schedule H, H1 and X which are to be sold only on prescription of registered medical practitioners. The dispensing (sale) should be supervised by a registered pharmacist. The Pharmacy Act stipulates that the dispensing should be carried out only by registered pharmacists only (though dispensing by registered medical practitioners allowed for their own patients). There is no provision on operation of internet pharmacy in Indian regulation. But, the internet pharmacies are operating illegally.
There are some other issues too associated with online availability of medicines. This encourages more self medication. Self medication with drugs like sildenafil (most frequently people avail from online pharmacy) may lead to serious cardiovascular issues. The medicines do require appropriate storage (temperature) for retaining potency. There is no assurance of temperature control either at their storage points or during transport. The patients loose the opportunity to have face to face discussion with the professional pharmacists. The internet has removed the boundary among the countries. The brand names may often cause confusion. There may be same brand but with different drugs (even the look alike drugs). Ultimately the patient is at receiving end getting wrong medicines.
There are concerns even for the survival or sustainability of general e-commerce. Currently in a population of over 1.3 billion only about 50 million are active internet users. Only a fraction of these active users buy online. Many of e-commerce players are reported to be in red. However, with improved connectivity of internet and promotion of use of apps, there could be consequent increase of deeper and faster Indian e-commerce. In spite of several current action by state drug regulatory authorities, a Hyderabad based retail pharmacy chain recently launched “Click, Pick and Save” programme where the consumers can book their medicines online and collect them from the nearest pharmacy after six hours of booking on producing relevant prescription.
Studies done in some other parts of the world (perhaps also true for India) have shown that the risk of buying medicines from an online pharmacy generally outweighs the potential benefits for the consumers. In absence of clear cut regulation, the Indian public are likely to fall prey into the trap of internet pharmacies losing both money and their health. Though internet pharmacies are illegal supplying medicines, the e-commerce of medicines cannot be stopped in this internet age. There is need for perhaps legalizing and regulating them is best option. The Central drugs authority should come out with guideline on operation of such pharmacies till the Drugs and Cosmetics Act amended in public interest.
(The authors are with Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu 608 002)