Online pharmacies have been accused of failing to carry out adequate identity checks and using inappropriate marketing tactics to sell strong and engaging opiate drugs, a Guardian investigation may reveal.
At least two of the leading online pharmacies – registered at the UK regulatory authority – send e-mails to customers who order medicines by stockpiling them or telling them that their "limit" has been removed and can now buy more codeine pills.
Online pharmacies have a limit on the amount of prescription drugs that can be ordered within a certain period of time.
There is growing international concern about the increasing use of opioid drugs, such as morphine, fentanyl, oxycodone, tramadol and codeine. The regulator of pharmacies in England, Scotland and Wales has recently introduced new rules to protect people from buying inappropriate drugs on the Internet.
The Doctor-4-U website contacted a customer about the purchase of codeine, which costs £ 84.99 for 200 tablets of 30g, writing, "What are you waiting for? … This item is going fast, so take them while you can still. "
Another online seller, MyUKDoctor, alerted customers whenever they could order highly addictive opiate drugs again, saying their "limit" had been removed. "Please click here to reorder the drug again," he said.
Ash Soni, the president of the Royal Pharmaceutical Society, said he was stunned by the marketing.
"This is, for me, something that should be firmly investigated by regulators, it's terrifying. This is really – to turn around and say" the restriction on that product has now been revoked if you want to buy a little more Please go and do it. "This is something you would never expect from a reputable pharmacist."
Dr. Jane Quinlan, an anesthetic and pain management consultant at Oxford University hospitals, called the tactic "really shocking".
Both MyUKDoctor and Doctor-4-U are approved by the Medicines and Healthcare product regulatory agency and both show the common EU logo with the message "click to see if this website works legally".
Yasir Abbasi, the clinical director of dependency services at the Mersey Care foundation, called aggressive marketing.
He said: "When it comes to opioid drugs, there should be no direct marketing to the consumer and if there are, then there must be clear rules and guidelines on the subject."
A spokesperson for Doctor-4-U said the message is not a marketing e-mail, rather, it was sent when a person placed an order but dropped out before paying.
"This is not a marketing tactic and we would like to emphasize that it is not possible to buy any opioid through the website without a doctor's approval," the spokesman said.
However, the company confirmed that it would stop sending the message "in an attempt to make our policy clearer."
MyUKDoctor did not respond to Guardian comment requests.
Opioids tend to be prescribed for chronic low back pain and arthritis, despite research showing that drugs are not the most effective way to treat such pain. There are concerns about the increase in prescription levels in an increase in overdoses and a growing problem of dependence and dependence on prescription drugs.
Codeine alone is only available on prescription, with unauthorized illegal possession. Small amounts of the drug are found in some drugs that can be purchased without a prescription, but only in pharmacies.
Quinlan said: "We are trying to reduce the number of patients with pain who have been prescribed opioids for chronic pain, since we know that they do not work for most patients and are trying to support those who now depend on opioids at high doses prescribed and taken in good faith.
"However, these online opiate sales represent an invisible population of drug addiction, with what appears to be minimal control and poor governance, risking patient safety."
The Guardian was able to get 200 tablets of codeine in two weeks by ordering 100 30g tablets from the UK Meds website as "David Smith", but with a card registered under a different name. Additional Pills were obtained from PillDoctor under the same pseudonym "David Smith" and a payment card with another name. Random photos were uploaded instead of proof of ID and proof of address. Both websites stated that customers must use their name and card.
Abbasi said: "The method and the governance of how drugs are ordered should raise many concerns in the UK".
PillDoctor, which is based in London but uses European doctors to issue consultations and prescriptions, has declared that the order has passed by mistake due to "human error".
"This does not reflect our practice … The human error has contributed to this and we have now taken swift steps to avoid such mistakes in the future," a spokesman said.
UK Meds, based in Nottingham, said its products have been prescribed by doctors regulated by the General Medical Council or other prescribers authorized and dispensed by a pharmacy regulated by the General Drug Council.
"The company recognizes and is aware of the reality that the potential for abuse of the service is an ever-present risk that must be addressed. It continually strives to implement rigorous procedures, operating in accordance with the applicable legislation, which attempts to limit the potential of abuse of his service ", they said.
Professor Helen Stokes-Lampard, president of the Royal College of GPs, said the revelations were of great concern.
He added: "Codeine is an opiate and is well known to be highly addictive and therefore its use must be monitored very carefully. General practitioners are experts in the prescription and will be extremely cautious in starting a patient with opioids, but they will also ensure that they are closely monitored and regularly reviewed ".
One customer claimed to have obtained drugs for more than three years from different websites, citing the same condition each time. "I'm ordering from a website always citing the same condition (basically lying, saying that I had a pilonidal cyst removed) and never questioned it and they just sent me the drugs … This would be unheard of at any medical clinic ".
The use of online pharmacies has increased rapidly in recent years, but regulatory issues have been raised.
Concern has also been raised about a legal loophole that allows people to buy strong painkillers from doctors based in Europe. Comes after the death of 51-year-old Jennifer Anne Lacey, who was found dead in a Travelodge hotel in Morden, south London, last summer.
The coroner concluded (pdf) Lacey committed suicide after overdosing on tramadol and alcohol. He had taken 210 tablets, half of which he bought online.
The doctor who gave her 100 50 mg tramadol tablets was based in Prague, Czech Republic. She had never seen and had no access to her medical records, nor had she spoken to her doctor. Lacey simply filled out an online form.
Concluding the investigation into his death, medical examiner Fiona Wilcox said she was worried that these potentially dangerous and addictive drugs were available online.