A Guardian investigation may reveal that online pharmacies have been accused of failing to carry out proper identity checks and using inappropriate marketing tactics to sell powerful and addictive opiates.
At least two large online pharmacies – registered with the UK regulator – send e-mails to customers to order drugs saying their stocks are exhausting or telling them that their "limit" has been removed and that They can now buy more codeine pills.
Online pharmacies have a limit on the amount of prescription drugs that can be ordered within a certain time.
The growing demand for opioids, such as morphine, fentanyl, oxycodone, tramadol and codeine, is causing growing concern internationally. The regulator of online pharmacies has recently introduced new rules to protect people against the purchase of inappropriate drugs on the Internet.
The Doctor-4-U website has contacted a client about the purchase of codeine, which costs £ 84.99 for 200 30g tablets, by writing: 'What do you hold on? … This article goes fast so grab them while you still can.
Another online provider, MyUKDoctor, alerted customers whenever they could order again highly addictive opiate drugs, claiming that their "limit" had been removed. "Please click here to rearrange your medication again," said.
Ash Soni, president of the Royal Pharmaceutical Society, said he was "surprised" by marketing.
"This is something for me that should be thoroughly investigated by the regulators, it is appalling. It's really – to turn around and say "the restriction on this product has been lifted if you want to buy more, go ahead, do it". This is something you would never expect from a reputable pharmacist. "
Dr. Jane Quinlan, consultant in anesthesia and pain management with confidence from the NHS Foundation of Oxford University Hospitals, described the tactics as "really shocking".
MyUKDoctor and Doctor-4-U are both approved by the Medicines and Health Products Regulatory Agency, and both display the EU's common logo with the message "Click to verify if this site Web works legally.
Yasir Abbasi, clinical director of drug treatment services at Mersey Care NHS Foundation, described the marketing as aggressive.
He said: "For opioid drugs, there should be no direct marketing to the consumer and, where appropriate, clear rules and guidelines should be established in this regard".
A spokesperson for Doctor-4-U said that the message was not a marketing email, but that when a person placed an order but then abandoned it before paying, the message was sent.
"This is not a marketing tactic and we point out that it is not possible to buy opioids via the website without the approval of the doctor," have- they declared. However, the company has confirmed that it will stop sending the message "to clarify our policy in this area".
MyUKDoctor did not respond to the Guardian's requests for comment.
Opioids tend to be prescribed for chronic lower back pain and arthritis, despite research showing that medications are not the most effective way of treating such pain. However, there is concern about rising prescribing rates due to an increase in overdoses and a growing problem of prescription addiction and dependence.
Codeine alone is only available on prescription, with illegal unauthorized possession. Some medications can be bought without a prescription, but only in pharmacies.
Quinlan said, "We are trying to reduce the number of opioid patients prescribed to relieve chronic pain because we know that they do not work for the majority of patients and we try to help those who are now dependent on opioids in high doses prescribed and taken in good faith. However, these online opioid sales represent an invisible population of addictions, with what appears to be minimal controls and poor governance, thus putting patient safety at risk. "
The Guardian was able to obtain 200 tablets of codeine in two weeks by ordering 100 30g tablets on the British Meds website under the name "David Smith", but with a card registered under another name. 100 additional tablets were obtained from PillDoctor, using the same pseudonym "David Smith" and a payment card under another name. Random photos were uploaded in place of a proof of identity and proof of address. Both websites said that customers should use their own name and their own card.
Abbasi said: "The method and governance of how medicines are ordered should cause a lot of concern in the UK."
PillDoctor, headquartered in London but using EU doctors to issue consultations and orders, said the order had been sent in error due to "human error".
"It does not reflect our practice. Human error has contributed to this and we have taken swift action to avoid such mistakes in the future, "said a spokesman.
Nottingham-based UK Meds said its products were prescribed by doctors regulated by the General Medical Council or by other approved prescribers and distributed by a pharmacy regulated by the General Pharmaceutical Council.
"The company recognizes and is aware that the potential for abuse of the service is a permanent risk it must manage. It strives continuously to put in place rigorous procedures, operating in accordance with the legislation in force, which aim to limit the potential for abuse of its service, "they said.
Professor Helen Stokes-Lampard, President of the Royal College of GPs, said the revelations were very troubling.
She added: "Codeine is an opioid and its addictive effect is recognized; its use therefore needs to be closely monitored. GPs are experts in prescribing and will be extremely cautious when they start taking an opioid, but they will also ensure that they are closely monitored and reviewed regularly. "
One client reported having purchased drugs for more than three years on different websites, citing the same problem each time. "I have been ordering from a website since I quote the same problem every time (lying, saying that my pilonidal cyst had been removed) and they never questioned it and sent me only medications … It would be unheard of in a doctor. "
New rules were introduced earlier this month to protect people from the dangers of buying inappropriate drugs in online pharmacies. The use of online pharmacies has increased rapidly in recent years, but regulatory issues have been raised.
Concerns have also been voiced about a legal loophole that would allow people to buy powerful painkillers from doctors based in Europe. It comes after the death of 51-year-old Jennifer Anne Lacey, who was found dead at a Travelodge hotel in Morden, South London, last summer.
The coroner concluded (PDF) Lacey had committed suicide after an overdose of opioid alcohol tramadol and tramadol. She had taken 210 tablets of tramadol, half of which had been purchased online.
The doctor who gave him 100 tablets of tramadol 50 mg was based in Prague, Czech Republic. He had never seen her and had no access to her medical record, and he had never spoken to her GP. Lacey simply filled out an online form.
In closing the inquest into her death, Coroner Fiona Wilcox said she was concerned that potentially dangerous and addictive drugs are so freely available online.