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Prescription only analgesics widely available on the internet



Patients can readily obtain controlled opioids and other POMs from internet pharmacies without a prescription, a research team from Edinburgh has shown.

This study found that of 96 websites selling analgesics to customers in the UK, 46 provided POMs, and 35 of these did not require the customer to have a valid prescription.

The authors identified websites selling analgesic medication to the public using standard internet search engines, and simulated the actions of motivated members of the public. Ninety six sites met the study criteria of selling analgesics to the public, delivering to addresses in the UK and offering free access.

Forty six websites provided prescription-only analgesics. Of the eight which required evidence of a prescription, six would accept a faxed or emailed prescription, contrary to the recommendations of the Royal Pharmaceutical Society and only one required the prescription to be posted by the customer or a phone call or fax from the patient's doctor. The other one did not give details. Valid prescriptions could therefore be sent to multiple pharmacies without hindrance.

Thirty five websites did not require the customer to possess a valid prescription. Nineteen of these required the customer to undertake an on-line health screen questionnaire, but 15 provided no information about instructions for use, side-effects, contraindications or interactions. At these sites a significant range of opioid analgesics was available in addition to NSAIDs. Opioids for sale included tramadol, and buprenorphine, both purchasable as oral and injectable preparations, and large numbers of tablets could potentially be purchased at one time (for example 1,000 tramadol 50mg tablets).

Controlled analgesics with the potential for misuse and dependence are freely available in large amounts from internet pharmacies without prescription in the UK. Lack of regulation of online suppliers means that medication can be fake, may contain more, or less, active ingredient than advertised, and may contain harmful ingredients. This presents a risk to public health, and should be borne in mind when GPs prescribe.

Raine C, Webb DJ, Maxwell SRJ. The availability of prescription-only analgesics purchased from the internet in the UK. Br J Clin Pharmacol 2008; 67: 250–254


Dr Richard Ma
GP Principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London

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