Published: August 2009

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Prescription medicines obtained over the internet - advice for prescribers

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Prescriber Update 30(3): 17
August 2009

The internet has now become a significant resource for patients to obtain supplies of prescription medicines from overseas. When these medicines are held at the New Zealand border prescribers are usually asked to provide a prescription to enable their release.

Prescribers are reminded to consider the following prior to providing a prescription for medicines obtained from an overseas source:

• Is this patient under you care?
• Is the medicine, dose and quantity appropriate for the patient?
• Is the patient aware of the risks of using medicines purchased over the internet?
• Is the patient aware of the risks of using medicines purchased over the internet?
• Are you willing to take on the responsibility for prescribing your patient an unapproved medicine that is likely to be of unknown quality and origin?

Patients who order medicines online commonly believe they are importing genuine branded medicines from countries with highly regulated systems such as Canada or the USA. These websites, which may be linked to spam emails, are sophisticated and misleading as the website may be based in a country different to where it appears to be hosted. A recent study conducted by the FDA of medicines ordered from websites claiming to be Canadian found only 15% of the medicines inspected actually originated in Canada.¹

Several websites offer medicines for sale without a prescription or in some cases require an online questionnaire to be completed. It is usually not clear whether a healthcare professional is involved in the process.

Medicines coming into New Zealand are intercepted by New Zealand Customs and passed to Medsafe for inspection. Last year approximately 11,000 parcels containing 17,000 medicines were inspected by Medsafe; it is estimated that up to 30% of these medicines may have been ordered over the internet. Medsafe’s experience is that many of the prescription medicines crossing the border are of poor quality and may be adulterated or counterfeit. For example, recent testing revealed four undeclared active ingredients in one product ordered over the internet.

The New Zealand medicines legislation requires anyone who imports, distributes, sells or possesses a prescription medicine to have a ‘reasonable excuse’. A patient will have a reasonable excuse if a New Zealand registered prescriber has prescribed the medicine. If a prescriber provides a prescription for a medicine that has been intercepted at the border they take on all the responsibilities of prescribing, including responsibility for the quality and appropriateness of the medicine for that patient. Without a prescription a patient is unlikely to have a reasonable excuse and would be in breach of this provision.

In addition to quality concerns, Medsafe is also concerned about the dangers of self-medication. Individuals may not have seen a medical professional, had an adequate diagnosis made, or received information on the risks and benefits of using a particular medicine.

Medsafe advises prescribers to carefully consider these issues before agreeing to authorise supply of a medicine purchased over the internet.

Reference

1. FDA (2005). FDA operation reveals many drugs promoted as “Canadian” products really originate from other countries. Accessed 3/7/09 from: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108534.htm