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Although the survey distribution is broad with attention to geographic diversity, the sample we utilized in this report is quite small and is likely not representative of the U. The survey was originally sent to a sample of 60, students, of which only Of these 11, students, only However, it should also be noted pain meds online without doctor prescription that this low figure is also due to the fact that the survey closes after valid responses are received, usually within only a few days after launch.

Nevertheless, because of the substantial level of non-response, sample bias is a potential issue in the College Survey. Unfortunately, we are unable to examine this potential due to the lack of available data on non-responders in this system. Prior research with college student samples has generally found either no significant differences on substance use measures between responders and non-responders to web-based surveys McCabe,or higher levels of substance use among responders Cranford et al.

If we assume that responders in the present College Survey follow the previously reported patterns of equal or higher drug-involvement than non-responders, the reported low prevalence of Internet use to obtain prescription medications would appear to be compelling.

Also, these two data sets were limited in scope to opioid medications. It is not known, for example: 1 how often the Internet was used to purchase prescription drugs; 2 how many drugs were involved in each purchase; 3 whether the drugs received were those that were ordered; and, 4 if any prescription drugs were actually received. Despite these and other reports indicating dealers as a primary source for diverted medications, additional data on this phenomenon are generally unavailable — primarily because dealers are a difficult population to access.

NDIC has indicated that street gangs and outlaw motorcycle gangs are becoming increasingly involved in the retail distribution of drugs obtained via the Internet, but no supporting documentation has generally been provided NDIC, Three dealers and two pill brokers were interviewed at length.

None of these dealers reported accessing the Internet, and all three generally had only small supplies for sale. Neither of these brokers had used the Internet to obtain drugs. Our analysis offers some useful insight on the Internet as a source for purchasing prescription medications. Importantly, we documented uniformly low rates of prescription drug acquisition from online sources across all five data systems we examined.

The consistency of this finding across very diverse populations suggests that the Internet is a relatively minor outlet for illicit purchases of prescription medications by the individual end-users of these drugs.

Nevertheless, Internet acquisition of pain meds online without doctor prescription medications by dealers and distributors would appear to be quite visible to law enforcement agencies, and may comprise the bulk of online prescription drug purchasing activities in the U. Drug Alcohol Depend. Author manuscript; available in PMC Dec James A.

Inciardia Hilary L. Elise Baileyd Richard C. Dartd and John J. Burke e. Hilary L. Theodore J. Elise Bailey. Richard C. John J. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Drug Alcohol Depend.

See other articles in PMC that cite the published article. Abstract Although prescription drugs are readily available on the Internet, little is known about the prevalence of Internet use for the purchase of medications without a legitimate prescription, and the characteristics of those that obtain non-prescribed drugs through online sources.

Prescription drugs purchased through the internet: Who are the end users? - PMC

Keywords: Prescription drug abuse, Non-medical use of prescription, medications, Internet, Online Drug sales, Diversion. Introduction The earliest report in the medical literature describing the sale of illicit drugs through the Internet was in Lieberman,and since that time a number of provocative phrases have been heard chronicling the ready availability of prescription drugs online.

Method 2. Opioid Treatment Program OTP Withut on the setting, procedure, and study instrument are briefly described below, prescrpition further details available in an earlier paper Pain meds online without doctor prescription et al. During the survey period, data were collected from respondents. College Survey Program The College Survey is a multi-round online questionnaire collecting data from self-identified students who are enrolled in 2- and 4-year colleges, universities, online courses, or technical schools at least part-time during a specified sampling period.

Monitoring the Future MTF Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, prescriptino students, and young adults.

Prescriptiion 3. Open in a separate window. Table 1 Sources of prescription drugs for most recent non-medical use among past year users. Pain relievers a Tranquilizers b Prescription stimulants c Sedatives d One doctor Pain relievers a Tranquilizers b Prescription stimulants c Sedatives d One doctor 81 Table 3 Sources of prescription opioid acquisition by surveillance system. References Adams C. Wall Street Ojline. Prescription-drug seizures from abroad surge; p.

USA Today.

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Problems grow with drugs bought on Net; p. J Stud Alcohol Drugs. Source of drugs for prescription opioid withoug abusers: a role for the Internet? Pain Med. Reasons for nonresponse in a web-based survey of alcohol involvement among first-year college students. Addict Behav. Record-breaking Internet pharmacy prosecution nets millions for Iowa law enforcement. United States Department of Justice; Press release. Pwin availability of web sites offering to sell opioid medications without prescriptions.

Am J Psychiatry. Washington Post. Internet trafficking in narcotics has surged; p. Knowledge and use of the Internet as a source of controlled substances. J Subst Abuse Treat. J Addict Dis. Prescription opioid abuse medz diversion in an urban community: the results of an ultrarapid assessment. Docyor 14—19, NIH Publication No Monitoring the Future national results on adolescent drug use: overview of key findings, Internet drug ring pain meds online without doctor prescription 20 arrested for illegally selling without prescriptions; p.

Abstract Background Many prescription drugs are freely available for purchase on the Internet without a legitimate prescription from a physician. Objective This study focused on the motivations for using no-prescription online pharmacies NPOPs to purchase prescription drugs rather than using the traditional doctor-patient-pharmacy model. Methods We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs.

Results Respondents in both groups were primarily white, female, and in their mid-forties nontraditional users to online pharmacy drugstore forties witgout users. Keywords: prescription drugs, health care quality, access, evaluation, health policy, substance-related disorders. Methods Selection of Target Drug Since most online pharmacies offer dozens of drugs for purchase, we needed to narrow the focus to users of a single representative target drug.

Recruitment It has been widely documented that recruiting and administering surveys over the Internet is an acceptable and beneficial research methodology [ 45 - 46 ]. Survey Instrument Since this study represents a preliminary approach into this area of research, no standardized instruments could address all points of inquiry. Data Analysis A total of tramadol users qualified for and completed this study.

Results Demographics As shown in Table 1both traditional and nontraditional users were primarily white wihout female. Table 1 Demographics and health information for traditional and nontraditional users. Open in a separate window. Figure 1.

Tramadol Use Pain meds online without doctor prescription 2 shows that nontraditional users were more likely to take the higher dose mg traditional users. Table 2 Tramadol use among traditional and nontraditional users.

Figure 2. Physical Dependence Both groups had high rates of suddenly stopping their use of tramadol, but nontraditional users were significantly more likely to cease use abruptly traditional users: Figure 3.

Discussion Our data indicate that those who eschew the typical doctor-patient relationship to obtain tramadol through NPOPs do so primarily for reasons related to cost and accessibility and, most importantly, expose themselves to great health risks.

Limitations Inherent in this study are all of the limitations typical of epidemiological and survey research, most notably generalizability and veracity of information gathered. Conclusion Our data suggest that online pharmacies may have a role in supplying prescribed medications because they are convenient and may charge less than traditional brick-and-mortar pharmacies.

Acknowledgments This study was financed with institutional funds and was approved by the Institutional Review Board at Washington University in St. References 1. Quality of global e-pharmacies: can we safeguard consumers? Eur J Clin Pharmacol. Controversies pain meds online without doctor prescription legal issues of prescribing and dispensing medications using the Internet.

Mayo Clin Proc. Henney JE. Montoya ID, Please click for source E. Online pharmacies: safety and regulatory considerations. Int J Health Serv. Weiss AM. Buying prescription drugs on the internet: promises and pitfalls. Cleve Clin J Med. Jul, []. Apr, []. Source of drugs for prescription opioid analgesic abusers: a role for the Internet?

Pain Med. Quality of online pharmacies and websites selling prescription drugs: a systematic review. Pharmacoepidemiol Drug Saf. C The Partnership at Drugfree. Marketing and pricing strategies of online pharmacies.

Health Policy. Forman RF. Availability of opioids on the Internet. The Internet as a source of drugs of abuse. Curr Psychiatry Rep. Interim final rule with request for comments.

Link Regist. Prescrption drugs purchased through the internet: who are the end users? Drug Alcohol Depend. Prescription opioid abuse among enrollees into methadone maintenance treatment.

Impact of Internet pharmacy regulation on opioid analgesic availability. J Stud Alcohol Drugs. Jun, []. Jones MJ. Internet-based prescription of sildenafil: a patient series. May, docto. Jul 22, []. Castronova JR. Operation cyber chase and other agency efforts to control internet drug trafficking. The "virtual" enforcement initiative is virtually useless. J Leg Med. Feb 16, []. Yahoo News Yahoo News. Jun 11, []. Silverman E. Washington Post. Oct 3, []. Jun 20, []. Jun 17, []. Comparison of simvastatin tablets from the US onnline international markets obtained via the Internet.

Ann Pharmacother. Quality assessment of internet pharmaceutical products using traditional and non-traditional analytical techniques. Int J Pharm. Not a good buy: value for med of prescription drugs sold on the internet. Veronin M. Packaging and labeling of pharmaceutical products obtained from the Internet. Eysenbach G.

Online prescribing of sildanefil Viagra on the World Wide Web. Bartholow M. Pharmacy Times. Although we only examined tramadol, it is logical to on,ine that similar results would be observed with dozens of equally accessible prescription drugs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care.

These pharmacies serve as an important resource for patients, particularly for those who have limited mobility or accessibility needs [ 1 - 5 ]. Unfortunately, this positive use of modern technology has had an unanticipated outcome: the advent of online pharmacies that provide drugs—such as opioid analgesics, antidepressants, cholesterol-management drugs, and erectile dysfunction medications—without a legitimate prescription from a physician [ 6 - 11 ].

In fact, it has been estimated that in the United States alone, 1 in 6 consumers, or roughly 36 million people, have bought or currently buy prescription medications online without a valid prescription [ 12 ]. Initially, as the number of no-prescription online pharmacies NPOPs [ 13 ] increased exponentially in the late s, there was widespread concern that the Internet would serve as a major source of diversion for prescription drug abusers, since many sites offered controlled substances such as hydrocodone and oxycodone for purchase [ 614 - 15 ].

After Ryan Haight died from an overdose of hydrocodone, allegedly bought over the Internet without a valid prescription, a law bearing his name was passed in that made it illegal in the United States for NPOPs to sell controlled substances [ 16 ]. No matter the reason, research has shown that the Internet has not evolved into a significant source click the following article prescription drugs for the purpose of drug abuse [ 17 - 18 ].

While controlled substances may not be readily accessible from domestic NPOPs [ 19 ], other studies have described the availability of many other types of medication through these outlets. These medications include HIV drugs, benzodiazepines, and cholesterol medications, as well as lifestyle drugs, such as diet pills and erectile dysfunction medications.

Unlike controlled substances with the potential for abuse, there are no current стали canadian pharmacies даже regulating the sale of these other potentially dangerous prescription medications through NPOPs.

The main arguments against taking the easiest step, which would be to simply eliminate all online pharmacies, is that they are difficult paln close down [ 4 ] and that with appropriate controls they can provide consumers advantages in both cost and accessibility [ 1 - 520 ].

In fact, one study demonstrated the efficacy of utilizing an accredited online pharmacy to prescribe Viagra. Patients who used the online pharmacy showed similar numbers of side effects and similar treatment efficacy compared to those receiving Viagra through a local pharmacy. They also provided a more complete medical history [ 21 ]. To manage the increased use of online pharmacies, however, pain meds online without doctor prescription regulations are being proposed, including the Online Pharmacy Safety Act and the development of state-run online pharmacy programs [ 2223 ].

In a major effort to steer consumers toward legitimate online pharmacies that are safe to use sithout away from rogue online pharmacies that pose a potential threat to consumer safety, the National Association witout Boards of Pharmacy developed the Verified Internet Pharmacy Practice Sites VIPPS program to accredit online pharmacies based pain meds online without doctor prescription a number of qualifying criteria [ 24 ].

Unfortunately, this accreditation is limited to domestic online pharmacies and, as it only approves online pharmacies that require a valid prescription [ 24 ], it does not address the larger issue of people seeking medications pakn NPOPs outside of a typical doctor-patient-pharmacy relationship. It should be stressed that no matter what legislative controls are adopted, there is a simple way to bypass these restrictions: move the NPOPs offshore, which is rapidly occurring with little government control [ 725 - 31 ].

This lack of oversight generates a number of safety concerns for NPOP consumers in distribution, information, and medication-related issues.

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Distribution issues include damaged pprescription that exposes pills to light and moisture, shipments that do not meet manufacturer specifications such as temperature-controlled or insulated packagingand the ability of the consumer to reorder as many pain meds online without doctor prescription as desired [ 8 - 1032 - 33 ]. The lack of proper labeling or safety information is common with NPOP-purchased medications and provides consumers with little to no information on dosage scheduling, dosage administration, or potential side effects [ 932 - 36 ].

Finally, the medications themselves could be expired, counterfeit, or cut with other substances. Even genuine drugs purchased from NPOPs could lead to a number of adverse events, including death, if the user is unaware of dangerous drug combinations or contraindicated medical conditions [ 353237 ].

While the recent focus, appropriately, has been placed on the regulation of online pharmacies, there is very little systematic research outside of case reports on two potentially more important basic issues: 1 why consumers use online pharmacies in the place of legitimate medical channels; and 2 with such a variety of safety concerns, why consumers source drugs purchased from NPOPs have worse health outcomes than those who obtain the same the drugs through legitimate healthcare channels.

The study described in this paper was designed to address these issues. Since most online pharmacies offer dozens of drugs for purchase, we needed to narrow the pzin to users of a single representative target drug. Tramadol was selected as the representative drug for this study because it is extensively prescribed the third most frequently used analgesic [ 38 ] and wityout is one of the most commonly offered read more drugs from NPOPs with few restrictions on refills or quantity of tablets offered [ 810 ].

Tramadol has a demonstrated abuse profile [ 39 - 41 ], wighout its rate of abuse is not as high as other opioids hence its noncontrolled status in the Controlled Substances Act. Msds all drugs, there is also the potential for adverse side effects that can pose serious health risks. For example, tramadol not only has the potential to produce many of the same adverse events as other opioids eg, constipation and dependence [ 39 ]but also carries a serious risk of potentially fatal grand prescriptio seizures, which are exacerbated by contraindicated medications and medical wiyhout [ 42 - 44 ].

In a prior report, we documented the ease of obtaining tramadol over the Internet, the authenticity of which was certified by a chemical analysis [ 8 ]. The purchase pain meds online without doctor prescription the completion of a brief questionnaire that served presccription a medical examination.

Subsequently, a virtual prescription was generated and filled by a pain meds online without doctor prescription in Canada. The tramadol was received within 24 hours, and numerous phone calls and emails were received almost immediately to refill the prescription some offers included up to pills in a medx order and have continued on a monthly basis for over three years thus far.

It has been widely documented that recruiting and administering surveys over the Internet is witgout acceptable and beneficial research methodology [ 45 - 46 prescripyion.

While these methods provide quick access to thousands of people, they are not easily used to attract a targeted audience. To circumvent this problem, we developed a recruitment program that directly targeted a population of tramadol users with access to the Internet. Thus, our advertisement only appeared to Internet onlinf who had an interest in tramadol or tramadol-related topics, making our target population more likely to mrds potential participants ie, users of tramadol.

When users clicked the ad, they were automatically directed to wityout online consent form and the subsequent survey hosted on an institutional website. Subjects were screened to be 18 years of age, users of tramadol in the past 30 days for any reason, and United States residents.

Since this study represents a preliminary approach into this area of research, no standardized instruments could address all points of inquiry. As such, we developed a descriptive tool centered on our representative drug, in which questions withoyt dosage schedules, adverse events, etc, were specifically related to tramadol.

While we developed this descriptive tool to meet the objectives of this pilot study, we hope that the results can provide a basis for a more standardized instrument that aithout be used to investigate the same objectives for any number of drugs omline from NPOPs pain meds online without doctor prescription future prescriptoon. Other than demographics, the survey covered a broad variety of topics related specifically to tramadol, including the following: dosage schedule, intended use, pain meds online without doctor prescription, legitimate and illegitimate drug use, and prescriphion events.

Participants who listed NPOPs as a source of tramadol were presented with a subset of questions to determine the underlying factors doctro their use of online pharmacies.

A total of tramadol users qualified for and completed this study. Of these participants, indicated that they received tramadol solely through a valid prescription from their local doctor and filled it at a local pharmacy. As shown in Table 1both traditional and nontraditional users were primarily white and female.

Traditional users were significantly older than nontraditional users. Table 2 shows that nontraditional users were more likely to take the higher dose mg traditional users. Nontraditional users were also considerably more likely to use tramadol more frequently 5 or more times per week. All traditional users used tramadol for its indicated purpose ie, to treat pain meda, with only 2. Nontraditional users experienced a pain meds online without doctor prescription more severe adverse event profile than traditional users Figure 2.

Both groups had high rates of suddenly stopping their use of tramadol, pain meds online without doctor prescription nontraditional users were significantly more likely to cease use abruptly traditional users: Upon cessation, nontraditional users experienced more severe withdrawal symptoms than traditional users see Figure 3.

Our data indicate that those who eschew the typical doctor-patient relationship to soctor tramadol through NPOPs do so primarily for reasons related to cost and accessibility and, most importantly, expose themselves to great health risks. We found that nontraditional users who used NPOPs had much higher rates of all recorded adverse events, particularly life-threatening seizures, than traditional users who obtained a prescription for tramadol from their physician.

While the precise mechanisms are unknown, seizures are more prevalent in people who take high doses of tramadol [ 4252 ], have predisposing medical conditions eg, history of head injuries [ 53 wityout, or take contraindicated medications eg, tricyclic antidepressants [ 54 - 55 ]. Physicians are trained to recognize such predisposing factors, but nontraditional users are likely to be unaware of these potential complications, prescriptioj to poor health outcomes.

Moreover, we found that nontraditional users experienced much more intense opioid withdrawal symptoms when they stopped taking tramadol. The most logical explanation for these findings is that the lack of physician oversight in monitoring dosage schedules, contraindicated conditions, and concomitant medications was responsible for the increased intensity and frequency of adverse events in nontraditional users. Nearly all nontraditional users in our study indicated that their tramadol use was motivated, at least in part, by a need to treat a health condition eg, pain that was not otherwise managed witnout legitimate health care channels.

It was this perception of their unmet medical need ie, inadequate pain management that drove prescripttion to use NPOPs. This finding raises an important question: Why were normal medical channels shunned in favor of an online pharmacy? There appear to be three distinct motivations for using online pharmacies: 1 inability to pay the costs associated with obtaining a legitimate prescription; 2 limited withput to a doctor who would prescribe tramadol or prescribe it at doses sufficient to fully relieve pain; and 3 unwillingness, not inability, to use legitimate medical channels.

There are several possible interpretations of the latter motivation. Second, the physician denied the patient additional tramadol because the doctor incorrectly believed the pain was managed to the extent possible ie, inadequate pain management.

Third, the physician was reluctant to prescribe opioid analgesics, even a weak one such as tramadol, at sufficient levels to adequately relieve pain due to the inherent fear of iatrogenic dependence.

Purchases of Narcotic Pain Medication Without Prescriptions We obtained hydrocodone from eight domestic Web sites on which we placed orders without. An online doctor can only prescribe you prescription medicines online if the doctor: The doctor needs to meet all these conditions to make a correct diagnosis.

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