A new study in the May 2013 Journal of Medical Internet Research illustrates just how easy it is for fake online pharmacies to advertise via social media outlets such as Facebook and Twitter.

Researcher Tim Mackey and co-author Dr. Bryan Liang set up dummy, no-prescription-required pharmacy websites, then created advertising for the dummy sites on Facebook, Twitter, MySpace, and Google+. They found that in the 10 months that their fake ads were running, close to 3,000 unique visitors went to the dummy sites in search of drugs that required no prescription. Surprisingly, though they had visits from all over the globe, the highest percentage of web traffic to their fake sites (54%) came from the United States.

Professional-looking websites are easily made
from stock images like this one put together
by researchers Liang and Mackey

No_Prescription_Safe_Drugs

The explosive growth and behavior of fake online pharmacies has been the subject of research by both medical professionals and computer scientists. Illicit online pharmacies make up 97% of all Internet pharmacies according to the National Association of Boards of Pharmacy. Researchers are studying the impact on patient safety from fake online pharmacies that dupe naïve consumers into purchasing medication that may be counterfeit or require careful supervision. They are testing consumer discernment between safe online pharmacies and dangerous ones, how consumers are abusing medication through fake online pharmacies, and what techniques fake online pharmacy operators use to encourage sales.

 

A new study in the May 2013 Journal of Medical Internet Research illustrates just how easy it is for fake online pharmacies to advertise via social media outlets such as Facebook and Twitter.

Researcher Tim Mackey and co-author Dr. Bryan Liang set up dummy, no-prescription-required pharmacy websites, then created advertising for the dummy sites on Facebook, Twitter, MySpace, and Google+. They found that in the 10 months that their fake ads were running, close to 3,000 unique visitors went to the dummy sites in search of drugs that required no prescription. Surprisingly, though they had visits from all over the globe, the highest percentage of web traffic to their fake sites (54%) came from the United States.

What they found particularly troubling was the lack of barriers to entry for direct-to-consumer advertising by patently fake online pharmacies on social media platforms. Mackey states, “This ease of creating a potential pharmaceutical criminal presence on globally accessible social media is highly alarming given its increasing utilization by online users and current lack of effective regulation.”

Earlier in April, the same researchers examined the danger posed by unlicensed online pharmacies that sell dangerous Narrow Therapeutic Index (NTI) drugs without a prescription in an article published in Clinical Therapeutics, April 2013. NTI drugs pose serious danger to patients if taken without a doctor’s supervision, due to the narrow range within which it is safe to take, resulting in dangerous therapeutic failures and high doses resulting in toxic adverse effects.

The adverse event incidence in patients taking NTI is double that of patients taking non-NTI drugs. Dr. Liang says, “Yet despite these dangerous conditions, we found the vast majority of high-risk NTI
drugs were readily available online without a prescription. Worse yet, suspect online vendors identified by NABP as being ‘Not Recommended’ were clearly participating in this market.”

They found that 92% of NTI drugs marketed as available without prescription all from vendors not recommended by the National Association of Boards of Pharmacy. Patients may believe they can save money by purchasing from online vendors who are not licensed pharmacies, but they don’t realize that substitutions in medication, or inaccurate dosing often found in counterfeit drugs sold on line may jeopardize their health. Liang warns that patients who use NTI drugs may have adverse events when switching between formulations and require careful monitoring. “Patients are often not aware that different formulations of the same drug can result in over or under-treatment of their sometimes life-threatening illnesses.”

Dr. Liang, a professor at both California Western School of Law and the University of California San Diego School of Medicine, is a board member for Partnership for Safe Medicines. He has also researched the fake vaccine online market, prescription contraceptive online market and shortage drug availability online.

Others have researched how easily consumers are convinced by fake online pharmacies, and whether they can make informed choices for patient safety. In 2010, Grazia Orizio and her team from the University of Brescia found that 80% of the online pharmacies sampled marketed convenience over safety and did not require prescriptions. Dr. Lana Ivanitskaya and her team from Central Michigan University created two mock-up fake online pharmacy websites that contained all the signs the FDA warns consumers to avoid in 2010. They found that one quarter of college students, including those in health programs, seemed completely unable to spot danger signs in fake pharmacy websites. In 2011, Dr. Anupam Jena and his team from the Harvard Medical School examined the relationship between prescription medication abuse and fake online pharmacies, and offered strategies to physicians recognize and minimize the impact of online access on patients.

NABP highlights the risks to uninformed patients from using online sources for medication. “Over the past five years it has become increasingly apparent that the likelihood of patients obtaining substandard or counterfeit drugs goes up substantially when online drug sellers are involved.”

In addition to spotlighting the naiveté of online consumers, researchers have observed the behavior of fake online pharmacy operators that promote online sales through spam advertising and coordinated search-redirection. A team of researchers from University of California San Diego, UC Berkeley, the International Computer Science Institute and Budapest University of Technology and Economics studied the business model behind spam marketing, emphasizing the high percentage of fake online pharmacies advertised via spam messages. Nektarios Leontiadis, Tyler Moore and Nicolas Christin, researchers from Carnegie Mellon and Harvard Universities investigated the manipulation of web search results to promote unauthorized medication sales online.

At USENIX 2012, Damon McCoy presented research exposing the business practices of affiliate programs that propagate online pharmacies. McCoy explained his research in some detail at the 2012 Interchange.

By S. Imber