Online pharmacies have been accused of failing to carry out proper ID checks and using inappropriate marketing tactics to sell strong and addictive opiate drugs, a Guardian investigation can reveal.
At least two major online pharmacies – registered with the UK regulator – are sending customers emails urging them to order drugs by claiming stocks are running out or telling them their “limit” has been removed and 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 period.
There is growing concern internationally about the rising use of opioid drugs, such as morphine, fentanyl, oxycodone, tramadol and codeine. The regulator of pharmacies in England, Scotland and Wales recently introduced new rules to protect people from buying inappropriate drugs over the internet.
The Doctor-4-U website contacted one customer about buying codeine, which costs £84.99 for 200 30g tablets, writing: “What are you waiting for? … This item is going fast so grab them while you still can.”
Another online vendor, MyUKDoctor, alerted customers whenever they could order highly addictive opiate drugs again, saying their “limit” had been removed. “Please click here to reorder your medication again,” it said.
Ash Soni, the president of the Royal Pharmaceutical Society, said he was astounded by the marketing.
“That is, for me, something that should be firmly investigated by the regulators, that is appalling. That really is – to turn around and say ‘the restriction on that product has now been lifted if you want to buy some more please go and do so’. That is something you would never expect a reputable pharmacist to do.”
Dr Jane Quinlan, a consultant in anaesthesia and pain management at Oxford University hospitals NHS foundation trust, described the tactics as “really shocking”.
Both MyUKDoctor and Doctor-4-U are approved by the Medicines and Healthcare products regulatory agency, and both display the EU common logo with the message “click to verify if this website is operating legally”.
Yasir Abbasi, the clinical director for addiction services at Mersey Care NHS foundation trust, described the marketing as aggressive.
He said: “When it comes to opioid medications there should not be any direct marketing towards the consumer and if there is then there needs to be clear regulations and guidelines around that.”
A spokesperson for Doctor-4-U said the message was not a marketing email, rather, it was sent out when a person had placed an order but abandoned it before paying.
“This is not a marketing tactic and we would stress it is not possible to purchase any opioids through the website without a doctor’s approval,” the spokesperson said.
However, the company confirmed it would stop sending the message “in a bid to make our policy clearer on this matter”.
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 the drugs are not the most effective way to treat such pain. There are concerns about growing prescription levels amid a rise in overdoses and an increasing problem of dependence and addiction to prescription drugs.
Codeine on its own is only available on prescription, with unauthorised possession being illegal. Small amounts of the drug are in some medicines that can be bought without prescription, but only in pharmacies.
Quinlan said: “We are trying to reduce the number of pain patients being prescribed opioids for chronic pain, as we know they don’t work for the majority of patients, and are trying to support those now dependent on high-dose opioids prescribed and taken in good faith.
“However, these online sales of opioids represent an invisible population of drug dependence, with what appears to be minimal checks and poor governance, risking patient safety.”
The Guardian was able to obtain 200 codeine tablets in two weeks by ordering 100 30g tablets from the UK Meds website as “David Smith”, but with a card registered under a different name. A further 100 tablets were obtained from PillDoctor, using the same “David Smith” pseudonym and a payment card under another name. Random photos were uploaded instead of proof of ID and the proof of address. Both websites said customers should use their own name and card.
Abbasi said: “The method and governance around the way medication is ordered should raise a lot of concerns in the UK.”
PillDoctor, which is based in London but uses EU doctors to issue consultations and prescriptions, said the order went through by mistake due to “human error”.
“This does not reflect our practice … Human error has contributed to this and we have now taken swift measures to avoid such errors in the future,” a spokesperson said.
UK Meds, based in Nottingham, said its products were prescribed by General Medical Council-regulated doctors or other licensed prescribers and dispensed by a General Pharmaceutical Council-regulated pharmacy.
“The company acknowledges and is alive to the reality that the potential for abuse of the service is an ever-present risk that it needs to address. It continually strives to put in place rigorous procedures, operating in accordance with applicable legislation, which attempt to limit the potential for abuse of its service,” they said.
Prof Helen Stokes-Lampard, the chair of the Royal College of GPs, said the revelations were of great concern.
She added: “Codeine is an opioid and well-known to be highly addictive and so its use needs to be very carefully monitored. GPs are experts in prescribing and will be extremely cautious about starting a patient on opioids, but will also make sure they are closely monitored and regularly reviewed.”
One customer said she had obtained drugs for more than three years from different websites, citing the same condition each time. “I’ve been ordering from one website since citing the same condition every time (lying basically, saying that I’d had a pilonidal cyst removed) and they’ve never questioned it and just sent me the meds … This would be unheard of at any doctors’ surgery.”
The use of online pharmacies has increased rapidly in recent years, but issues have been raised about regulation.
Concern has also been raised about a legal loophole that allows people to buy strong painkillers from doctors based in Europe. It comes after the death of Jennifer Anne Lacey, 51, who was found dead in a Travelodge hotel in Morden, south London, last summer.
The coroner concluded (pdf) Lacey had killed herself after overdosing on tramadol and alcohol. She had taken 210 tablets, half of which she bought online.
The doctor who gave her 100 tablets of 50mg tramadol was based in Prague, Czech Republic. He had never seen her and had no access to her medical records, nor had he spoken to her GP. Lacey simply filled in an online form.
Concluding the inquest into her death, the coroner Fiona Wilcox said she was concerned such potentially dangerous and addictive drugs were so freely available online.
