Navigating the World of Online Pharmacies with CDR Lysette Deshields

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Claim 0.5 CE credit (CME/AAPA/CNE/CPE/CPT/CPH) by listening to our podcast and responding to the questions

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Dr. Roach: Welcome to “Q&A with FDA” from the FDA’s Division of Drug Information. In this podcast series, we answer some of the most frequently asked questions that we’ve received from the public.

My name is Dr. Sara Roach, and today we will be discussing how to navigate the world of internet pharmacies.

According to the National Association of Boards of Pharmacy, for the past 10 years, industry experts have consistently estimated that, at any given time, there are between 30,000 and 40,000 active illegal online pharmacies.

Today, we are joined by Commander Lysette Deshields, an FDA officer in the United States Public Health Service Commissioned Corps. CDR Deshields is a Regulatory Officer in the Supply Chain Security Branch in the Office of Drug Security, Integrity and Response, Office of Compliance within the FDA’s Center for Drug Evaluation and Research. She will be discussing FDA’s BeSafeRx campaign, a national initiative to educate consumers and health care professionals about the potential dangers of buying medicine from unsafe online pharmacies, along with identifying safe online pharmacies so that consumers can make more informed decisions when purchasing prescription medicine online, and tools that healthcare professionals can use to guide patients.

Welcome, CDR Deshields, and thank you for speaking with us today!

CDR Deshields: My pleasure.

Dr. Roach: CDR Deshields, the internet provides us with instant access to information and services, which can be really helpful for a lot of our day-to-day needs. Like any endeavor online, it can be difficult to tell a reputable site from one you should avoid. Considering that people are choosing to sometimes buy their medicines online for a variety of reasons, including convenience, privacy, and cost savings, it’s confusing to know whether the products being purchased online are what they are purported to be. How do you advise consumers who are shopping online for medicines?

CDR Deshields: You make some great points. It’s true that there are online pharmacies that operate with patients’ best interest in mind and may offer convenience, privacy, cost savings and safeguards for purchasing medicines online. However, there are many unsafe online pharmacies and websites that may put patients’ health at risk. My advice to consumers is that not all websites are the same and that before making a purchase they should follow a few steps to ensure they are getting the medication that they need.

Dr. Roach: Can you review some of the specific reasons it is important to verify a safe online pharmacy before ordering medicine?

CDR Deshields: Yes, our goal with BeSafeRx is to provide consumers and health care professionals with information about the potential dangers of buying medicine from an online pharmacy and help educate consumers about how to buy medicines safely online. There are warning signs, or red flags, to watch out for. Unsafe online pharmacies may sell medicines without requiring a prescription, putting consumers at risk. These websites may sell products that, while being passed off as authentic, may contain too much or too little of the active ingredient, contain the wrong ingredients altogether, or even contain harmful substances. This of course can lead to a number of serious and even potentially life-threatening consequences, ranging from ineffective treatment to drug interactions, side effects, and dangerous allergic reactions.

Dr. Roach: And then there’s the risk to consumers’ personal and financial information as well. Some unsafe online pharmacies do not provide clear written protections of your personal and financial information or sell it to other websites. You mentioned reviewing the steps to take to verify that a pharmacy site is safe, and I know we’ll get to that in a minute; but first, since we are talking about unsafe sites, what are some of the signs that an online pharmacy may be unsafe and should be avoided?

CDR Deshields: You’re right, it’s important to know what to look for on both ends of the spectrum because it’s not always easy to spot an unsafe online pharmacy. Criminals can use fake storefronts and other methods to deceive consumers. As far as tips, here are a few I always like to share:

When looking around for a safe online pharmacy, before you order, beware of websites that offer deep discounts or prices that seem too good to be true; or websites that send unsolicited mail, email, or other spam offering cheap medicines. You want to avoid any online pharmacies that are located outside of the United States and those that ¬state their medicines will be shipped from a foreign country.

As I mentioned, unsafe online pharmacies also use fake “storefronts” to mimic licensed pharmacies and make consumers think the medicine comes from countries with equivalent safety standards, but the medicines could have been made anywhere, with little to no regard for safety and effectiveness.

If you’re listening to this and you’ve already ordered medicine online, some things to look for when your order arrives include medicines sent in packaging that is broken, damaged, contains misspellings or has other signs that it’s not the FDA-approved drug, or that it has no expiration date, or is already expired. Another red flag is if you were charged for a drug you never ordered or received.

Your medicine should come from a United States-licensed pharmacy. Medicines approved for use in the United States have been reviewed for safety, effectiveness, and quality by FDA, and our drug supply is among the safest in the world. In the United States, we have federal and state laws that create a closed drug distribution system that helps to ensure that our drug supply is safe. FDA does not have regulatory oversight of prescription medicines from outside the legitimate United States drug supply chain and cannot guarantee the safety or effectiveness of these medicines. That is why it is so important to only shop online from a pharmacy that is licensed by its State Board of Pharmacy.

Dr. Roach: That seems like the perfect segway to review the steps consumers and health care professionals can take to verify that an online pharmacy is safe.

CDR Deshields: Absolutely. Knowing what to look for when shopping for medicine online is critically important to patient safety. You want to check and verify four main things to make sure an online pharmacy is safe.

1. Make sure the online pharmacy requires a prescription from a licensed health care provider.
2. Check that the pharmacy provides a physical address and telephone number in the United States.
3. A safe online pharmacy will be licensed in the state where they are operating as well as the state where you are ordering from, if they are different.
4. And finally, they will have a licensed pharmacist on staff to answer your questions.

Dr. Roach: There are some helpful online look-up sites that we recommend frequently to consumers and health care professionals, that can take the guesswork out of verifying if an online pharmacy is licensed properly with their State Board of Pharmacy. Can you review those resources for our listeners?

CDR Deshields: Yes I can. A great look-up tool we use and recommend is called “Locate a State-Licensed Online Pharmacy.” It’s available right on FDA.gov and is easy to access from a computer or mobile device. This locator tool allows you to click on a state to check an online pharmacy’s license. If a pharmacy isn’t listed in the database, it shouldn’t be used. And if it is listed, you still want to verify the other 3 factors – that is, (1) confirming that the pharmacy requires a prescription from a licensed health care provider, (2) checking that a physical address and United States telephone number are provided, and (3) making sure a licensed pharmacist is available to answer questions.

Dr. Roach: Those are really great tips, and the tools available make identifying safe and unsafe online pharmacies so much easier. We know this information supports a larger national campaign by FDA called BeSafeRx. Can you expand on the additional tools and resources that provide important information about online pharmacies?

CDR Deshields: Yes. BeSafeRx is an excellent resource located on the FDA website. As you know, the tools and resources offered help educate consumers about online pharmacies and can also help health care professionals have conversations with consumers about the risks of buying medicines online.

Some of the other resources provided by BeSafeRx that we haven’t talked about yet include webpages about the National Association of Boards of Pharmacy’s Buy Safely tool for checking whether a website is “safe” or “not recommended.” You can find that online at Safe.pharmacy. We also offer downloadable educational and informational materials that can be shared with consumers and medical professionals.

Dr. Roach: How can consumers and health care professionals report unsafe online pharmacies to FDA?

CDR Deshields: If someone believes they have found a website that may be illegally selling medicines, we encourage them to submit the information through the Report Unlawful Sales webpage available on the FDA website. If someone receives a medicine from an online pharmacy and experiences unexpected or serious side effects, they can report that information to FDA using MedWatch, FDA’s medical product safety reporting program.

Dr. Roach: Great advice. Thank you again, CDR Deshields, for sharing so many helpful tips and resources. FDA’s BeSafeRx campaign resources and tools are available on FDA’s website at fda.gov/besaferx. To bookmark any of the resources mentioned today, please visit our transcript at fda.gov/QAwithFDA for the weblinks.

Thanks for listening. The full podcast and transcript of this recording is available at fda.gov/QAwithFDA. If you have drug-related questions, reach out to us at druginfo@fda.hhs.gov

Resources to list on transcript webpage:

1. BeSafeRx: Your Source for Online Pharmacy Information
2. Locate a State-Licensed Online Pharmacy
3. Report a Problem > Reporting Unlawful Sales of Medical Products on the Internet
4. Medwatch: The FDA Safety Information and Adverse Event Reporting Program