NABP: 96.6% of online pharmacies are not in compliance with US prescription-dispensing laws

Continuing its years-long efforts to bring order to the online pharmacy world, the National Assn. of Boards of Pharmacy (NABP; Mt. Prospect, IL) has found in its latest surveying that almost 97% of over 10,758 sites investigated and reviewed by the organization do not meet basic laws and regulations for dispensing pharmaceuticals to consumers. The new report, Internet Drug Outlet Identification Program, is available at the NABP website.

Of the rogue sites, which NABP compiles in a “Not Recommended” list, the violations are widespread:

• 88% do not require a valid prescription (and 59.5% issue prescriptions based on “online consultations”)
• 49% offer foreign or non-FDA-approved drugs
• 23% have an address outside the US and most post no address whatsoever
• 16% do not have secure sites, putting consumers’ financial and identity information at risk.

Of 104 sites newly added to the Not Recommended list, 28 provide controlled substances, and 18 more provide tramadol, an abused analgesic--both should be high concerns to drug-abuse authorities. NABP has a long-established program for accrediting online pharmacies under its VIPPS (Verified Internet Pharmacy Practice), Vet-VIPPS (for veterinarians) and e-Advertiser (for sites that provide refills or prescribing information, but don’t dispense first prescriptions) programs. As of March 31, 110 sites have one of these accreditations; NABP finds an additional 256 sites that do not violate online-prescribing norms, but lack accreditation from it.

Of particular interest to investigators and law enforcement, NABP finds that 1,529 sites have locations identified as being in the US; and 5,645 sites have servers physically inside the US. Policing the Internet is difficult, since parts of it operate supranationally; but when the business has a US location, it is accessible to law enforcement.

All of these conditions have existed for quite a while, and FDA and other law-enforcement agencies have not ignored them: FDA has been a participant in annual, international “Operation Pangea” programs, where Interpol, US Customs and Border Patrol, FDA and others simultaneously investigate, shut down and arrest violators around the world. The 2013 Operation Pangea netted 1,677 shutdowns of US-based sites. But as the NABP numbers attest, new sites can proliferate as quickly as old ones are shut down. The “Canadian pharmacy” ploy—where online pharmacies purport to be safe, Canadian-based organizations attractive to US consumers—is still widespread.

GLTD and .pharmacy

In the report, NABP includes an update of its ongoing effort to obtain control of the “.pharmacy” generic level top-domain suffix (gLTD—the word or letters after the dot in an Internet URL), which is being regulated by ICANN, the Internet Corporation for Assigned Names and Numbers. NABP is in the “contracting phase” of the ICANN process, and next steps include “execution of the registry agreement with ICANN … testing and contracting with registrars to ensure compliance with established pharmacy standards.” With this agreement in place, NABP and collaborating organizations will be able to control who gets to use the “.pharmacy” domain name and in time, hopefully, steer consumers to those sites in preference to the rogue sites.