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By Sara Austin, SELF Magazine
Women are buying potent and potentially addictive medicines via the Internet - without ever seeing a doctor. A SELF investigation.
Don't get us wrong: Here at SELF, we're all in favor of shopping online. But when we heard that women were buying everything from Viagra and Valium to the powerful narcotic Vicodin over the Internet - without ever seeing a doctor - we had to investigate. Sure enough, armed only with Google and a credit card, we purchased nine prescription drugs from seven online pharmacies in four different countries. We got our hands on drugs that can be habit forming. Drugs that shouldn't be mixed. Even a drug that isn't meant to be taken by women.
Not only could this practice be deadly, but it's also embarrassingly easy. Typically, you log on, answer a few perfunctory questions about your medical history (on your honor, now) and click a box waiving your intimate health information to a doctor on its payroll, who writes a prescription without ever speaking to you - something no self-respecting M.D. should do. The doctor, and the drugs, can rarely clear where you're ordering from until your medicine arrives.
Online, women can get medications no responsible physician would give them - and no responsible patient should ever take. Virtually none of the no-prescription pharmacies are licensed, according to the watchdog group PharmacyChecker.com, raising the risk that drugs will be expired, mishandled, weak or worse. "A rogue site could send you counterfeit meds or the wrong meds," says Carmen Catizone, executive director of the National Association of Boards of Pharmacy in Park Ridge, Illinois. Drug maker Pfizer discovered Latin American Counterfeiters copying one of its products with boric acid, floor wax, and leaded highway paint. "If you self-prescribe, you have a fool for a doctor," says Ronald Wender, M.D. president of the division of medical quality at the Medical Board of California in Sacramento. "People who order from these sites don't understand interactions or side effects," he adds. Nor do some of the doctors, it seems. In SELF's experiment, one physician in Pakistan, working for an Australian site, prescribed the antianxiety drug Xanax, the infertility treatment Clomid and the epilepsy therapy Topamax - all to the same person. That's one frightening cocktail. Xanax and Topamax taken together could sedate you into a stupor. Withdrawal from Xanax can cause seizures, a threat to epileptics. And Xanax and Topamax are not recommended for most pregnant women.
Still, a SELF poll found that one woman in five buys drugs online, many undoubtedly from illicit sites. Some like the convenience. Some are embarrassed to talk about a health problem. Others are trolling for bargains - although drugs sold by prescription - free pharmacies cost 54 percent more on average than those at sites requiring a prescription, warns Tod Cooperman, M.D., president of PharmacyChecker.com. There are outright rip-offs, too: Months after our payment was pocketed, there was no sign of the $324 worth of Vicodin ordered from a Mexican pharmacy.
Letting people shop freely for pharmaceuticals "is like allowing people to buy guns on the Internet," Dr. Wender says. Unfortunately, regulations governing the sites vary wildly from state to state and can baffle, even the regulators, a big reason why 200 to 400 fly-by night pharmacies are still in business, says Dale Austin (no relation to the author), chief operating officer of the Federation of State Medical Boards in Dallas, which helps authorities police rogue sites. When California and Florida began to pull the licenses of doctors and pharmacists behind the websites, the perpetrators moved to the other states. Foreign pharmacies are the FDA's problem, but as Austin notes, it's nearly impossible to control them from across the ocean. (SELF sent the names of doctors and pharmacists involved in its purchases to the federation for investigation.)
"You can get anything online," says a 27-year-old fighting an addiction to antianxiety pills (she asked to remain anonymous). The Detroit resident says she began ordering Xanax one year ago after a friend loaned her a single pill. Soon she was taking as many as 6 milligrams a day - 50 percent more than the maximum recommended dose - and dabbling in muscle relaxers, codeine and other painkillers. "There was no way my doctor was going to prescribe these for me," she says, "but I found more than 50 online pharmacies that sell it all. I've gained 30 pounds, have constant stomach pain and headaches, and I've involved my family in my addiction. I'm extremely disappointed in myself."
Keep yourself out of trouble by using only sites that make you fax or mail them a prescription; one third of online pharmacies don't, says Dr. Cooperman. Choose a site that is licensed by a pharmacy board - half aren't - and that protects your credit card and medical data. The site should have a street address and a phone number you can call if a problem arises. Consult the ratings at PharmacyChecker.com.
Think of SELF's experiment not as a how-to but a why-not-to. Below, the spoils of a truly ill-advised shopping spree:
Phentermine: A Florida website shipped us this drug, half of the notorious Phen-Fen weight loss cocktail. (The "fen," fenfluramine, is banned in the United States.) Most doctors won't give the drugs to anyone with a body-mass index under 27, but in an Internet patient "consultation," dieters can easily lie. They are motivated by desperation and often ignorant of the stimulant's potential side effects, which include insomnia, heart problems and, rarely, paranoia and delusions.
Viagra: Those ubiquitous "Buy Viagra Now!" spams don't discriminate against women, and neither did the Mexican pharmacy that sold us these little blue pills. They arrived without even a label on the bottle. Using a phony male name, we nabbed more Viagra from a Florida site. Research may someday definitely show that Viagra helps female sexual dysfunction. In the meantime, neither the FDA nor Viagra's manufacturer, Pfizer, recommends women take it. Think about it: The drug has made billions. If it were proven safe and effective for women, wouldn't Pfizer be selling it to us?
Prozac: It's technically illegal to import drugs into the United States, but authorities can seize only a tiny percentage of the packages. So pharmacies thrive north and south of the border. Most Canadian sites are heavily regulated and rarely allow users to self prescribe, but "the Mexican pharmacies aren't licensed," says Dr. Cooperman. "Quality is questionable." We paid a Mexican pharmacy double the Canadian rate - and got a box of pills that was so mangled, it looked like it made the trip from Tijuana by carrier pigeon.
Tetracycline: Prescription-free pharmacies exploded on the Internet after the 2001 anthrax attacks, when consumers rushed to stockpile antibiotics. The result health crisis, says medical board officer Dale Austin. Overuse of antibiotics weakens their effectiveness over time. There are more immediate reasons to fear the pills we got: They came from Bangkok with no directions, a flattened box and a label written mostly in Thai.
Accutane: There's a reason the FDA has warned consumers never to buy Accutane over the Internet, with or without a prescription: According to its manufacturer, the super potent acne drug can cause depression, psychosis, suicidal thoughts, hearing and vision impairment, liver disease and birth defects so severe that doctors require users to produce two negative pregnancy tests and use two forms of contraception. Despite the FDA's consumer alert, we were able to buy Accutane from a foreign pharmacy with little difficulty. It arrived with only a cursory warning on the label and no instructions, leaving potential users clueless about the drug's frightening side effects.
Topamax: The majority of online shoppers would seem to have little use for Topamax, an antiepilepsy drug that can severely slow speech, language and motor functions. Except, of course, for those who've heard about one of the drug's other potent side effects: weight loss. By altering the brain chemicals that regulate appetite, Topamax may quash cravings. That could make it as irresistible as catnip for desperate dieters and shady pill-peddlers alike - but doctors warn that any use of Topamax outside of a physician's care is dangerous due to its brain-numbing properties.
Clomid: Because fertility treatments are pricey and generally not covered by insurance, women go to great lengths to get drugs without paying to see a doctor, says Pamela Madsen, executive director of the American Infertility Association in New York City. The price was right on this batch of Clomid, a synthetic hormone that stimulates ovulation and is one of the cheaper fertility drugs. But "access to infertility medications without physician supervision is a really bad idea," says Madsen. Taking Clomid unmonitored may decrease the odds of getting pregnant while increasing the chance of risky multiple births and even cancer if the drug is overused, she adds. "The risk is very real."
Ritalin and Xanax: Two pills ripe for abuse, the first an upper, the second a downer, both shipped with no prescription. How dangerous is this open access to supposedly controlled substances? "I am 27, have a great job and let this put me into the greatest depression of my life," says the Xanax user in Detroit. She enrolled in a hospital's substance abuse program but then panicked she might lose her job if she submitted to the six-day-a-week program. "I'm trying to wean myself off," she says, "but I still spend thousands of dollars a month, and I'm finding the drugs I took before are no longer giving me a buzz. It gets worse and worse."
Copyright (c) 2003 Conde Nast Publications. All rights reserved.
Originally published in Self, September 2003. Reprinted by permission.
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