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Buyers beware: the digital dangers of purchasing medicines online

Recently, INTERPOL announced it had coordinated the shutdown of close to 5,000 websites illegally selling medicines online. Dubbed “Operation Pangea IX”, this ninth annual international week of action against illicit online pharmacies boasted the participation of over 103 countries from a multi-stakeholder coalition, led to 393 arrests, and resulted in the seizure of $53 million dollars worth of potentially dangerous medicines. Yet a fundamental question remains: is Operation Pangea really a “panacea” in the global fight against criminal organizations looking to profit from fake, substandard, and downright dangerous medicines sold online?

For those consumers, clinicians, and policymakers who don’t know, there is a robust and active transnational criminal trade in fake medicines that impacts patients from the poorest to the richest countries. Though the exact scope and impact from this insidious form of health crime is hard to determine, seizures of fake medicines by customs, regulatory, and law enforcement officials occur throughout the world, reflecting what is estimated to be a multi-billion dollar criminal enterprise.

Fueling this underground industry is the Internet, which has made everything from flowers to iPhones easier to buy on the web. Yet, the advantages of e-commerce (allowing consumers expanded choices, 24/7 convenience, competitive pricing, and access to goods and services globally) have also empowered criminals with the same tools and platforms, leading to new and dangerous forms of cybercrime.

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Technology by Daniel Agrelo. CC0 Public Domain via Pixabay.

Herein lies the rise of the illicit online pharmacy: a crime of opportunity borne from the unhealthy union of the global fake medicines trade and widespread accessibility and anonymity of e-commerce solutions, a problem we explore in detail in a recent review article published in the British Medical Bulletin. In fact, while it is estimated that 35,000 online pharmacies are in existence, 96% of them are actually illegal, with many operating as “no prescription” online pharmacies.

“No prescription, no problem?”

A “no prescription” online pharmacy is exactly what it advertises. Essentially it allows consumers to buy prescription drugs online without a legitimate script from their doctor and in the absence of partnership from a healthcare professional. Though this may seem ideal for the modern empowered and independent “e-patient”, it creates several patient safety risks that could endanger one’s health. At the heart of this risk is the fact that many of these online medicines are actually fake, ineffective, and often dangerous.

The health risks of buying a medicine from an illicit online pharmacy is real, with documented patient deaths and adverse events resulting from overdose, toxicity, and misuse. Indeed, some of the medicines sold by illegal online pharmacies are dangerous no matter what the context, with studies finding everything from controlled and highly addictive substances, vaccines (to be self-administered by a prospective consumer), and even recalled drugs sold online.

Your health is not the only risk, with many of these sites simply swindling consumers out of their money by engaging in financial fraud or infecting computers with viruses and other malware. Are you one of the millions who have received email spam to buy “cheap” erectile dysfunction drugs online? It turns out this is just one of the ways online pharmacies market their wares.

In fact, illicit online pharmacies are savvy at marketing, using multiple strategies (including online marketing, social media, and marketing affiliate networks) to advertise their products in a competitive landscape. They focus on “selling arguments” in order to convey a false sense of safety and emphasize lower pricing and convenience in order to lure in consumers. They also engage in outright fraud, including the use of fake licenses/accreditation, and misleading consumers about the legality of purchasing their products.

“Whack-a-mole?”

If you don’t know what “whack-a-mole” is, then you likely haven’t been to an amusement arcade. Essentially the game involves a machine with a large amount of holes, a black mallet, and moles (plastic versions of the small mammalian variety) that move up and down while players attempt to hit them on the head and score points.

Coincidentally, this same futile effort to knock down constantly re-emerging and elusive targets is the way many in the law enforcement community characterize the fight against online pharmacies.

In order to better understand this analogy, one has to understand that an illicit online pharmacy is only one small part of a much larger and complex ecosystem. To start, a website is simply code that is indexed on the World Wide Web. Enabling its services are both legitimate companies (including registrars, internet service providers, search engines, payment processors, and global shipping companies) and criminal networks that manufacture and distribute illegal medicines (see figure below).

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Internet ecosystem for illicit online pharmacies. Edited image based on original from “Digital danger: a review of the global public health, patient safety and cybersecurity threats posed by illicit online pharmacies” in the British Medical Bulletin. Used with the author’s permission.

Hence, any effective solution requires international cooperation, coordination, and enforcement engaging all of these disparate actors, which is challenging to say the least. It also demands more than just simply closing down websites (or whacking the mole), as new illicit online pharmacies quickly “pop up” in place of the ones being shut down.

A digital problem, a digital solution?

The same digital technology that enables illicit online pharmacies to criminally profit from global consumers is also a vulnerability that should be exposed in research, policymaking, and law enforcement activities.

For example, online pharmacies cannot survive without electronic payment, so computer scientists have targeted their access to banks. Our recent research employs data mining and machine learning strategies in order to proactively identify high-risk illicit online pharmacies and their marketing affiliates that advertise via social media.

However, no solution will be effective until there is international consensus on the need for sustained action, a commitment to increased resources research and law enforcement activities, better consumer education and outreach, and harmonization of laws against this form of health-related cybercrime. A week of international attention, albeit laudable, is simply not enough.

Featured image: Cure by Ewa Urban. CC0 Public Domain via Pixabay.

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