Searching for Cybersecurity: Accountability for Illicit Online Drug Sales

by Bryan A. Liang

President Obama recently announced that the US would engage in a coordinated effort to ensure America’s cybersecurity. Yet his approach does not address or even acknowledge an area of cybercrime that represents a serious danger to citizen health: illegal sale of drugs via the internet.

The risks involved with internet drug sales are numerous. They include the absence of physician oversight, the high chance of receiving a counterfeit/substandard product, as well as the risk of financial fraud and
identity theft.

Sadly, the uninsured and underinsured represent the most at-risk groups. Despite at least some information on the dangers of online pharmacies, consumers obtaining prescription drugs over the internet have either not received the message or have chosen to ignore it.

For example, a recent National Consumers League survey found 15% of US respondents had purchased drugs online. Yet an incredible 93% of these respondents never suspected that the products might be tainted or fake.

Further, even though more than half of these patients expressly noted that there is no way to tell if a drug is real or counterfeit, they still purchased the drug over the internet. And more than a quarter said that, if the online seller guaranteed the medication was genuine, then that was enough to assuage their

Unfortunately, high-risk drug sources dominate the internet. According to the World Health Organization, more than half of internet drug sellers with no physical address listed on their web sites are selling fake or tainted drugs.

In addition, a National Association of Boards of Pharmacy study found that more than 90 percent of internet drug sellers were not compliant with state or federal laws regarding prescription drug sale and oversight.

It’s no wonder, considering how easy it is to get into the online drug business. By using business-to-business websites such as, anyone can purchase massive amounts of drug ingredients (or, for that matter, fake materials that appear similar to legitimate drug ingredients), pill presses (some of which are the same as those used by the actual manufacturer), and blister packaging machines to create products that can’t be discerned as fake even by experts.

These dangers together with the well-documented instances where patients have died because of drug products purchased online, has indicated the absolute need to address this growing phenomenon.

To deal with this social scourge, all internet drug sales should be prohibited unless the internet pharmacy is licensed through the NABP Verified Internet Pharmacy Practice Site program. This program requires inspections, consumer protections, and legitimate prescriptions from all drug vendors.

To break the illicit drug supply chain, a no-cost/low-cost national Drug Access Program should be created that mandates brand name and generic company participation in exchange for access to the US market.

The health insurance industry also has a role to play in this. By reducing drug co-pays for low-income customers, insurance companies would be giving Americans less reason to fill their prescriptions at suspect internet pharmacies.

Lowering co-pays would also make it easier for patients to adhere to their prescribed treatment regimen, instead of going off their medication to save money, as many do. Indeed, non-adherence of this kind not only results in poor
clinical outcomes for patients, but it also raises medical costs across the board by as much as $300 billion each year.

Finally, all parties — including websites, search engines, and others — who facilitate the illegal sale of drugs over the internet should suffer criminal penalties, including life imprisonment for any illicit drug sale that results in
the death of a patient.

The President and Congress in their efforts to address cybercrime must take into account the challenges associated with unfettered online drug sales. Otherwise, we will simply allow drug pushers to move from the streets to the information

(Bryan A. Liang, M.D., Ph.D., J.D., is Executive Director, Institute of Health Law Studies, California Western School of Law, and Co-Director, San Diego Center for Patient Safety, UCSD School of Medicine. He is author of the report, “Searching for Safety: Addressing Search Engine, Website, and Provider Accountability for Illicit Online Drug Sales.”)

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