People with addiction problems are able to order hundreds of powerful opioid painkillers by taking advantage of a lack of proper checks with registered online pharmacies, the Guardian can reveal.
A number of online pharmacies that are regulated and operating legally have no alert system in place to identify when someone makes multiple orders to the same address.
The safeguarding loophole means people can order hundreds of tablets a month.
The online pharmacy regulator, the General Pharmaceutical Council (GPhC), is calling for stricter measures to be introduced and says it is consulting on whether online pharmacies should stop supplying opiates unless further checks are carried out.
David (not his real name) told the Guardian that his wife, who had an addiction, this year made four orders in a month for the strong opioid dihydrocodeine from the website Doctor-4-u after setting up multiple accounts. Hundreds of pills were delivered to the same address, but the unusual activity was not flagged on its system.
“Why do online pharmacies not have the capability to check various accounts linked to the same addresses?” he said. “This happens with insurance and many other industries.”
Doctor-4-u said it carried out thorough ID checks, but multiple orders to the same address were possible if someone used a different family member’s ID and credit card. It said this would not be flagged up on its system.
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After the Guardian raised the issue, the company said it would put safeguarding measures in place to protect against this problem, “to demonstrate our commitment to making our online pharmacy as safe as possible”.
John Elliott, the IT director at Doctor-4-u’s owner Med Connections, said: “We are constantly investing in our systems to detect this kind of fraudulent activity.”
The GPhC said it was not aware of a study that showed the numbers using online pharmacies, but it is likely to be in the thousands. Last year, Pharmacy2U, which claims it is the UK’s largest online pharmacy, said it dispensed more than 200,000 items to patients in a month.
The Guardian has also discovered that Doctor-4-u and another leading online pharmacy, UK Meds, are being investigated by the GPhC, which regulates pharmacies operating online, although details of what concerns had been raised – even whether they related to multiple ordering – about them could not be revealed.
A UK Meds spokesperson said: “[We are] a regulated and responsibly run online healthcare portal, which is actively lobbying for the highest safety standards to be introduced across the industry. Patient care and safety is at the core of our business.”
The news comes as concerns grow about the rising number of people seeking help over prescription pills bought online. The Guardian reported this month that a clinic set up to help teenagers addicted to Xanax and other prescription drugs is being sought out by adults who use pills purchased online.
Yasir Abbasi, the clinical director for addiction services at Mersey Care NHS foundation trust, said: “If you are getting multiple prescriptions from one address in the UK, there should be an alert system to make it hard for this to go ahead, just as there are regulation[s] to make sure you cannot buy two boxes of paracetamol at one supermarket …
“If you buy something online you should have to go through one central system, regardless of which online pharmacy you visit online, so what you buy can be monitored.”
Changing the prescription for regulating pharmacies
The GPhC said it investigated 17 cases involving online pharmacies in the year to June. Its main concerns were about how patients accessed medications online that may be subject to abuse and about the safety of the processes in place.
Duncan Rudkin, the chief executive of the GPhC, said: “We have set out actions we’re proposing that online pharmacy owners would be expected to take to meet our standards and make sure that people obtain medicines safely online. This includes identifying multiple orders to the same address or using the same payment details.”
The watchdog is holding a public consultation on proposed new safeguards, including whether online pharmacies should stop supplying certain drugs, such as opiates and opioids, unless further checks are carried out.
There are currently 445 pharmacies that bear the council’s logo. They can sell opiates and opioids medicines such as tramadol, co-codamol, codeine and dihydrocodeine, which if abused can lead to severe addictions.
David said his wife was able to order hundreds of pills using his credit card. She started doing so in 2016 after becoming addicted to the opioid hydrocodone, which she was given for a slipped disc.
She was able order medicines while she was pregnant by clicking a question on a form to say she was not pregnant, although in this instance the pills were not obtained from Doctor-4-u and David could not recall which website they came from.
“This meant when my son was born, he rated high on the Finnegan scale – basically children born who show signs of opiate addiction – but it did pass,” he said.
He added that addiction had had a huge impact on his family. “The checks are simply not good enough for medication issuing. I cannot go to doctor and say, ‘I want this medication’ – I tell them my symptoms and the doctor prescribes medication, but it’s the opposite way around with online pharmacies. You say ‘I want this’ and the doctors look at it,” he said.
Concerns have also been raised about websites allowing people to select medicines including opiates and opioids before a consultation. The GPhC said: “There are additional risks to patient safety when prescription-only medicines can be chosen before having an appropriate consultation with a prescriber.
“For example, if a patient simply has to answer questions before the healthcare professional makes their prescribing decision, they might fill in a number of questionnaires, learning what answers to give so they can get the medicine in question.”
Speaking anonymously, a former online pharmacy worker who left his employer recently due to concerns about safeguarding said that “even though there are procedures and safeguards put in place, customers are still able to make multiple orders using different email addresses and accounts”.
He added: “It’s not such a problem with some products, but for opioids it can be very dangerous.”
Abbasi said: “We are seeing an increase in drug-related deaths, and prescription drugs are playing a role more and more. Things are almost at a crisis point.”