International legislation

As there is no globally controlled jurisdiction of medicines, this is controlled on a State / Country level and then a Federal / Union level in most cases. The main source of reference is the World Health Organisation (WHO). Their published stance on the matter tends to be quite negative as from a world wide web perspective there are still many different unregulated websites. Risks of using such services have been highlighted to patients worldwide these mainly include:

• There is no guarantee that the product supplied will be that which was originally ordered.
• There is no guarantee of where the product was manufactured or how it was stored.
• There is no guarantee that the supplier is authorised or qualified to dispense medical products.
• There is no guarantee that the medical product is appropriate for you, or may react with other medicines you are taking.
• Your personal data may be misused.
• Your payment card details may be misused.
• Some SPAM email advertising medicines have been found to contain hidden software which will compromise your computer and privacy.

European Union

The EU is currently implementing the eHealth Digital Service Infrastructure (eHDSI). This intends to facilitate the cross-border exchange of health data including patient summaries and e-prescriptions. Through ‘core services‘, the European Commission is providing a common ICT infrastructure and crosscutting services (terminology, interoperability etc.) to EU countries. They can then set up ‘generic services’ to connect national eHealth systems through ‘National Contact Points for eHealth (NCPeH)’, with financial assistance from the Connecting Europe Facility Telecom Programme (2015-2020).

United Kingdom

Much of the releases from the GPhC have gone along the same lines as their traditional brick-and-mortar recommendations. The ability to sell codeine has plagued community pharmacies since the Victorian era and has been transmitted to pharmacy practice online. In September 2019, the GPhC released a document entitled “Taking action on unsafe supply of high-risk medicines online” which addressed patient safety concerns in relation to the supply of high-risk habit-forming medicines online. This followed pharmacists who were offering codeine-containing products for sale online with limited barriers to entry. The release took main offence to “online questionnaires with no access to a patient’s medical history or consent to contact a patient’s GP, and without appropriate risk management and safeguards in place.”

More recently, an announcement from the GPhC entitled “Advice to pharmacists about risks relating to online services” highlighted serious patient safety concerns relating to some online pharmacies and online prescribing services. The late 2022 release highlighted that over 30% of open Fitness to Practise cases related to online pharmacies which is disproportionate to the sector of the market that online services occupy. Seven interim orders on the registration of pharmacists who have worked for or with online prescribing services had been released after the GPhC identified serious concerns with practice. Common themes in these cases included:

• prescription of high-risk drugs or medications that require monitoring without proper precautions providing pharmaceuticals to patients based only on an online questionnaire, with no direct interaction between the prescriber and either the patient or their GP
• large numbers of pharmacist prescriptions written in a short amount of time for drugs that are beyond the area of their speciality.
• prescribing of medicines outside the prescriber’s scope of practice
• high volumes of prescriptions being issued by the prescriber in short periods of time.

References

¹ Electronic cross-border health services. https://ec.europa.eu/health/ehealth/electronic_crossborder_healthservices_en

² Taking action on unsafe supply of high-risk medicines online. GPhC: https://www.pharmacyregulation.org/regulate/article/taking-action-unsafe-supply-high-risk-medicines-online