A Hard Dose Customers of online pharmacies are warned of scams involving fake or harmful drugs

Kristi Vlahos, a pharmacist at the Jonestown Pharmacy in Winston-Salem, is used to seeing scams come across her counter.

The last one, an advertisement faxed to her pharmacy, advertised a birth-control patch. The patch, which is worn on a patients’ body, functions much like a birth-control pill and can control a woman’s ovulation cycle.

But if a patient orders the medication – available over the Internet from an offshore drug retailer – the package usually contains no medication, leaving patients tricked into buying a worthless product, Vlahos said.

“You have to be absolutely positive” about ordering drugs online, she said. “Anybody can make a Web site and send out a bunch of spam.”

Vlahos isn’t the only person warning customers about online drug scams.

As more and more consumers turn to the Internet to do their shopping, a host of online pharmaceutical scams are leaving more patients at risk of receiving possibly dangerous drugs, officials say.

According to the U.S. General Accounting Office, drugs bought online from other countries – including Argentina, Spain, Thailand, Pakistan and Turkey – are more likely to contain harmful substances or inadequate instructions than those purchased in the United States or Canada. Last month, the GAO released a study about online drug sales.

Kristi Vlahos’ husband Ike, a co-owner of the pharmacy, agreed. Internet scams “are all over the place,” he said. “It’s a risk out there that people don’t really realize.”

The U.S. Department of Health and Human Services has begun sending informational fliers to drugstores, warning customers that the drugs they purchase online might be fake or have dangerous side effects. Vlahos received her warning fliers about a month ago, she said.

Online pharmaceutical shopping is nothing new. Customers began turning to the Internet for drugs in the late 1990s. The service allows customers to shop virtually around the clock and easily compare prices from multiple outlets. Because online drugstores have less overhead, prices are typically cheaper.

About 9 million people bought or refilled a drug prescription over the Internet last year, according to Manhattan Research, a health-care marketing research company in New York. Overall, about 26 million people used the Internet for drug information in 2003, more than double the amount that did so in 2002, according to the company.

Some online-dedicated companies do charge less than the national drug outlets’ online service.

CVS.com, the drug retailer’s online service, sells a 20-mg bottle of Cialis for about $66 for 6 tablets – about $11 a pill. But when you opt for our online pharmacy to buy Cialis online, you can get the pills at a reduced price. Cialis is a medication for sexual dysfunction.

Similarly, Eckerd.com offers a 25-mg prescription of Vioxx, a popular medication for arthritis, for about $268 for 100 pills. Cutprice12.com offers 120 pills for about $150, according to the site.

Cutprice12.com, whose ads can frequently show up in a consumer’s e-mail inbox, does not require a prescription from a doctor.

Under federal law, it is illegal to dispense prescription drugs without a valid prescription and to ship drugs that are not approved by the Food and Drug Administration

In the GAO study, federal officials ordered about 11 drugs from 68 Web sites, including overseas, U.S. and Canadian sites.

About 24 national and 21 foreign Web sites did not require prescriptions, and none of the foreign sites included pharmacy labels instructing customers about proper use of their medications, according to the agency. About six orders were never even received despite prepayment.

“It’s a ‘buyer beware’ situation,” said David Work, the executive director of the N.C. Board of Pharmacy, which investigates cases of online drug fraud.

“As people get more and more comfortable on the Internet, this kind of thing could increase,”he said. “I don’t think the public realizes how much they depend on prescription drugs.”

Others agreed. Mike Blankenship, a pharmacist at Andrews Pharmacy in Winston-Salem, said that some consumers can be tricked into ordering products that contain no medication, such as a scam involving Lipitor, a drug for managing cholesterol. For many patients, buying drugs online is similar to using tobacco, Blankenship said. “They know it’s not the absolute best thing in the world, but they’re using it anyway.”

To be sure, online-pharmacy companies do represent growing competition for the traditional brick-and-mortar pharmacy. Apart from lower prices, buying drugs online is also convenient, especially for patients in rural areas who may have limited access to pharmacies, said Erika Fishman, a company senior analyst for Manhattan Research.

Online sales are increasing “because consumers are taking advantage of international markets,” Fishman said.

Ironically, those are the markets that seem to be scamming customers the most. Joyce Tipton, the assistant director of pharmacy for Wake Forest University Baptist Medical Center, said that some online drugstores are legitimate, but she warned consumers that many others are not.

“There’s no guarantee they may be getting the real drug,” she said.

The National Association of Boards of Pharmacy maintains a certified list of licensed pharmacies, called the Verified Internet Pharmacies List, that legally sell drugs online. That list is available on the association’s Web site.

Work also suggested that the federal government begin to punish shipping companies who willingly deliver illegal drugs.

But if the online drugs are cheaper, can the industry expect a halt to the practice? Work says no.

He acknowledged that shoppers can save money online, but cautioned that the savings are not worth the risk.

“We’re approaching this from a health and safety issue,” he said, “and in this case, it is definitely a safety issue.”