Illicit Online Pharmacies: Paths Forward in Addressing an Emerging Ethical and Regulatory Challenge

This chapter develops a precise definition of illicit online pharmacies (IOPs). IOPs commonly dispense high-demand restricted access medications and therapeutics. Access to scarce, discontinued, or urgently needed medication leads patients to overlook their legitimacy. Privacy, confidentiality, and government surveillance concerns encourage IOP purchases to treat personally sensitive or societally contentious health conditions. Escalating distrust of medical experts has encouraged self-diagnosis with self-medication sourced from no-prescription IOPs. Despite displaying low prices, IOPs increase overall costs for patients and the healthcare system. Purchasers experience lost health, privacy, and financial resources. No-prescription IOPs threaten joint physician-pharmacist control over medicine, and fraudulent practices further erode public trust in the healthcare system. Despite impediments to effective enforcement, paths forward to combat IOPs remain. This chapter suggests steps for various stakeholders and opportunities to disrupt consumer purchases from IOPs by examining the customer journey for online medication purchases. It also briefly reviews relevant ethical issues.