The Canadian International Pharmacy Association (CIPA) has posted here previously about the realities of people using the Internet today to purchase prescription medications. We’ve written extensively about the importance of access to safe online pharmacy websites—run by licensed, legitimate pharmacies—dispensing legally manufactured maintenance drugs to individuals with valid prescriptions. We’ve also been clear that the damage by ‘rogue’ actors needs to be addressed, as they cloud the benefits of purchasing online and erode trust in safe Internet pharmacies.

To these points, the Alliance for Safe Online Pharmacies (ASOP Global) recently announced the findings of a new national survey about Americans purchasing medications online.

Specifically, the survey found that more than one-third of Americans (35%) have now used an online pharmacy to purchase medication, up from 23% in 2013. In 2020, 16% of Americans report increasing their use of online pharmacies. Of those who have bought prescription medication online, 31% did so for the first time in 2020 because of the pandemic, and 72% indicate that they plan to do so again in the future, according to the ASOP Global news release. The release refers to the “digitalization of consumerism, including the use of online pharmacies.”

These findings are consistent with CIPA members’ continued experience over the past 18 years with new and existing customers, many of whom are senior citizens taking multiple daily medications for chronic conditions, and are now housebound due to COVID-19. Additionally, even U.S residents who live along the Canadian border and would normally travel to Canada to purchase their prescription medications have been affected by border closures.

CIPA member pharmacies sell 90-day supplies of maintenance medications—taken daily for chronic health conditions—exclusively for personal use. CIPA pharmacies, which are licensed in their jurisdiction of operation, do not sell opioids, other controlled substances, or highly temperature-sensitive medications, and do not sell in bulk to medical practitioners or healthcare facilities.

Additionally, CIPA pharmacies require the patient to have a written prescription from a U.S. doctor and have pharmacists on site to review all orders and be available for patient consultations.

Most importantly, CIPA member pharmacies have a 100% perfect safety record, serving millions of American customers since 2002 and selling pharmaceuticals at up to 80% less than in the U.S.

All of the above notwithstanding, much more needs to be done to make consumers aware of the many rogue actors selling questionable medications without having licensed pharmacies, trained pharmacists, or requiring patients to submit a doctor’s prescription. The ASOP Global survey highlighted risks associated with illegitimate or unsafe online pharmacies, including those rogues posing as ‘safe’ Canadian pharmacies. Dr. Aria Ilyad Ahmad, of York University’s Dahdaleh Institute for Global Health Research, is a specialist in the development of policy around safe internet pharmacies. He has made clear that we now stand at the intersection of health and governance, and that the actions of rogue pharmacy operators who sell fake or otherwise dangerous medications over the Internet must come to an end. CIPA agrees unequivocally with this assessment and works with the Canadian Anti-Fraud Centre, a collaboration of the Ontario Provincial Police and the Royal Canadian Mounted Police, to identify and close down rogue pharmacies illegally using the CIPA seal, which designates pharmacies meeting the strict safety and privacy requirements for membership in the association.

During COVID-19 we have observed the increase in new domain registrations related to pandemic keywords and have noted activities by unscrupulous operators peddling fake cures, vaccines or PPE. These actions are, in truth, a clarion call to focus our attention on the critical need to educate the public and as such, CIPA supports ASOP Global’s call for educating consumers. The “Beware of Rogues” section of the CIPA website, educates customers, and the “Verify a Website” page assists with identifying legitimate CIPA pharmacies, to support safe behaviour for consumers. As a result, many of CIPA member customers come directly from referrals from their healthcare providers, who have done their homework and recognize CIPA’s legitimacy and safety protocols; another factor identified by the survey.

To achieve the objective of establishing the same level of trust in Internet pharmacies as we have in bricks and mortar ones, much work still needs to be done to address the transnational complexities of a highly-regulated industry. Fortunately, stakeholders from across the pharmacy/Internet governance spectrum have been gathering at RightsCon and the IGF over the last several years to address the insidious problem of rogue actors. Discussions around favoring White Lists (to replace ineffective Black Lists); recent positive results from the Trusted Notifier pilot run by the FDA with .ORG, .COM, and .NET; and other novel approaches that begin to reveal what is being referred to as “the regulatory sweet-spot” that avoids the pitfalls of both over- and under-regulation, with an appropriate focus on human rights.

Exciting progress is being made and we, at CIPA, welcome this broad-based cooperation from experts, academics and likeminded groups who share our dedication to safety as we move into what ASOP Global references as the “digitalization of consumerism, including the use of online pharmacies.”