Online pharmacy use in America is growing, but a survey conducted by the ASOP Global Foundation suggests that Americans’ knowledge of the risks is not.

In June 2021, building on a similar 2020 survey conducted by the Alliance for Safe Online Pharmacies, 1,500 Americans across the nation were asked about their perceptions and use of online pharmacies. Respondents were also asked about their awareness of and reaction to the Importation of Prescription Drugs final rule issued in September 2020, which allows states and other non-federal governmental bodies to submit proposals to Food and Drug Administration (FDA) to import medicines from Canada.

The results showed that Americans’ use of the internet for health care services continues to rise, yet far too few consumers are aware of the prevalence of illegal online pharmacies and the associated risks of substandard, falsified, or otherwise counterfeit products found on many of these sites. Up 7% from last year, nearly half of Americans 18 and older have ordered prescription medication online for either themselves or someone under their care. Moreover, the survey found that Americans are purchasing virtually every type of medication online, from prescriptions for chronic, ongoing conditions such as high blood pressure, asthma, and diabetes (23%) to specialty prescriptions for cancer and hormone replacement therapy (11%). And while many started purchasing prescriptions online in the past year due to coronavirus disease 2019 (COVID-19), 64% reported they will continue to use online pharmacies after the pandemic ends.

The survey also reaffirmed that the primary forces behind online pharmacy use across all demographics are convenience (60%) and cost (56%). These are clearly powerful drivers, as nearly half of individuals who have purchased prescriptions online acknowledged that it is at least somewhat risky to purchase their prescriptions online. But Americans are not just taking calculated risks. Many are willing to ignore trusted sources, such as FDA and health care providers, for these benefits. Nearly half of Americans would be open to purchasing prescription medicines from an online source not sanctioned by FDA if it increased their access, decreased their cost, and provided convenience to more medicines. That number is significantly higher (62%) among those who have previously purchased from an online pharmacy. Also consistent with last year’s results, 29% of Americans said they would likely use a website to order prescription medicines without consulting a health care provider and that number jumps to 50% for those who have purchased medication online in the past. 

This risky behavior is made worse by the fact that a significant number of Americans still have dangerous misconceptions about regulatory oversight online. Nearly half of Americans erroneously believe that all websites offering health care services and/or prescription medications via the internet have been approved by FDA or state regulators for compliance with all applicable laws. This misperception is even higher (59%) among those individuals who have purchased medication online before. Most Americans also expect some level of protection online. Nearly three-quarters of Americans believe that verified, safe websites selling prescription medications should appear first in search results and/or be clearly identified as legitimate in social posts and online marketplace listings, which is not the case. This is particularly alarming, as one in five Americans exclusively rely on online search platforms and social media platforms (Twitter, Facebook, Instagram) to locate the online pharmacies they visit.

With widespread assumptions of safety online, another concern is that recent approval of the prescription drug importation final rule may send many Americans online in search of cheaper medications sold by “Canadian pharmacies.” And the ASOP Global Foundation survey found those concerns may be warranted. When told that the rule allows United States pharmacies to buy prescription medicines from Canada, 37% of respondents said they would be more likely to consider purchasing medicines from Canadian online pharmacies. Of those individuals, 34% said knowing that the rule explicitly prohibits individual American patients from buying medicines from Canadian online pharmacies will not change their behavior and they are likely to consider buying from a Canadian online pharmacy.

These results underscore the need for policies that safeguard consumers from illegal online pharmacies by holding internet intermediates, such as search engines and domain registrars, accountable for the content on their platforms. In the wake of widespread misinformation online around the COVID-19 pandemic, policymakers on Capitol Hill have renewed interest in internet accountability, but it is yet to be seen whether illegal online pharmacies will enter part of the debate. It is far too easy today for bad actors to anonymously create illegal online pharmacies that dupe unsuspecting Americans searching for deals online. At any given time, there are thousands of websites ready to take advantage of Americans who trust that the websites they find online are legitimate and abiding by all applicable laws.