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Ashraf AR, Mackey TK, Fittler A. Search Engines and Generative Artificial Intelligence Integration: Public Health Risks and Recommendations to Safeguard Consumers Online. JMIR Public Health Surveill 2024; 10:e53086. [PMID: 38512343 PMCID: PMC10995787 DOI: 10.2196/53086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The online pharmacy market is growing, with legitimate online pharmacies offering advantages such as convenience and accessibility. However, this increased demand has attracted malicious actors into this space, leading to the proliferation of illegal vendors that use deceptive techniques to rank higher in search results and pose serious public health risks by dispensing substandard or falsified medicines. Search engine providers have started integrating generative artificial intelligence (AI) into search engine interfaces, which could revolutionize search by delivering more personalized results through a user-friendly experience. However, improper integration of these new technologies carries potential risks and could further exacerbate the risks posed by illicit online pharmacies by inadvertently directing users to illegal vendors. OBJECTIVE The role of generative AI integration in reshaping search engine results, particularly related to online pharmacies, has not yet been studied. Our objective was to identify, determine the prevalence of, and characterize illegal online pharmacy recommendations within the AI-generated search results and recommendations. METHODS We conducted a comparative assessment of AI-generated recommendations from Google's Search Generative Experience (SGE) and Microsoft Bing's Chat, focusing on popular and well-known medicines representing multiple therapeutic categories including controlled substances. Websites were individually examined to determine legitimacy, and known illegal vendors were identified by cross-referencing with the National Association of Boards of Pharmacy and LegitScript databases. RESULTS Of the 262 websites recommended in the AI-generated search results, 47.33% (124/262) belonged to active online pharmacies, with 31.29% (82/262) leading to legitimate ones. However, 19.04% (24/126) of Bing Chat's and 13.23% (18/136) of Google SGE's recommendations directed users to illegal vendors, including for controlled substances. The proportion of illegal pharmacies varied by drug and search engine. A significant difference was observed in the distribution of illegal websites between search engines. The prevalence of links leading to illegal online pharmacies selling prescription medications was significantly higher (P=.001) in Bing Chat (21/86, 24%) compared to Google SGE (6/92, 6%). Regarding the suggestions for controlled substances, suggestions generated by Google led to a significantly higher number of rogue sellers (12/44, 27%; P=.02) compared to Bing (3/40, 7%). CONCLUSIONS While the integration of generative AI into search engines offers promising potential, it also poses significant risks. This is the first study to shed light on the vulnerabilities within these platforms while highlighting the potential public health implications associated with their inadvertent promotion of illegal pharmacies. We found a concerning proportion of AI-generated recommendations that led to illegal online pharmacies, which could not only potentially increase their traffic but also further exacerbate existing public health risks. Rigorous oversight and proper safeguards are urgently needed in generative search to mitigate consumer risks, making sure to actively guide users to verified pharmacies and prioritize legitimate sources while excluding illegal vendors from recommendations.
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Affiliation(s)
- Amir Reza Ashraf
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Tim Ken Mackey
- Global Health Program, Department of Anthropology, University of California, La Jolla, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
| | - András Fittler
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
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Persson A, Troein M, Lundin S, Midlöv P, Lenander C. Exploring pharmacists' perspectives about substandard and falsified medical products through interviews. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100421. [PMID: 38405083 PMCID: PMC10885592 DOI: 10.1016/j.rcsop.2024.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/28/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Background The problem with substandard and falsified (SF) medical products may grow in high-income countries when e-commerce of medicines increases. Unauthorized websites offer medicines of insufficient quality. This underscores the importance of evaluating how the problem with SF medical products can be prevented from escalating. However, little is known about what knowledge and experience professionals working primarily with medicines have about the phenomenon. Objective This study was conducted to explore purposively selected pharmacists' experience and knowledge about SF medical products. Methods Twelve individual interviews were conducted with purposively selected pharmacists between May 2021 and September 2021. An interview guide was used with specific questions about e-commerce, which focused on exploring pharmacists' experience and knowledge about SF medical products. The interviews lasted, on average, 49 min and were analyzed using inductive qualitative content analysis. Results A main theme 'Pharmacists as guardians of safe medicines' emerged. This theme consisted of three categories pinpointing 'risk factors', 'protective factors', and 'opportunities for improvement' regarding SF medical products. Findings suggest that pharmacists can play a role in preventing the problem with SF medical products from escalating. Participants emphasized they were in this line of work to help patients and increase patient safety. Conclusions Pharmacists have the opportunity to empower the public with knowledge about SF medical products since they discuss medicines with many people every day. Awareness of risk factors for SF medical products enables pharmacists to guide patients to avoid risky purchases from unauthorized websites. To do this, better communication, and cooperation with patients and other healthcare professionals are needed.
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Affiliation(s)
- A. Persson
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, SE-20213 Malmö, Sweden
| | - M. Troein
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, SE-20213 Malmö, Sweden
| | - S. Lundin
- Department of Arts and Cultural Sciences, Lund University, LUX, Helgonavägen 3, SE-22100 Lund, Sweden
| | - P. Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, SE-20213 Malmö, Sweden
| | - C. Lenander
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Box 50332, SE-20213 Malmö, Sweden
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Monteith S, Glenn T, Geddes JR, Whybrow PC, Achtyes ED, Bauer M. Implications of Online Self-Diagnosis in Psychiatry. PHARMACOPSYCHIATRY 2024; 57:45-52. [PMID: 38471511 DOI: 10.1055/a-2268-5441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Online self-diagnosis of psychiatric disorders by the general public is increasing. The reasons for the increase include the expansion of Internet technologies and the use of social media, the rapid growth of direct-to-consumer e-commerce in healthcare, and the increased emphasis on patient involvement in decision making. The publicity given to artificial intelligence (AI) has also contributed to the increased use of online screening tools by the general public. This paper aims to review factors contributing to the expansion of online self-diagnosis by the general public, and discuss both the risks and benefits of online self-diagnosis of psychiatric disorders. A narrative review was performed with examples obtained from the scientific literature and commercial articles written for the general public. Online self-diagnosis of psychiatric disorders is growing rapidly. Some people with a positive result on a screening tool will seek professional help. However, there are many potential risks for patients who self-diagnose, including an incorrect or dangerous diagnosis, increased patient anxiety about the diagnosis, obtaining unfiltered advice on social media, using the self-diagnosis to self-treat, including online purchase of medications without a prescription, and technical issues including the loss of privacy. Physicians need to be aware of the increase in self-diagnosis by the general public and the potential risks, both medical and technical. Psychiatrists must recognize that the general public is often unaware of the challenging medical and technical issues involved in the diagnosis of a mental disorder, and be ready to treat patients who have already obtained an online self-diagnosis.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, Michigan, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, California, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Eric D Achtyes
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
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Limbu YB, Huhmann BA. What influences consumers' online medication purchase intentions and behavior? A scoping review. Front Pharmacol 2024; 15:1356059. [PMID: 38414739 PMCID: PMC10896895 DOI: 10.3389/fphar.2024.1356059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
Objective: Consumers increasingly buy pharmaceuticals online. No scoping review has been carried out to summarize and synthesize the studies that have identified drivers of consumers' purchase intention and behavior from online pharmacies. Thus, we conducted a scoping review to explore the extent to which prior research has studied consumer purchase intentions and behavior related to online pharmacies, the drivers previously identified to explain consumers' online pharmacy purchase intentions and behavior, and how these antecedents differ between OTC and prescription medications. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research. Methods: We searched PubMed, Web of Science, and Scopus to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-eight eligible studies. Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors. Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors (e.g., convenience, availability, lower prices, and favorable evaluations toward the purchase environment) more consistently enhanced online medication purchase intentions and behavior. An extensive agenda for future research is advanced.
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Affiliation(s)
- Yam B Limbu
- Department of Marketing, Montclair State University, Montclair, NJ, United States
| | - Bruce A Huhmann
- Department of Marketing, Virginia Commonwealth University, Richmond, VA, United States
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Haupt MR, Cuomo R, Cui M, Mackey TK. Is This Safe? Examining Safety Assessments of Illicit Drug Purchasing on Social Media Using Conjoint Analysis. Subst Use Misuse 2024; 59:999-1011. [PMID: 38319039 PMCID: PMC11019931 DOI: 10.1080/10826084.2024.2310507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Illicit substance sales facilitated by social media platforms are a growing public health issue given recent increases in overdose deaths, including an alarming rise in cases of fentanyl poisoning. However, little is known about how online users evaluate what features of social media posts convey safety, which can influence their intent to source illicit substances. Objectives: This study adapts conjoint analysis which assessed how attributes of social media posts (i.e., features) influence safety evaluations of mock posts selling illicit substances. 440 participants were recruited online for self-reporting use or purchase of controlled substances or prescription medicines recreationally. The following attributes were tested: drug packaging, drug offerings, profile photo of seller, payment info provided, and use of emojis. Results: Packaging was ranked the most important attribute (Average Importance =43.68, Offering=14.94, Profile=13.86, Payment=14.11, Emoji=13.41), with posts that displayed drugs in pill bottles assessed as the most safe. Attribute levels for advertising multiple drugs, having a blank profile photo, including payment information, and including emojis also ranked higher in perceived safety. Rankings were consistent across tested demographic factors (i.e., gender, age, and income). Survey results show that online pharmacies were most likely to be perceived as safe for purchasing drugs and medications. Additionally, those who were younger in age, had higher income, and identified as female were more likely to purchase from a greater number of platforms. Conclusions: These findings can assist in developing more precise content moderation for platforms seeking to address this ongoing threat to public safety.
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Affiliation(s)
- Michael Robert Haupt
- Department of Cognitive Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Global Health Policy & Data Institute, San Diego, CA USA
| | - Raphael Cuomo
- Global Health Policy & Data Institute, San Diego, CA USA
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA USA
| | - Manying Cui
- Global Health Policy & Data Institute, San Diego, CA USA
| | - Tim K. Mackey
- Global Health Policy & Data Institute, San Diego, CA USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA USA
- S-3 Research LLC, San Diego, CA USA
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Lyall B, Smith AKJ, Attwell K, Davis MDMDM. Antibiotics online: digital pharmacy marketplaces and pastiche medicine. MEDICAL HUMANITIES 2023; 49:713-724. [PMID: 37524441 DOI: 10.1136/medhum-2022-012574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 08/02/2023]
Abstract
The internet enables access to information and the purchasing of medical products of various quality and legality. Research and regulatory attention have focused on the trafficking of illicit substances, potential physical harms of pharmaceuticals, and possibilities like financial fraud. However, there is far less attention paid to antibiotics and other antimicrobials used to treat infections. With online pharmacies affording greater access, caution around antibiotic use is needed due to the increasing health risks of antimicrobial resistance (AMR). The COVID-19 pandemic has helped to normalise digital healthcare and contactless prescribing, amplifying the need for caution. Little is known of how antibiotics are consumed via digital pharmacy and implications for AMR prevention. To expand insight for AMR prevention policy in Australia and internationally, we use digital ethnographic methods to explore how digital pharmacies function in the context of health advice and policy related to AMR, commonly described as antimicrobial stewardship. We find that digital pharmacy marketplaces constitute 'pastiche medicine'. They curate access to pharmaceutical and information products that emulate biomedical authority combined with emphasis on the 'self-assembly' of healthcare. Pastiche medicine empowers the consumer but borrows biomedical expertise about antibiotics, untethering these goods from critical medicine information, and from AMR prevention strategies. We reflect on the implications of pastiche medicine for AMR policy, what the antibiotics case contributes to wider critical scholarship on digital pharmacy, and how medical humanities research might consider researching online consumption in future.
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Affiliation(s)
- Ben Lyall
- School of Media, Film and Journalism, Monash University, Caulfield, Victoria, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Attwell
- School of Social Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Gharaibeh L, Alameri MA, Al-Kabariti AY, Alsa'd AA, Abed A, Karameh N, Aldeeb ID. Practices, perceptions and trust of the public regarding online drug purchasing: a web-based survey from Jordan. BMJ Open 2023; 13:e077555. [PMID: 37890969 PMCID: PMC10619020 DOI: 10.1136/bmjopen-2023-077555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES Online purchasing, including drugs, increased dramatically in the last decade especially through the COVID-19 pandemic. The aim of this study was to investigate the frequency and attitudes of consumers concerning online drug purchasing and assess their perceptions regarding the benefits and disadvantages. DESIGN A web-based survey conducted through a self-administered questionnaire that was approved by the Institutional Review Board (IRB) committee, ethical approval number: IRB/Al-Ahliyya Amman University/3/13/2021-2022. Cronbach's alpha for the attributes of benefits and disadvantages was 0.608 and 0.744, respectively. Primary outcome measures were extent of trust of the public in online drug purchasing using Likert scale. Multivariate linear regression was used to assess predictors of the trust score. SETTINGS Hashemite Kingdom of Jordan. PARTICIPANTS Inclusion criteria; residents of the Hashemite Kingdom of Jordan 18 years or older. The questionnaire was distributed through snowball effect via different social media. RESULTS A total of 428 participants filled the questionnaire, their average age was 29.7±11.2. Almost all participants, 419 (98.6%) use the internet daily but only 79 (18.6%) participants shop online regularly. Fifty participants (11.8%) purchased drugs online and they had higher benefits score of online purchasing compared with those who did not buy drugs online, 12.5±3.7 and 10.9±3.1, respectively, p=0.002. Participant who purchased drugs online had an increase in trust score of 0.847 compared with those who did not purchase drugs online, p<0.001. In the multivariate model, participants with education level of high school or higher than high school, compared with those with education lower than high school had an increase in trust score of 1.336 (p=0.026) and 1.137 (p=0.039), respectively. CONCLUSION The public recognises the risks in buying drugs online. Awareness campaigns and regulations that control and monitor online drug purchasing should be implemented.
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Affiliation(s)
- Lobna Gharaibeh
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | | | - Aya Y Al-Kabariti
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Alhareth A Alsa'd
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Anas Abed
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Nida Karameh
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
| | - Ibrahim D Aldeeb
- Biopharmaceutics and Clinical Pharmacy Department, Al-Ahliyya Amman University, Amman, Jordan
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Almomani H, Raza A, Patel N, Donyai P. Reasons that lead people to buy prescription medicines on the internet: a systematic review. Front Pharmacol 2023; 14:1239507. [PMID: 37719862 PMCID: PMC10501782 DOI: 10.3389/fphar.2023.1239507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Aim: This systematic review explores the factors that could influence consumer's decision of purchasing prescription medicines using the Internet. Methods: Relevant databases were searched to retrieve studies published from 2012 to 2021. The studies selected for inclusion were those focused on the consumer's perspective and the purchase of prescription medicines. A narrative synthesis was employed. The Capability Opportunity Motivation-Behaviour (COM-B) and the Theoretical Domains Framework (TDF) were employed as conceptual lenses that guided the analysis. Results: Seventeen studies were included. These studies have adopted various methodologies: qualitative method (n = 4), quantitative method (n = 12), and mixed methods (n = 1). The studies were based in Europe (n = 8), North America (n = 3), Middle East (n = 4), and 2 studies were conducted in several countries (multinational). The analysis of these studies revealed 7 themes that represent the reasons that lead people to buy prescription medicines via the Internet. These themes were the consumers' beliefs about the outcomes of the purchase (perceived benefits and risks of the purchase), consumer's emotions that could influence the purchasing decision, the factors that increase or decrease consumer's level of behavioural control over the purchase (facilitators and barriers of the purchase), consumers knowledge about the purchase, the trusting beliefs that lead consumers to trust the online sellers of medicines, the social influencing factors, and the external environmental factors that could encourage the purchase. Discussion: This study provides a comprehensive review of the breadth of reasons that drive people to buy prescription medicines via the Internet. Identifying those reasons could provide the basis for regulators to design evidence-based awareness campaigns to minimise the purchase of prescription medicines via the Internet. Furthermore, future research directions have been provided in this review to build upon the existing knowledge and address the research gaps in this area.
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Affiliation(s)
- Hamzeh Almomani
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Amna Raza
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Parastou Donyai
- Department of Pharmacy and Forensic Science, Faculty of Life Science and Medicine, King’s College London, London, United Kingdom
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Yang G, Xu M, Li J. Impact of Digital Globalization on Health Behavior Through Integration of Ideological and Political Education in Schools Leading to the Spirit for Fighting Against (COVID)-19. Am J Health Behav 2023; 47:567-578. [PMID: 37596752 DOI: 10.5993/ajhb.47.3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objectives: In this study, we examined the impact of digital globalization on health behavior among students in Chinese schools, particularly in relation to the fight against COVID-19. Despite China's well-established system and positive health behavior towards the pandemic, students' health behavior is lacking. The study focuses on the role of ideological and political education in addressing this issue. Methods: Data were collected from Chinese schools with the help of a survey questionnaire by using area cluster sampling. Data analysis was carried out by employing Smart PLS. Results: We found that digital globalization has a positive effect on health behavior. Digital globalization also has a positive effect on global knowledge about COVID-19 and ideological and political education leading to health behavior. Conclusion: We identified that the influential role of digital globalization can change health behavior. Digital globalization led to global knowledge about the COVID-19 and further caused an influence health behavior among schools that led to improved health behavior of students. The outcomes of the study have valuable importance for the management of schools to decrease the effect of COVID-19 by developing positive health behavior.
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Affiliation(s)
- Guangping Yang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Ming Xu
- Academic Affairs Office of Xuzhou Medical University, Xuzhou, China
| | - Jiayuan Li
- President's Office of Xuzhou Medical University, Xuzhou, China
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Tang G, Izumi K, Izumisawa M, Koyama S. Analysis of Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and eHealth literacy: an online survey for digital experience design. Front Digit Health 2023; 5:1173229. [PMID: 37293181 PMCID: PMC10244771 DOI: 10.3389/fdgth.2023.1173229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Since the enactment of the revised Pharmaceutical Affairs Act in Japan in 2009, self-medication practices have increased in the country. However, studies report that consumers pay little attention to the medication facts and risks indicated on the packages of over-the-counter (OTC) medicines, which could be a potential risk. Since the COVID-19 pandemic, the digital transformation of purchasing OTC medicines has progressed. As an appropriate design for the digital transformation is likely to improve consumers' literacy and them obtaining medical information, this study systematically examines Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and its correlation to eHealth literacy, exploring an appropriate digital experience design in purchasing OTC medicine. Methods Participants from the Greater Tokyo Area of Japan participated in an online survey. Consumers' current behavior and preferences in accessing OTC medicine, receiving medication guidance, and obtaining medical information were examined. eHealth literacy was assessed using the J-eHEALS. Descriptive statistics, text mining, and thematic analysis were conducted to answer research questions. Results Over 89% of the respondents who had experience in purchasing OTC medicines preferred local pharmacies or stores rather than online purchasing, p < 0.001. Obtaining medicine guidance in pharmacies or stores was the main preference over other approaches, p < 0.001. Furthermore, most of the participants accepted selecting medicine on shelves and digital screens in-store. However, they were accustomed to using smartphones to obtain additional information at the pharmacy or drug store, p < 0.001; this behavior was positively correlated with eHealth literacy, p < 0.001. Conclusions Japanese consumers are seeking a combination of conventional and digital behaviors for purchasing OTC medicine rather than opting for a particular method. Most consumers prefer purchasing and receiving instructions in-store while searching for additional decision-making information online. eHealth literacy is positively associated with digital behaviors of OTC medicine information acquisition but less associated with medicine purchases and selections. The hybrid digital experience design may enhance the OTC medicine purchase experience and reduce potential risks by providing appropriate information.
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Affiliation(s)
- Guyue Tang
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Kairi Izumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | | | - Shinichi Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Faculty of Art and Design, University of Tsukuba, Ibaraki, Japan
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Limbu YB, Huhmann BA. Illicit Online Pharmacies: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095748. [PMID: 37174265 PMCID: PMC10178756 DOI: 10.3390/ijerph20095748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
This scoping review presents the extent and nature of the body of literature on illicit online pharmacies (IOPs) and identifies research gaps. Using the five-step framework developed by Arksey and O'Malley, we searched PubMed, Web of Science, EMBASE, CINAHL, Science Direct and PsycInfo to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-three articles that met the inclusion criteria. Ten themes were identified and categorized into five clusters: patient risk, healthcare providers, marketing and supply chain, public health and society, and policy and regulation. Research into these clusters has evolved over time and has focused increasingly on issues related to specific drugs rather than the overall phenomenon. Data collection has been dominated by convenience sampling, online searches, content analysis and surveys. Data analysis remains primarily descriptive. Gaps within the extant literature suggest an agenda for future research into regulation and enforcement; public health awareness and education; healthcare services; risks to patients and public health; patient-, price- and product-related issues; website design; social media promotion; and supply chains and logistics. We conclude that IOPs are vastly understudied and suggest an urgent need for further empirical and conclusive research.
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Affiliation(s)
- Yam B Limbu
- Feliciano School of Business, Montclair State University, 1 Normal Ave., Montclair, NJ 07043, USA
| | - Bruce A Huhmann
- Department of Marketing, Virginia Commonwealth University, Richmond, VA 23284, USA
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12
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Gibbs N. #Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram. TRENDS IN ORGANIZED CRIME 2023:1-40. [PMID: 37363752 PMCID: PMC10043544 DOI: 10.1007/s12117-023-09491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/28/2023]
Abstract
This article sets out to investigate the marketing of image and performance enhancing drugs (IPEDs) on the social media platforms Facebook and Instagram. Drawing upon a 'connective' ethnographic exploration of IPED use and supply, the paper first outlines a supplier typology on these platforms, before shedding light on the marketing strategies employed by sellers in order to overcome the inherent distrust of online sales and build a trustworthy brand. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered.
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Affiliation(s)
- Nick Gibbs
- Northumbria University, Lipman 032, 2 Sandyford Rd, Newcastle upon Tyne, NE1 8SB UK
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Almomani H, Patel N, Donyai P. News Media Coverage of the Problem of Purchasing Fake Prescription Medicines on the Internet: Thematic Analysis. JMIR Form Res 2023; 7:e45147. [PMID: 36943354 PMCID: PMC10131998 DOI: 10.2196/45147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND More people are turning to internet pharmacies to purchase their prescription medicines. This kind of purchase is associated with serious risks, including the risk of buying fake medicines, which are widely available on the internet. This underresearched issue has been highlighted by many newspaper articles in the past few years. Newspapers can play an important role in shaping public perceptions of the risks associated with purchasing prescription medicines on the internet. Thus, it is important to understand how the news media present this issue. OBJECTIVE This study aimed to explore newspaper coverage of the problem of purchasing fake prescription medicines on the internet. METHODS Newspaper articles were retrieved from the ProQuest electronic database using search terms related to the topic of buying fake prescription medicines on the internet. The search was limited to articles published between April 2019 and March 2022 to retrieve relevant articles in this fast-developing field. Articles were included if they were published in English and focused on prescription medicines. Thematic analysis was employed to analyze the articles, and the Theory of Planned Behavior framework was used as a conceptual lens to develop the coding of themes. RESULTS A total of 106 articles were included and analyzed using thematic analysis. We identified 4 superordinate themes that represent newspaper coverage of the topic of buying prescription medicines on the internet. These themes are (1) the risks of purchasing medicines on the internet (eg, health risks and product quality concerns, financial risks, lack of accountability, risk of purchasing stolen medicines), (2) benefits that entice consumers to make the purchase (eg, convenience and quick purchase, lower cost, privacy of the purchase), (3) social influencing factors of the purchase (influencers, health care providers), and (4) facilitators of the purchase (eg, medicines shortages, pandemic disease such as COVID-19, social media, search engines, accessibility, low risk perception). CONCLUSIONS This theory-based study explored the news media coverage of the problem of fake prescription medicines being purchased on the internet by highlighting the complexity of personal beliefs and the range of external circumstances that could influence people to make these purchases. Further research is needed in this area to identify the factors that lead people to buy prescription medicines on the internet. Identifying these factors could enable the development of interventions to dissuade people from purchasing medicines from unsafe sources on the internet, thus protecting consumers from unsafe or illegal medicines.
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Affiliation(s)
- Hamzeh Almomani
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Parastou Donyai
- Department of Pharmacy and Forensic Science, King's College London, London, United Kingdom
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14
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Chen R, Liu F, Zhang C, Wang W, Yang R, Zhao Y, Peng J, Kong W, Huang J. Trends in digital detection for the quality and safety of herbs using infrared and Raman spectroscopy. FRONTIERS IN PLANT SCIENCE 2023; 14:1128300. [PMID: 37025139 PMCID: PMC10072231 DOI: 10.3389/fpls.2023.1128300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
Herbs have been used as natural remedies for disease treatment, prevention, and health care. Some herbs with functional properties are also used as food or food additives for culinary purposes. The quality and safety inspection of herbs are influenced by various factors, which need to be assessed in each operation across the whole process of herb production. Traditional analysis methods are time-consuming and laborious, without quick response, which limits industry development and digital detection. Considering the efficiency and accuracy, faster, cheaper, and more environment-friendly techniques are highly needed to complement or replace the conventional chemical analysis methods. Infrared (IR) and Raman spectroscopy techniques have been applied to the quality control and safety inspection of herbs during the last several decades. In this paper, we generalize the current application using IR and Raman spectroscopy techniques across the whole process, from raw materials to patent herbal products. The challenges and remarks were proposed in the end, which serve as references for improving herb detection based on IR and Raman spectroscopy techniques. Meanwhile, make a path to driving intelligence and automation of herb products factories.
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Affiliation(s)
- Rongqin Chen
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Fei Liu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Chu Zhang
- School of Information Engineering, Huzhou University, Huzhou, China
| | - Wei Wang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Rui Yang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Yiying Zhao
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Jiyu Peng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Wenwen Kong
- College of Mathematics and Computer Science, Zhejiang A & F University, Hangzhou, China
| | - Jing Huang
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
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15
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Cox L, Gibbs N, Turnock LA. “Emerging anabolic androgenic steroid markets; the prominence of social media”. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2176286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Luke Cox
- Faculty of Movement & Rehabilitation Sciences (FaBeR), KU Leuven, Leuven, Belgium
| | - Nick Gibbs
- Leeds Trinity University, Leeds, England
| | - Luke A Turnock
- School of Social and Political Sciences / College of Social Science, University of Lincoln, Lincoln, England
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16
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Mavragani A, Patel N, Donyai P. Reasons That Lead People to End Up Buying Fake Medicines on the Internet: Qualitative Interview Study. JMIR Form Res 2023; 7:e42887. [PMID: 36795460 PMCID: PMC9982721 DOI: 10.2196/42887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many people in the United Kingdom are turning to the internet to obtain prescription-only medicines (POMs). This introduces substantial concerns for patient safety, particularly owing to the risk of buying fake medicines. To help reduce the risks to patient safety, it is important to understand why people buy POMs on the web in the first place. OBJECTIVE This study aimed to identify why people in the United Kingdom purchase medicines, specifically POMs, from the internet, and their perceptions of risks posed by the availability of fake medicines on the web. METHODS Semistructured interviews were conducted with adults from the United Kingdom who had previously purchased medicines on the web. Purposive sampling was adopted using various methods to achieve diversity in participants' experiences and demographics. The recruitment was continued until data saturation was reached. Thematic analysis was employed, with the theory of planned behavior acting as a framework to develop the coding of themes. RESULTS A total of 20 participants were interviewed. Participants had bought various types of POMs or medicines with the potential to be misused or that required a higher level of medical oversight (eg, antibiotics and controlled medicines). Participants demonstrated awareness of the presence and the risks of fake medicines available on the internet. The factors that influence participants' decision to buy medicines on the web were grouped into themes, including the advantages (avoiding long waiting times, bypassing gatekeepers, availability of medicines, lower costs, convenient process, and privacy), disadvantages (medicine safety concerns, medicine quality concerns, higher costs, web-based payment risks, lack of accountability, and engaging in an illegal behavior) of purchasing medicines on the web, social influencing factors (interactions with health care providers, other consumers' reviews and experiences, word of mouth by friends, and influencers' endorsement), barriers (general barriers and website-specific barriers) and facilitators (facilitators offered by the illegal sellers of medicines, facilitators offered by internet platforms, COVID-19 outbreak as a facilitating condition, and participants' personality) of the purchase, and factors that lead people to trust the web-based sellers of medicines (website features, product appearance, and past experience). CONCLUSIONS In-depth insights into what drives people in the United Kingdom to buy medicines on the web could enable the development of effective and evidence-based public awareness campaigns that warn consumers about the risks of buying fake medicines from the internet. The findings enable researchers to design interventions to minimize the purchasing of POMs on the web. A limitation of this study is that although the interviews were in-depth and data saturation was reached, the findings may not be generalizable, as this was a qualitative study. However, the theory of planned behavior, which informed the analysis, has well-established guidelines for developing a questionnaire for a future quantitative study.
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Affiliation(s)
| | - Nilesh Patel
- Department of Pharmacy Practice, Reading School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Parastou Donyai
- Department of Pharmacy and Forensic Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
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17
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Bashayr Ali A, Barrett R. Community pharmacists' knowledge of substandard and falsified medicines in clinical practice: a cross-sectional survey in Saudi Arabia. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:176-182. [PMID: 36748987 DOI: 10.1093/ijpp/riac107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/16/2022] [Indexed: 02/08/2023]
Abstract
AIM The main objective of this study was to explore community pharmacists' knowledge of substandard and falsified medicines (SFs). METHOD A descriptive cross-sectional study was conducted with community pharmacists in the Kingdom of Saudi Arabia using a pre-validated electronic survey. KEY FINDINGS Ninety-two community pharmacists participated in this study. Many of the respondents (68.5%) had no experience with identifying SFs. We identified a concerning trend of under-reporting SFs (P < 0.003). Respondents reported that SFs constitutes 1-5% of medicines, with weight loss medicines being the most targeted for falsification. Most of the respondents had a low level of awareness about the newly implemented anti-counterfeit system in Saudi Arabia called the 'Drug Track and Trace System' (28.3% not really, 23.1% not at all). Respondents showed low levels of knowledge about technologies available to detect SFs (P < 0.01). CONCLUSIONS Community pharmacists' self-reported awareness and knowledge of SFs in Saudi Arabia was inadequate; this deficiency may affect their ability to protect their patients from potential harm by combating SFs. As a regulatory body responsible for issues related to SFs, the Saudi Food and Drug Authority should develop an action plan to equip community pharmacists with training in SFs to enhance their ability to respond to SFs.
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Affiliation(s)
- Alsaeed Bashayr Ali
- School of Applied Sciences, Cockcroft Building, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
| | - Ravina Barrett
- School of Applied Sciences, Cockcroft Building, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
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18
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Jillani Z, Reinhard L, Hertig J. A narrative review of illegal online pharmacies and contemporary issues with restricting FDA-approved medication access. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231220512. [PMID: 38149839 PMCID: PMC10750516 DOI: 10.1177/27550834231220512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
The rapid growth of technology has transformed the way the public purchases many products, including medications. Online medication purchasing has become a convenient and confidential route for patients to access healthcare without leaving their homes. Online pharmacies have many benefits but also present an increased risk for patient harm caused by unintentionally purchasing from illegal online pharmacies. Illegal online pharmacies are those that operate online without the requisite valid licenses or supply drugs not approved by the Food and Drug Administration (FDA). As obtaining certain medications has become restricted, either due to policy or drug shortages, more patients are relying on services provided by Internet pharmacies. The overturning of Roe versus Wade has caused an emerging drug restriction that may coerce the public to turn to Internet pharmacies for purchasing medications. A narrative review was conducted to analyze both the past and present effects of medications sold by illegal online pharmacies to help recognize the implications of restricting access to FDA-approved medications. Several large science and health literature databases were searched to find relevant references. Resulting resources, which referenced the connection between restricting access to FDA-approved medications and the increase in illegal online sales, were included in this review. The information evaluated in this article will help inform healthcare providers and policymakers of the inadvertent effects of restricting access to FDA-approved medications.
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19
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Mavragani A, Jarmusch AK, Xu Q, Sun K, Lu A, Aguirre S, Lim J, Bhakta S, Dorrestein PC. Multifactor Quality and Safety Analysis of Antimicrobial Drugs Sold by Online Pharmacies That Do Not Require a Prescription: Multiphase Observational, Content Analysis, and Product Evaluation Study. JMIR Public Health Surveill 2022; 8:e41834. [PMID: 36563038 PMCID: PMC9823576 DOI: 10.2196/41834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a significant global public health threat. However, the impact of sourcing potentially substandard and falsified antibiotics via the internet remains understudied, particularly in the context of access to and quality of common antibiotics. In response, this study conducted a multifactor quality and safety analysis of antibiotics sold and purchased via online pharmacies that did not require a prescription. OBJECTIVE The aim of this paper is to identify and characterize "no prescription" online pharmacies selling 5 common antibiotics and to assess the quality characteristics of samples through controlled test buys. METHODS We first used structured search queries associated with the international nonproprietary names of amoxicillin, azithromycin, amoxicillin and clavulanic acid, cephalexin, and ciprofloxacin to detect and characterize online pharmacies offering the sale of antibiotics without a prescription. Next, we conducted controlled test buys of antibiotics and conducted a visual inspection of packaging and contents for risk evaluation. Antibiotics were then analyzed using untargeted mass spectrometry (MS). MS data were used to determine if the claimed active pharmaceutical ingredient was present, and molecular networking was used to analyze MS data to detect drug analogs as well as possible adulterants and contaminants. RESULTS A total of 109 unique websites were identified that actively advertised direct-to-consumer sale of antibiotics without a prescription. From these websites, we successfully placed 27 orders, received 11 packages, and collected 1373 antibiotic product samples. Visual inspection resulted in all product packaging consisting of pill packs or blister packs and some concerning indicators of potential poor quality, falsification, and improper dispensing. Though all samples had the presence of stated active pharmaceutical ingredient, molecular networking revealed a number of drug analogs of unknown identity, as well as known impurities and contaminants. CONCLUSIONS Our study used a multifactor approach, including web surveillance, test purchasing, and analytical chemistry, to assess risk factors associated with purchasing antibiotics online. Results provide evidence of possible safety risks, including substandard packaging and shipment, falsification of product information and markings, detection of undeclared chemicals, high variability of quality across samples, and payment for orders being defrauded. Beyond immediate patient safety risks, these falsified and substandard products could exacerbate the ongoing public health threat of antimicrobial resistance by circulating substandard product to patients.
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Affiliation(s)
| | - Alan K Jarmusch
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Qing Xu
- S-3 Research, San Diego, CA, United States.,Department of Healthcare Technology and Policy, University of California, San Diego, La Jolla, CA, United States
| | - Kunyang Sun
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Aileen Lu
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Shaden Aguirre
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Jessica Lim
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Simran Bhakta
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Pieter C Dorrestein
- Collaborative Mass Spectrometry Innovation Center, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States.,Department of Pharmacology, University of California, San Diego, La Jolla, CA, United States.,Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
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20
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Fittler A, Ambrus T, Serefko A, Smejkalová L, Kijewska A, Szopa A, Káplár M. Attitudes and behaviors regarding online pharmacies in the aftermath of COVID-19 pandemic: At the tipping point towards the new normal. Front Pharmacol 2022; 13:1070473. [PMID: 36642991 PMCID: PMC9833114 DOI: 10.3389/fphar.2022.1070473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic accelerated the online purchase of goods and services in which today's e-pharmacy is now an integral part of healthcare provisions in developed countries. The aim of our research was to assess the frequency and attitudes of European consumers purchasing medications online prior to and following the pandemic in the Visegrad Group countries (V4). An online cross-sectional study was conducted between May-August 2022. A 25-item questionnaire with single choice and 5-point Likert scale answers was used and implemented in Google forms and Pollfish. A sampling of 2087 responses was collected. A majority (92.8%) of the respondents were aware medicines can be purchased online, yet prefer traditional pharmacies (4.6 ± 0.8) and somewhat oppose the internet channel (2.8 ± 1.3). Following the outbreak of COVID-19 pandemic, respondents' attitude towards purchasing consumer goods (3.65 ± 0.89) and medications (3.26 ± 0.91) online increased, however, the change regarding medications is significantly smaller (p < 0.01). A distinct increase in the frequency of buying medicines (from 49.16% to 55.48%) and health products (from 60.61% to 63.0%) online was measured since the breakout of the COVID-19 pandemic (p < 0.05). Despite the relatively high prevalence witnessed in previous purchases, our results highlight the trend in which 18.3% of participants will definitely purchase medications online while a proportionate 17.7% will not in the future. Although long-term post-COVID attitudes towards the internet pharmacy channel have modestly increased, in comparison to previously published research the frequency of purchasing medications online has significantly increased during the past years. As national legislation in V4 countries permit only non-prescription online sales, our findings are primarily applicable to countries with similar regulatory environment. The rapid global spread of the coronavirus has transitionally affected medicinal purchase behaviors, augmenting potential public health concerns related to online sourcing. Consequently, public awareness campaigns are needed to promote verified online pharmacies and prevent the utilization of illicit websites and the use of unregistered, substandard and falsified medicinal products.
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Affiliation(s)
- András Fittler
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary,*Correspondence: András Fittler,
| | - Tünde Ambrus
- Department of Applied Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czechia
| | - Anna Serefko
- Department of Clinical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Lenka Smejkalová
- Department of Applied Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czechia
| | - Anna Kijewska
- Department of Clinical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Szopa
- Department of Clinical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Mátyás Káplár
- Department of Applied Psychology, Faculty of Humanities and Social Sciences, University of Pécs, Pécs, Hungary
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21
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Merino D, Gérard AO, Destere A, Askenazy F, Drici MD, Thümmler S. Antipsychotic Abuse, Dependence, and Withdrawal in the Pediatric Population: A Real-World Disproportionality Analysis. Biomedicines 2022; 10:biomedicines10112972. [PMID: 36428541 PMCID: PMC9687123 DOI: 10.3390/biomedicines10112972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Antipsychotic drugs (APs) aim to treat schizophrenia, bipolar mania, and behavioral symptoms. In child psychiatry, despite limited evidence regarding their efficacy and safety, APs are increasingly subject to off-label use. Studies investigating addictology-related symptoms in young people being scarce, we aimed to characterize the different patterns of AP misuse and withdrawal in children and adolescents relying on the WHO pharmacovigilance database (VigiBase®, Uppsala Monitoring Centre, Sweden). Using the standardized MedDRA Query 'drug abuse, dependence and withdrawal', disproportionality for each AP was assessed with the reporting odds ratio and the information component. A signal was detected when the lower end of the 95% confidence interval of the information component was positive. Results revealed mainly withdrawal symptoms in infants (under 2 years), intentional misuse in children (2 to 11 years), and abuse in adolescents (12 to 17 years). Olanzapine, risperidone, aripiprazole, and quetiapine were disproportionately reported in all age groups, with quetiapine being subject to a specific abuse signal in adolescents. Thus, in adolescents, the evocation of possible recreational consumption may lead to addiction-appropriate care. Further, in young patients with a history of AP treatment, a careful anamnesis may allow one to identify misuse and its role in the case of new-onset symptoms.
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Affiliation(s)
- Diane Merino
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice, CHU-Lenval, 06200 Nice, France
- CoBTek Laboratory, Université Côte d’Azur, 06000 Nice, France
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Alexandre O. Gérard
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Alexandre Destere
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Florence Askenazy
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice, CHU-Lenval, 06200 Nice, France
- CoBTek Laboratory, Université Côte d’Azur, 06000 Nice, France
| | - Milou-Daniel Drici
- Pharmacovigilance Center, Department of Pharmacology, University Hospital of Nice, 06000 Nice, France
| | - Susanne Thümmler
- Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice, CHU-Lenval, 06200 Nice, France
- CoBTek Laboratory, Université Côte d’Azur, 06000 Nice, France
- Correspondence:
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22
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Fittler A, Paczolai P, Ashraf AR, Pourhashemi A, Iványi P. Prevalence of Poisoned Google Search Results of Erectile Dysfunction Medications Redirecting to Illegal Internet Pharmacies: Data Analysis Study. J Med Internet Res 2022; 24:e38957. [PMID: 36346655 PMCID: PMC9682446 DOI: 10.2196/38957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/31/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background
Illegal online pharmacies function as affiliate networks, in which search engine results pages (SERPs) are poisoned by several links redirecting site visitors to unlicensed drug distribution pages upon clicking on the link of a legitimate, yet irrelevant domain. This unfair online marketing practice is commonly referred to as search redirection attack, a most frequently used technique in the online illegal pharmaceutical marketplace.
Objective
This study is meant to describe the mechanism of search redirection attacks in Google search results in relation to erectile dysfunction medications in European countries and also to determine the local and global scales of this problem.
Methods
The search engine query results regarding 4 erectile dysfunction medications were documented using Google. The search expressions were “active ingredient” and “buy” in the language of 12 European countries, including Hungary. The final destination website legitimacy was checked at LegitScript, and the estimated number of monthly unique visitors was obtained from SEMrush traffic analytics. Compromised links leading to international illegal medicinal product vendors via redirection were analyzed using Gephi graph visualization software.
Results
Compromised links redirecting to active online pharmacies were present in search query results of all evaluated countries. The prevalence was highest in Spain (62/160, 38.8%), Hungary (52/160, 32.5%), Italy (46/160, 28.8%), and France (37/160, 23.1%), whereas the lowest was in Finland (12/160, 7.5%), Croatia (10/160, 6.3%), and Bulgaria (2/160, 1.3%), as per data recorded in November 2020. A decrease in the number of compromised sites linking visitors to illegitimate medicine sellers was observed in the Hungarian data set between 2019 and 2021, from 41% (33/80) to 5% (4/80), respectively. Out of 1920 search results in the international sample, 380 (19.79%) search query results were compromised, with the majority (n=342, 90%) of links redirecting individuals to 73 international illegal medicinal product vendors. Most of these illegal online pharmacies (41/73, 56%) received only 1 or 2 compromised links, whereas the top 3 domains with the highest in-degree link value received more than one-third of all incoming links. Traffic analysis of 35 pharmacy specific domains, accessible via compromised links in search engine queries, showed a total of 473,118 unique visitors in November 2020.
Conclusions
Although the number of compromised links in SERPs has shown a decreasing tendency in Hungary, an analysis of the European search query data set points to the global significance of search engine poisoning. Our research illustrates that search engine poisoning is a constant threat, as illegitimate affiliate networks continue to flourish while uncoordinated interventions by authorities and individual stakeholders remain insufficient. Ultimately, without a dedicated and comprehensive effort on the part of search engine providers for effectively monitoring and moderating SERPs, they may never be entirely free of compromised links leading to illegal online pharmacy networks.
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Affiliation(s)
- András Fittler
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Péter Paczolai
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Amir Reza Ashraf
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Amir Pourhashemi
- Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Péter Iványi
- Department of Systems and Software Technologies, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
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23
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Song HS, Lee BM. The Viability of Online Pharmacies in COVID-19 Era in Korea. Int J Health Policy Manag 2022; 11:1977-1980. [PMID: 33590745 PMCID: PMC9808250 DOI: 10.34172/ijhpm.2020.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/19/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Hyun Sue Song
- Division of Medical Products Safety, Ministry of Food and Drug Safety, Cheongju, South Korea
| | - Byung-Mu Lee
- Division of Toxicology, College of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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24
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Hu Q, Hu H, Hu M, Zhang J, Gou L, Shi S, Zhou J, Zhou N, Huang Z. Use of failure mode and effect analysis to reduce patient safety risks in purchasing prescription drugs from online pharmacies in China. Front Med (Lausanne) 2022; 9:913214. [PMID: 35928298 PMCID: PMC9343844 DOI: 10.3389/fmed.2022.913214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Online pharmacies have gradually penetrated the market, but pose risks to patients' health. Failure Mode and Effect Analysis (FMEA) is an effective and reliable method for reducing pharmacy and medication risks. The purpose of this study was to conduct a prospective risk analysis of the process of purchasing prescription drugs from online pharmacies in China to guarantee drug quality and patient safety. Methods The FMEA was performed at Sichuan University, China. A multidisciplinary team was assembled comprising a leader, four regulators, four pharmacists, two experts, etc. The process was composed of eight subprocesses: searching for prescription drugs, submitting medication requirements, completing patient information forms, dispensing, delivering, etc. Brainstorming was used to identify and prioritize failure modes, propose corrective actions, and reduce risks. Risk priority numbers were the main criterion and were obtained by multiplying three scores: severity, occurrence and detectability, which were scored by the team The team proposed corrective actions for each selected failure mode. Results A total of forty-one potential failure modes were identified, and the causes, effects, and corrective actions of the 30 top failure modes were analyzed. The highest risk value was assigned to “photocopies of paper prescriptions uploaded were reused by patients.” Three failure modes for the S value of 5 were: “drugs are eroded and polluted by moisture or insects in the process of transportation,” “the qualification information of the pharmacies were absent or fake,” and “pharmacists fail to check prescriptions in accordance with Prescription Administrative Regulation.” Of the top failure modes, 36.67% were from Step 5, delivering the drug. After taking corrective measures to control risks, the risks reduced by 69.26%. Conclusion The results of this study proves that the FMEA is a valuable tool for identifying and prioritizing the risks inherent in online pharmacies. This study shows that there are many potential risks in the process of purchasing prescription drugs from online pharmacies, especially in the drug delivery stage. Enhanced training and the introduction of smart devices may minimize risks. Online pharmacies and Chinese regulators should consider these findings for risk mitigation and the improvement of regulations pertaining to online pharmacies.
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Affiliation(s)
- Qinyuan Hu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
- Administration for Market Regulation of Qionglai, Chengdu, China
| | - Haiyao Hu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ming Hu
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Jun Zhang
- Administration for Market Regulation of Chengdu, Chengdu, China
| | - Liangwen Gou
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Shuping Shi
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Jingyi Zhou
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Naitong Zhou
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
- *Correspondence: Naitong Zhou
| | - Zhen Huang
- Administration for Market Regulation of Chengdu, Chengdu, China
- Zhen Huang
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Sun Y, Hendrix A, Muluneh B, Ozawa S. Online Pharmacy Accessibility of Imatinib, An Oral Chemotherapy Medication. J Natl Compr Canc Netw 2022; 20:808-814. [PMID: 35830891 DOI: 10.6004/jnccn.2022.7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since prices of imatinib (Gleevec) remain high, patients on oral chemotherapy are looking for alternative methods to access this life-saving medication. We assessed the accessibility of imatinib through online pharmacies and analyzed each website for medication safety, price, and marketing tactics. METHODS We searched the term "buy imatinib online" using 4 commonly used internet search engines (Google, Bing, Yahoo!, and DuckDuckGo) and screened web pages displayed in the first 10 pages. Websites were included if they were published in English, sold imatinib, were free to access, and offered shipping in the United States. Websites were classified using LegitScript's categorization as "certified," "unclassified," "unapproved," or "rogue." We analyzed information on websites' patient safety characteristics, marketing techniques, pricing, domain registration information, and IP addresses. RESULTS Of the 44 online pharmacies identified, only 3 (7%) were certified, and the remainder were classified as rogue (52%; n=23), unapproved (30%; n=13), or unclassified (11%; n=5). Thirteen online pharmacies (30%; 9 rogue, 4 unclassified) sold imatinib without a prescription. Nearly one-quarter (n=10) of online pharmacies selling imatinib did not include drug-related warnings on their websites, and nearly half (n=21) did not limit the purchasable quantity. More than three-quarters (n=34) of online pharmacies selling imatinib did not offer pharmacist consultations, even though nearly all websites extended offers to speak with sales associates (91%; n=40). Most online pharmacies selling imatinib claimed price discounts (95%; n=42), but fewer provided bulk discounts (23%; n=10) or coupons (34%; n=15). One-third of rogue pharmacies selling imatinib (n=7) claimed to be registered or accredited on their websites. CONCLUSIONS The lack of safety measures taken by illegitimate online pharmacies endangers patient safety because they allow patients to purchase imatinib without appropriate evaluation for response, drug interactions, and adverse effects. Healthcare providers need to be aware of this practice and should assure patient access to imatinib through safe and legitimate pharmacies.
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Affiliation(s)
- Yujiao Sun
- Division of Practice Advancement and Clinical Education, and
| | - Adam Hendrix
- Division of Practice Advancement and Clinical Education, and
| | - Benyam Muluneh
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, and
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, and.,Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Leem JW, Jeon HJ, Ji Y, Park SM, Kwak Y, Park J, Kim KY, Kim SW, Kim YL. Edible Matrix Code with Photogenic Silk Proteins. ACS CENTRAL SCIENCE 2022; 8:513-526. [PMID: 35647284 PMCID: PMC9136975 DOI: 10.1021/acscentsci.1c01233] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 05/28/2023]
Abstract
Counterfeit medicines are a healthcare security problem, posing not only a direct threat to patient safety and public health but also causing heavy economic losses. Current anticounterfeiting methods are limited due to the toxicity of the constituent materials and the focus of secondary packaging level protections. We introduce an edible, imperceptible, and scalable matrix code of information representation and data storage for pharmaceutical products. This matrix code is digestible as it is composed of silk fibroin genetically encoded with fluorescent proteins produced by ecofriendly, sustainable silkworm farming. Three distinct fluorescence emission colors are incorporated into a multidimensional parameter space with a variable encoding capacity in a format of matrix arrays. This code is smartphone-readable to extract a digitized security key augmented by a deep neural network for overcoming fabrication imperfections and a cryptographic hash function for enhanced security. The biocompatibility, photostability, thermal stability, long-term reliability, and low bit error ratio of the code support the immediate feasibility for dosage-level anticounterfeit measures and authentication features. The edible code affixed to each medicine can serve as serialization, track and trace, and authentication at the dosage level, empowering every patient to play a role in combating illicit pharmaceuticals.
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Affiliation(s)
- Jung Woo Leem
- Weldon
School of Biomedical Engineering, Purdue
University, West Lafayette, Indiana 47907, United States
| | - Hee-Jae Jeon
- Weldon
School of Biomedical Engineering, Purdue
University, West Lafayette, Indiana 47907, United States
| | - Yuhyun Ji
- Weldon
School of Biomedical Engineering, Purdue
University, West Lafayette, Indiana 47907, United States
| | - Sang Mok Park
- Weldon
School of Biomedical Engineering, Purdue
University, West Lafayette, Indiana 47907, United States
| | - Yunsang Kwak
- Department
of Mechanical System Engineering, Kumoh
National Institute of Technology, 61 Daehak-ro, Gumi-si, Gyeongsangbuk-do 39177, Republic of Korea
| | - Jongwoo Park
- Department
of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Jeollabuk-do 55365, Republic of Korea
| | - Kee-Young Kim
- Department
of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Jeollabuk-do 55365, Republic of Korea
| | - Seong-Wan Kim
- Department
of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Jeollabuk-do 55365, Republic of Korea
| | - Young L. Kim
- Weldon
School of Biomedical Engineering, Purdue
University, West Lafayette, Indiana 47907, United States
- Purdue
University Center for Cancer Research, West Lafayette, Indiana 47907, United States
- Regenstrief
Center for Healthcare Engineering, West Lafayette, Indiana 47907, United States
- Purdue Quantum
Science and Engineering Institute, West Lafayette, Indiana 47907, United States
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Lobuteva L, Lobuteva A, Zakharova O, Kartashova O, Kocheva N. The modern Russian pharmaceutical market: consumer attitudes towards distance retailing of medicines. BMC Health Serv Res 2022; 22:582. [PMID: 35490211 PMCID: PMC9055368 DOI: 10.1186/s12913-022-07991-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Russia, remote retail trade of over-the-counter (OTC) medicines was legalised. According to statistics as of April 2020, consumer demand in the categories of “online pharmacies” increased by 803%. Methods The study was conducted in two stages by cross-sectional method using a structured questionnaire in the central region of Russia: 1st stage - July-August 2020; 2nd stage - February-March 2021. The results of the study were obtained using qualitative (method of discussions in focus groups) and quantitative methods (survey) of sociological research, logical and statistical analysis. The representativeness of the data was ensured by a sufficient sample size including 1194 consumers (with confidence probability = 0.95 and confidence interval ≤ 0.05). Results The number of respondents fully supporting the legalisation of online trade in medicines increased. Consumer attitudes towards online commerce depend on the age group of the respondents. 1.5 times more respondents over 46 years (12.1%) are strongly against distance selling of medicines compared to survey participants aged 18 to 25 years (7.8%). Six months after the first survey, no respondent strongly opposed the sale of prescription medicines through the internet, whereas in the first survey half of consumers held this view. The percentage of respondents who considered pharmaceutical counselling when purchasing medicines online as extremely important decreased by a factor of 4 over time (10.9%) M (08.2020) = 3.66 (0.992); M (03. 2021) = 3.17 (0.981) t = 7.66 (p < 0.05). Consumers consider accessibility for people with disabilities (80.3%) to be the most significant advantage of distance selling medicines. Conclusion Consumer demand for the purchase of medicines online will grow as this type of sale has undeniable advantages. However, some risks remain when buying medicines online.
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Affiliation(s)
- Liudmila Lobuteva
- Department of Organization and Economics of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Alisa Lobuteva
- Department of Organization and Economics of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
| | - Oksana Zakharova
- Department of Organization and Economics of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Oxana Kartashova
- Department of Organization and Economics of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Natalia Kocheva
- Department of Organization and Economics of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Penley B, Minshew L, Chen HH, Eckel S, Ozawa S. Accessibility of Low-cost Insulin From Illegitimate Internet Pharmacies: Cross-sectional Study. J Med Internet Res 2022; 24:e25855. [PMID: 35156937 PMCID: PMC8887631 DOI: 10.2196/25855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/30/2020] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is much public debate regarding the high cost of insulin. With 1-in-4 patients in the United States with type 1 diabetes reporting difficulties affording insulin, there is concern that some of these patients might look for cost savings on the internet, unaware that 96% of internet pharmacies are illegitimate. Patients who purchase insulin from illegitimate internet pharmacies remove themselves from traditional health care systems that ensure safe, quality-assured, and effective medication use. Objective This study aims to determine the accessibility of Humalog and NovoLog insulin from internet pharmacies and characterize how these sites approached patient safety, and priced as well as marketed their products. Methods From September to December 2019, we queried the phrases buy insulin online, buy Humalog online, and buy NovoLog online in common search engines. The first 100 search results from Google and Bing, and the first 50 search results from Yahoo! and DuckDuckGo were screened. Websites were included if they claimed to sell Humalog or NovoLog insulin, were active, free access, in the English language, and had a unique URL. The legitimacy of websites was classified using LegitScript. Safety and marketing characteristics were compared across the legitimacy of internet pharmacies. Internet pharmacy prices were compared with the prices offered through brick-and-mortar pharmacies using GoodRx. Results We found that 59% (n=29) of the 49 internet pharmacies in our analysis were illegitimate, whereas only 14% (n=7) were legitimate and 27% (n=13) were unclassified. Across illegitimate internet pharmacies, Humalog and NovoLog insulin were 2 to 5 times cheaper as compared with both legitimate internet pharmacies and brick-and-mortar stores. Risks associated with the use of illegitimate internet pharmacies by American consumers were evident: 57% (8/14) did not require a prescription, 43% (6/14) did not display medication information or warnings, and only 21% (3/14) offered access to purported pharmacists. This included 9 rogue internet pharmacies that sold Humalog and NovoLog insulin within the United States, where 11% (1/9) required a prescription, 11% (1/9) placed quantity limits per purchase, and none offered pharmacist services. Rogue internet pharmacies often offered bulk discounts (11/18, 61%), assured privacy (14/18, 78%), and promoted other products alongside insulin (13/18, 72%). The marketing language of illegitimate internet pharmacies appealed more to quality, safety, and customer service as compared with legitimate sites. Conclusions The ease of access to low-cost insulin through illegitimate internet pharmacies calls for urgent attention. Illegitimate internet pharmacies place patients at risk of poor-quality medications and subpar pharmacy services, resulting in adverse events and poor diabetes control. A multifaceted approach is needed to close illegitimate internet pharmacies through legal and regulatory measures, develop better search engine filters, raise public awareness of the dangers of illegitimate internet pharmacies, and address the high costs of insulin.
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Affiliation(s)
- Benjamin Penley
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lana Minshew
- Center for Innovative Pharmacy Education and Research, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephen Eckel
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Garcia JF, Diez MJ, Sahagun AM, Diez R, Sierra M, Garcia JJ, López C, Fernandez MN. Availability of Antibiotics for Veterinary Use on the Internet: A Cross-Sectional Study. Front Vet Sci 2022; 8:798850. [PMID: 35224075 PMCID: PMC8873107 DOI: 10.3389/fvets.2021.798850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
The misuse or overuse of antibiotics can favor the emergence of antimicrobial resistance, with a direct impact on human and animal health as well as on ecosystems. In this work, we have analyzed the web pages in which antibiotics for veterinary use can be purchased online. By using a specifically developed software, we carried out a detailed search to know if each individual antibiotic and the families included in the OIE list of antimicrobial agents of veterinary importance (in English and in Spanish) were sold, reviewing the offers according to the administration route and the species for which the antibiotics were intended. The greatest offer of antibiotics was for those compounds considered critically important by OIE. In the search in English, penicillins were available on 55.8% of the sites, tetracyclines on 55.0%, and fluoroquinolones on 52.7%. In Spanish, the families with the greatest presence were fluoroquinolones (67.9% of the sites), tetracyclines (67.9% of the sites), and penicillins (65.4% of the sites). Regarding individual antibiotics, the most offered in both searches were amoxicillin (49.6% of the sites in English and 57.7% in Spanish) and doxycycline (46.5% of the sites in English and 53.8% in Spanish). Most offers were for oral and parenteral administration and intended for cats and dogs and for bovines.
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Affiliation(s)
- Juan F. Garcia
- Department of Mechanical, Informatics and Aerospatiale Engineering, University of Leon, Leon, Spain
| | - M. Jose Diez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
| | - Ana M. Sahagun
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
- *Correspondence: Ana M. Sahagun
| | - Raquel Diez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
| | - Matilde Sierra
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
| | - Juan J. Garcia
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
| | - Cristina López
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
| | - M. Nelida Fernandez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, Leon, Spain
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Bansal S, Kaur H, Mahendiratta S, Sarma P, Kumar S, Sharma AR, Joshi R, Bhattacharyya A, Prajapat M, Prakash A, Medhi B. A preliminary study to evaluate the behavior of Indian population toward E-pharmacy. Indian J Pharmacol 2022; 54:131-137. [PMID: 35546465 PMCID: PMC9249159 DOI: 10.4103/ijp.ijp_836_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The use of the Internet has increased exponentially for buying as well as selling of goods. Even the purchase of medications online is no exception. Owing to its benefits, there are certain risk factors in purchase of online medicines. Currently, the data on the use of Internet pharmacies are limited. Thus, the main objective of our study is to assess the knowledge, attitude, and practices (KAP) of Indian population toward E-pharmacy in India carried out in the Department of Pharmacology, PGIMER, Chandigarh. A KAP questionnaire was prepared which was distributed to the participants through Google Forms and a URL sent to them. This questionnaire was divided into four sections including demographics, occupation, income, and use of the Internet to measure the alertness toward the online purchase of medicines. A total of 322 responses were collected, out of which only 268 (83.2%) participants were aware of online pharmacy. The awareness was more in males and that too in urban population. Among the respondents, majority of the users prefer to buy medicines offline (81%, n = 217) which can be due to poor quality of medicines and lack of trustworthy websites. The utmost reason for buying the medicine online was deficiency of availability in the market and differences in the prices. The most preferred drugs respondents were willing to buy online were prescription drugs followed by cosmetics and dietary supplements. In conclusion, of our results, most of the people use the Internet to search for the medications online who prefer to consult the physicians before buying. Therefore, the future of online pharmacy can be improved if there will be some set guidelines, awareness, and knowledge among the users.
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Affiliation(s)
- Seema Bansal
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,MM College of Pharmacy, Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India
| | - Hardeep Kaur
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saniya Mahendiratta
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Phulen Sarma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subodh Kumar
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Raj Sharma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupa Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anusuya Bhattacharyya
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Prajapat
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Prof. Bikash Medhi, Department of Pharmacology, Room No: 4044, 4th Floor, Research Block B, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
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Ahmed J, Modica de Mohac L, Mackey TK, Raimi-Abraham BT. A critical review on the availability of substandard and falsified medicines online: Incidence, challenges and perspectives. THE JOURNAL OF MEDICINE ACCESS 2022; 6:23992026221074548. [PMID: 36204527 PMCID: PMC9413502 DOI: 10.1177/23992026221074548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Simultaneous expansion of the Internet and increased globalisation of the
pharmaceutical industry have meant medication can be accessed transnationally
from both legal and illicit sources. This has coincided with the rise of
substandard and falsified medicines (SFMs) online. These products fail to meet
regulatory or quality standards and/or are constituted with substandard
ingredients, causing undesired pharmacological effects, including possible
injury and death. This review aimed to identify original research studies that
examined characteristics of SFM online sales, attitudes towards purchasing
medicines online and strategies to address this drug safety challenge. Keywords
of ‘Substandard’ and ‘Falsified’/‘Counterfeit’ and ‘Medicines’/‘Drugs’ and
‘Online’/‘Internet’ were searched using Web of Knowledge and PubMed databases.
Resulting literature, which satisfied the study’s inclusion criteria, was
included in the review, and the findings from each paper were assessed. From an
initial 185 literature articles, 7 were eligible according to the inclusion
criteria to be reviewed. These articles identified studies testing SFMs
purchased online, surveys of attitudes and knowledge about SFMs online, and
website content analysis to detect illegal online sales. Challenges identified
were lack of knowledge and awareness among consumers and physicians, in addition
to the use of direct-to-consumer-advertising, via Internet platforms and social
media, providing easy access to SFMs. Despite this, medicine authentication
technology, website verification approaches and new detection methods were
identified as potential solutions specific to online SFM sales. To address
online sales of SFMs, more robust research, greater awareness/educational
programmes, analytical detection methods and more stringent online global
governance are required.
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Affiliation(s)
- Jamee Ahmed
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Laura Modica de Mohac
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Tim K Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
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Predicting the Number of GHB-Related Toxicologic Admissions Using Google Trends Data. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
In the era of novel psychoactive substances (NPS), the internet became a relevant source of information and purchase for those who consume psychoactive drugs. Parallelly, a growing body of research aim to utilize web search metrics (most commonly by relying on Google Trends data) in the prediction of substance use-related trends, including epidemiological forecasting. The main goal of the current study was to assess the utility of web search queries in the prediction of Gamma-hydroxybutyrate (GHB)-related toxicologic admissions in Hungary by performing additive decomposition of time series to identify trend and seasonal components. Monthly data identified GHB-related search volume representing nationwide web interest towards this substance was found to be a significant covariate of admission rates; the seasonal component showed two peaks in the admission rates: one in December/January and another one in May, whereas more admissions on the weekends were observed as compared to weekday data in Hungary. By taking into account the subtle effect sizes of this study, these results suggest that Google Trends data may be useful in forecasting toxicologic admissions on a monthly level, yet a number of limitations should be considered when interpreting these associations. Web search metrics can therefore be used for early warning purposes in the field of toxicology as well. An external validation approach is also suggested by the authors.
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Fittler A, Adeniye L, Katz Z, Bella R. Effect of Infodemic Regarding the Illegal Sale of Medications on the Internet: Evaluation of Demand and Online Availability of Ivermectin during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147475. [PMID: 34299920 PMCID: PMC8304957 DOI: 10.3390/ijerph18147475] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic and the related infodemic generated confusion and increased demand of various pharmaceuticals, ushering in the opportunity for illicit online vendors to fill a gap in the marketplace using potentially dangerous products. The aim of our study is to provide evidence regarding increased demand, online availability and consumer accessibility of ivermectin, an anthelmintic agent, without substantiated indications in reference to SARS-CoV-2. In our study, we combined infodemiology methodology aligned with search engine result assessment and website analytics to evaluate patient safety risks. Users’ Google queries regarding ivermectin were trending and peaked during the last week of November 2020 and March 2021. Consumers more likely found links leading directly or indirectly (via redirection) to illegal online retailers representing nearly half (53.3%) of search engine result links regarding the first three result pages in December 2020 and topped off at 73.3% by March 2021. Illicit medicine retailers outnumbered and outranked their legitimate counterparts and dominated the first search engine results page. A vast majority (77.7%) of the identified online pharmacies were characteristically rogue; more than half (55.5%) offered prescription-only products without a valid medical prescription. Our results illustrate connection between infodemic and its consequences on the illicit online pharmacy market
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Affiliation(s)
- András Fittler
- Faculty of Pharmacy, Department of Pharmaceutics, University of Pécs, Rókus Street 2, 7624 Pécs, Hungary; (L.A.); (R.B.)
- Correspondence:
| | - Latifat Adeniye
- Faculty of Pharmacy, Department of Pharmaceutics, University of Pécs, Rókus Street 2, 7624 Pécs, Hungary; (L.A.); (R.B.)
| | - Zoltán Katz
- Department of Operational Medicine, University of Pécs, Medical School, Szigeti Street 12, 7624 Pécs, Hungary;
| | - Richárd Bella
- Faculty of Pharmacy, Department of Pharmaceutics, University of Pécs, Rókus Street 2, 7624 Pécs, Hungary; (L.A.); (R.B.)
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Miller R, Wafula F, Onoka CA, Saligram P, Musiega A, Ogira D, Okpani I, Ejughemre U, Murthy S, Garimella S, Sanderson M, Ettelt S, Allen P, Nambiar D, Salam A, Kweyu E, Hanson K, Goodman C. When technology precedes regulation: the challenges and opportunities of e-pharmacy in low-income and middle-income countries. BMJ Glob Health 2021; 6:bmjgh-2021-005405. [PMID: 34016578 PMCID: PMC8141442 DOI: 10.1136/bmjgh-2021-005405] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/16/2021] [Accepted: 05/01/2021] [Indexed: 11/15/2022] Open
Abstract
The recent growth of medicine sales online represents a major disruption to pharmacy markets, with COVID-19 encouraging this trend further. While e-pharmacy businesses were initially the preserve of high-income countries, in the past decade they have been growing rapidly in low-income and middle-income countries (LMICs). Public health concerns associated with e-pharmacy include the sale of prescription-only medicines without a prescription and the sale of substandard and falsified medicines. There are also non-health-related risks such as consumer fraud and lack of data privacy. However, e-pharmacy may also have the potential to improve access to medicines. Drawing on existing literature and a set of key informant interviews in Kenya, Nigeria and India, we examine the e-pharmacy regulatory systems in LMICs. None of the study countries had yet enacted a regulatory framework specific to e-pharmacy. Key regulatory challenges included the lack of consensus on regulatory models, lack of regulatory capacity, regulating sales across borders and risks of over-regulation. However, e-pharmacy also presents opportunities to enhance medicine regulation—through consolidation in the sector, and the traceability and transparency that online records offer. The regulatory process needs to be adapted to keep pace with this dynamic landscape and exploit these possibilities. This will require exploration of a range of innovative regulatory options, collaboration with larger, more compliant businesses, and engagement with global regulatory bodies. A key first step must be ensuring that national regulators are equipped with the necessary awareness and technical expertise to actively oversee this e-pharmacy activity.
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Affiliation(s)
- Rosalind Miller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University, Strathmore Business School, Nairobi, Kenya
| | - Chima A Onoka
- Department of Community Medicine, University of Nigeria, Nsukka, Nigeria
| | | | - Anita Musiega
- Institute of Healthcare Management, Strathmore University, Strathmore Business School, Nairobi, Kenya
| | - Dosila Ogira
- Institute of Healthcare Management, Strathmore University, Strathmore Business School, Nairobi, Kenya
| | - Ikedichi Okpani
- National Primary Healthcare Development Agency, Abuja, Nigeria
| | | | - Shrutika Murthy
- The George Institute for Global Health India, New Delhi, India
| | | | - Marie Sanderson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefanie Ettelt
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pauline Allen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
| | - Abdul Salam
- The George Institute for Global Health India, New Delhi, India
| | | | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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35
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Jairoun AA, Al-Hemyari SS, Abdulla NM, El-Dahiyat F, Jairoun M, Al-Tamimi SK, Babar ZUD. Online medication purchasing during the Covid-19 pandemic: potential risks to patient safety and the urgent need to develop more rigorous controls for purchasing online medications, a pilot study from the United Arab Emirates. J Pharm Policy Pract 2021; 14:38. [PMID: 33931118 PMCID: PMC8086226 DOI: 10.1186/s40545-021-00320-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Since the WHO announced that Covid-19 had become a global pandemic, online pharmacies have emerged as an extremely popular way to purchase medication due to the quarantine measures introduced by numerous countries to prevent the virus's spread. Aim The aim of this study was to collect information regarding the extent of online medication purchasing in the UAE and to assess the factors that motivating the purchase of medications from the internet. Method A convenience sampling of people living in the UAE was used to conduct an online descriptive cross-sectional study. Respondents were solicited using the social media platforms WhatsApp and Facebook, whereby they were asked to fill in a validated web-based questionnaire. The number of people buying medications from online pharmacies was calculated using a percentage with 95% CIs. Results 131 respondents (31.2%) [95% CI: 26.7–35.6] stated that they purchased medication via the Internet after Covid-19 was classed as a pandemic. It was found that those respondents most likely to have purchased medication via the Internet were male, single, and older and with a high school education. Conclusion More research should be conducted to investigate and compare the self-medication and associated risk factors between online pharmacies and community pharmacies. Moreover, regulatory bodies need to make and implement changes to the regulations that govern the sale and use of medications during COVID-19.
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Affiliation(s)
| | | | | | | | - Maimona Jairoun
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | | | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, West Yorkshire, UK
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36
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Alwhaibi M, Asser WM, A Al Aloola N, Alsalem N, Almomen A, Alhawassi TM. Evaluating the frequency, consumers' motivation and perception of online medicinal, herbal, and health products purchase safety in Saudi Arabia. Saudi Pharm J 2021; 29:166-172. [PMID: 33679178 PMCID: PMC7910136 DOI: 10.1016/j.jsps.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives Purchasing medicinal products from the internet has become more popular in the last three decades. Understanding consumers’ use and perception of the safety of medicinal products obtained online is essential. Therefore, this study aims to evaluate the extent of medicines purchased from the internet in Saudi Arabia, types of products, sources of information, the satisfaction, the motivational factors, and estimate consumers’ vigilance and tendency to report ADRs if occurred. Design A prospective cross-sectional study using a custom-designed questionnaire was conducted among community adults in Saudi Arabia, age ≥ 18. Setting Evaluation of community subjects' perception towards buying medicinal products was done through the internet in Saudi Arabia from 1st July 2020 until the end of August 2020. Main outcome measure(s) The main outcome of the study was purchasing medicinal products from the internet (Yes, No). Results Overall, 36% of the study participants (n = 643) have ever bought medicinal products from the internet (Table 2). Of those, the most obtained was herbal medicine, supplements, or cosmetics (61.3%). Motivational factors towards purchasing medicinal products from the internet were mostly positive, with the most commonly reported agreed motivational factors were lower cost (55.7%), easy online access (54.1%), a wide variety of products (52.6%), and more privacy (43.6%). Around 60.4% of participants believed that buying medicinal products from the internet can be safe. The most perceived risk was the difficulty of distinguishing between registered online pharmacies and other unlicensed commercial websites, with only 32.7% of the participants distinguishing between registered and unlicensed commercial websites. Conclusions This study sheds light on the consumers’ use and perception of the safety and risks of medicinal products purchased from the internet. The study findings noticeably describe the great need to increase safety awareness about obtaining medicinal products from the internet among the Saudi community.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wesam M Asser
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Noha A Al Aloola
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alsalem
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aliyah Almomen
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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37
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Rahman MS, Yoshida N, Tsuboi H, Maeda E, Ibarra AVV, Zin T, Akimoto Y, Tanimoto T, Kimura K. Patient safety and public health concerns: poor dissolution rate of pioglitazone tablets obtained from China, Myanmar and internet sites. BMC Pharmacol Toxicol 2021; 22:12. [PMID: 33653417 PMCID: PMC7923830 DOI: 10.1186/s40360-021-00478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Poor quality medicines have serious implications for public health. The aim of this study was to explore the quality of the antidiabetic pioglitazone, using samples collected in China and Myanmar, and samples purchased online. Methods In this cross-sectional study, we examined samples (n = 163) collected from hospitals in Shanghai, China in 2012 (n = 44), products purchased via the internet and imported into Japan in 2013 (n = 59), and samples purchased in shops in Yangon, Myanmar in 2015 (n = 60). Collected samples were subjected to visual inspection, authenticity investigation and quality testing (potency, content uniformity and dissolution test) by high-performance liquid chromatography. Samples were rated as compliant or non-compliant based on the relevant pharmacopoeial acceptance criteria. Results Visual inspection of all samples revealed compliant products. However, responses from manufacturers during authenticity investigation were poor. Among the n = 44 samples from China, one was non-compliant in the potency test. Among the n = 59 samples personally imported into Japan, 38% of generic samples were found to be non-compliant. In Myanmar, 13.3% of samples were non-compliant. Non-compliant samples predominantly failed in the dissolution test. All non-compliant samples were generic. Conclusions Despite the apparent satisfactory outcome on the samples from China, pioglitazone samples collected in Myanmar and purchased online for personal import into Japan included many substandard products, which failed quality assessment predominantly because of poor dissolution. Internet providers did not comply with Japanese regulations in various respects. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-021-00478-x.
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Affiliation(s)
- Mohammad Sofiqur Rahman
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan.
| | - Naoko Yoshida
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Hirohito Tsuboi
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Erina Maeda
- Department of Clinical Pharmacy and Healthcare Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | | | - Theingi Zin
- Department of Food and Drug Administration (FDA), Ministry of Health and Sports, Naypyidaw, Myanmar
| | - Yoshio Akimoto
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
| | - Tsuyoshi Tanimoto
- Pharmaceutical and Medical Device Regulatory Science Society of Japan, 150-0002, Osaka, Japan
| | - Kazuko Kimura
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, 920-1192, Kanazawa, Japan
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38
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Fincham JE. Negative Consequences of the Widespread and Inappropriate Easy Access to Purchasing Prescription Medications on the Internet. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:22-28. [PMID: 33841622 PMCID: PMC8025924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purchase of prescription medications via the Internet is a global phenomenon with significant economic, social, and health-related impacts. The growth of online purchasing of prescription medicines is significant and has been amplified by social isolation related to the COVID-19 pandemic, with many patients unable to obtain medicines as they normally would. By contrast, there are licensed, certified, legitimate retail pharmacies that provide significant and vital services to patients. OBJECTIVE To review the major public health threat from illegal entities that sell any type of prescription medicines to individuals without proper physician oversight. DISCUSSION Rogue and inappropriate online vendors are providing counterfeit and substandard medications fraudulently with untold impacts on morbidity and mortality globally. This article presents the differentiation between the types of legal and illegal Internet pharmacies, as well as the actions that are currently in play to affect the illegal online purchase of prescription medicines. Much must be done in a collaborative, global effort to address the public health threat of obtaining prescription drugs via the Internet. CONCLUSION Global, federal, state, health professional, societal, and patient-specific collaborations are necessary to affect the significant threat that is now present via the increasing ease of access to online medication purchases.
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Affiliation(s)
- Jack E Fincham
- Professor, Osher Lifelong Learning Institute, University of Arizona, and Dean Emeritus, University of Kansas School of Pharmacy, Tucson, AZ
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39
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Vida RG, Merczel S, Jáhn E, Fittler A. Developing a framework regarding a complex risk based methodology in the evaluation of hazards associated with medicinal products sourced via the internet. Saudi Pharm J 2020; 28:1733-1742. [PMID: 33424264 PMCID: PMC7783221 DOI: 10.1016/j.jsps.2020.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/31/2020] [Indexed: 11/18/2022] Open
Abstract
Today, the increasing number of illicit internet pharmacies is a global phenomenon, however, the size of the online pharmaceutical market is still relatively unknown and the dubious quality of products is questionable and warrants investigation. Descriptive data from this black market channel are derived from studies analyzing the online availability of different medications procured over the internet and their methodology is quite heterogeneous. Our aim was to develop a comprehensive and specific risk assessment for selecting high patient safety risk medications from the online pharmaceutical market. A rapid tool was developed based upon the two quality and safety standard resolutions in pharmaceutical practice, published by the European Directorate for the Quality of Medicines, and was illustrated on eye drops. We developed five dimensions in support of the risk assessment including intrinsic, extrinsic and potential risks of counterfeiting. The five criteria were integrated in a comprehensively weighted risk-scoring format. The probability of procuring the product from the internet was also assessed based on the number of relevant links within the first twenty search engine results and the cost of the products. With the application of the tool a dorzolamide & timolol combination eye drop represented the highest overall patient safety risk score. In consideration of our literature review of the past 20 years, there is no current, standardized methodology to effectively identify pharmaceutical products associated with high patient safety risks. Notably, the fully comprehensive analysis of the internet pharmaceutical market and the test purchase of all online available medicines is unrealistic. Therefore, we developed a method to aid online surveillance researches and targeted international organizational led joint actions against the uncontrolled sale of falsified and substandard medications (e.g.: Operation Pangea).
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Affiliation(s)
- Róbert György Vida
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Honvéd Street 3, 7624 Pécs, Hungary
- Corresponding author.
| | - Sára Merczel
- Department of Pharmacy, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, 7400 Kaposvár, Hungary
| | - Eszter Jáhn
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Honvéd Street 3, 7624 Pécs, Hungary
| | - András Fittler
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Honvéd Street 3, 7624 Pécs, Hungary
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40
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Matchanova A, Woods SP, Cushman C, Morgan EE, Medina LD, Babicz MA, Verduzco M, Loft S. Online pharmacy navigation skills are associated with prospective memory in HIV disease. Clin Neuropsychol 2020; 35:518-540. [PMID: 33131420 DOI: 10.1080/13854046.2020.1840632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The increased use of online pharmacy services in the midst of the COVID-19 pandemic provides an important backdrop against which to examine the role of neurocognitive functions in health-related Internet navigation skills among persons with chronic medical conditions, such as HIV disease. Prospective memory (PM) is reliably impaired in HIV disease and is related to laboratory-based measures of medication management capacity in other populations. This study examined whether PM shows veridicality in relationship to online pharmacy navigation skills in persons with HIV disease. METHOD Participants included 98 persons with HIV disease age 50 and older who completed the Cambridge Prospective Memory Test (CAMPROMPT) and the Medication-Management Test-Revised (MMT-R) as part of a neuropsychological study. Participants also completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate a simulated, experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). RESULTS Lower PM had medium associations with poorer MMT-R and TOPS accuracy scores that were not better explained by other neurocognitive functions. The association between PM and TOPS accuracy was driven by errors of omission and did not vary meaningfully based on whether the intention was cued by time or an event. CONCLUSIONS These data suggest that PM cue detection processes show veridicality with online pharmacy navigation skills. Future studies might examine the benefits of PM-based strategies (e.g., salient prompts) in supporting online health navigation skills in populations that experience clinically impactful PM failures.
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Affiliation(s)
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX, USA.,School of Psychological Science, University of Western, Perth, Australia
| | - Clint Cushman
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erin E Morgan
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Marizela Verduzco
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Shayne Loft
- School of Psychological Science, University of Western, Perth, Australia
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41
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Chiappini S, Schifano F. What about "Pharming"? Issues Regarding the Misuse of Prescription and Over-the-Counter Drugs. Brain Sci 2020; 10:brainsci10100736. [PMID: 33066476 PMCID: PMC7602178 DOI: 10.3390/brainsci10100736] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
Recently, a range of prescription and over-the-counter (OTC) drugs have emerged as being used recreationally, either on their own or in combination with other substances, both licit and illicit, including new psychoactive substances (NPS). Among them, the misuse of prescription drugs involves not only traditionally recorded substances, such as benzodiazepines and opioid pain relievers, but also gabapentinoids (e.g., pregabalin and gabapentin); some antidepressants, e.g., bupropion and venlafaxine; some second-generation antipsychotics, e.g., quetiapine and olanzapine. Moreover, the use of some OTC for recreational purposes appears on the increase, especially in vulnerable categories such as young people/youths, including the use of high dosages of the antidiarrheal loperamide; first-generation antihistamines, e.g., promethazine, cyclizine, and diphenhydramine; cough and cold preparations containing dextromethorphan and/or codeine. In this context, the role of the Internet has rapidly increased, playing a significant role both in the diffusion of emerging trends of drug misuse among users and experimenters, and the marketing, sale, and distribution of drugs through online pharmacies. This phenomenon within the context of a rapidly modifying drug scenario is a globally recognized health problem, determining severe adverse consequences, including fatalities, and represents a challenge for clinicians in general, psychiatrists, public health, and drug-control policies.
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Parmaksiz K, Pisani E, Kok MO. What Makes a National Pharmaceutical Track and Trace System Succeed? Lessons From Turkey. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:431-441. [PMID: 33008856 PMCID: PMC7541108 DOI: 10.9745/ghsp-d-20-00084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/16/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Track and trace systems are increasingly being implemented as a technological solution to secure pharmaceutical supply chains. Turkey was the first country to implement a full pharmaceutical track and trace system throughout the entire regulated domestic supply chain. This article explores the emergence and functioning of this system and the consequences for substandard and falsified medicine with a focus on the underlying political and economic factors. METHODS This study uses an explanatory case study approach that combined interviews with purposefully selected key informants and document analyses. RESULTS The main drivers for implementing the pharmaceutical track and trace system in Turkey centered on the elimination of reimbursement fraud and the prevention of falsified medicine in the regulated supply chain. Although stakeholders experienced both physical and software-related problems in implementation, the alignment of incentives of all stakeholders with the power of the state, along with leeway for adaptations, ultimately resulted in a successful process. This track and trace system provides a clean regulated supply chain, minimizes reimbursement fraud, facilitates fast market recalls, and can flag likely medicine shortages. Staff previously engaged in pharmacy inspections now concentrate on ensuring production quality, which reduces the risk of substandard medicines. CONCLUSIONS In Turkey, 4 factors drove the successful implementation of pharmaceutical track and trace: the political determination to eliminate reimbursement fraud, a large pharmaceutical market dominated by a single payer, medicine reimbursement being contingent on verified dispensing and prescription, and flexibility to adapt the system according to the needs of stakeholders during implementation.
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Affiliation(s)
- Koray Parmaksiz
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
| | - Elizabeth Pisani
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Policy Institute, King's College London, London, United Kingdom
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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43
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Penley B, Chen HH, Eckel SF, Ozawa S. Characteristics of online pharmacies selling Adderall. J Am Pharm Assoc (2003) 2020; 61:e103-e109. [PMID: 32912756 PMCID: PMC7476499 DOI: 10.1016/j.japh.2020.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Adderall (amphetamine-dextroamphetamine) is a controlled substance with harmful adverse effects if abused or misused. We assessed the availability of Adderall from common search engines, and evaluated the safety and marketing characteristics of online pharmacies selling Adderall. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS From December 2019 to February 2020, the phrase "buy Adderall online" was queried in four search engines: Google (N = 100), Bing (N = 100), Yahoo (N = 50) and DuckDuckGo (N = 50). Online pharmacies that claimed to sell Adderall and had unique Uniform Resource Locators, were active, free-access, and in English language were included. OUTCOME MEASURES Online pharmacies were categorized as rogue, unclassified, or legitimate on the basis of LegitScript classifications. Safety and marketing characteristics, and costs were collected. RESULTS Of the 62 online pharmacies found to sell Adderall, 61 were rogue or unclassified. Across all rogue and unclassified online pharmacies, prescriptions were not required (100%), pharmacist services were not offered (100%), and quantity limits were not placed on the number of Adderall purchases (100%). Rogue and unclassified online pharmacies appealed to cost, offering price discounts (61%), bulk discounts (67%), and coupon codes (70%). Contrary to their claims, cheaper prices were available for all formulations and dosages of Adderall from GoodRx than from these online pharmacies. Rogue and unclassified online pharmacies promoted and enabled the illicit purchase of Adderall, appealing to privacy (74%), offering purchase through cryptocurrency (74%), and claiming registration or accreditation of their sites (33%). CONCLUSION Rogue online pharmacies are pervasive in search engine results, enabling the illicit purchase of Adderall without a prescription. Consumers are at risk of purchasing Adderall, a medication with high abuse potential, from unsafe sources. Law enforcement, regulatory agencies, and search engines should work to further protect consumers from unregistered and illegitimate online pharmacies selling Adderall.
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Liu J, Zhou Y, Jiang X, Zhang W. Consumers' satisfaction factors mining and sentiment analysis of B2C online pharmacy reviews. BMC Med Inform Decis Mak 2020; 20:194. [PMID: 32807175 PMCID: PMC7433132 DOI: 10.1186/s12911-020-01214-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background In recent years, online pharmacies have been accepted by increasingly more consumers, and the prospects for online pharmacies are optimistic. This article explores the consumers’ satisfaction factors addressed in Business to Customer (B2C) online pharmacy reviews and analyzes the sentiments expressed in the reviews. The goal of this work is to help B2C online pharmacy enterprises identify consumers’ concerns, continuously improve the health services level. Methods This article was based on the Latent Dirichlet Allocation (LDA) topic model. From a third-party platform-based B2C online pharmacy and a proprietary B2C online pharmacy (JD Pharmacy and J1.COM, respectively), 136,630 pieces of over-the-counter (OTC) drug review data posted from January 1, 2015 to December 31, 2018 were selected as samples and used to explore the satisfaction factors of B2C online pharmacy consumers regarding the entire drug purchasing process. Then, the sentiments expressed in the drug reviews were analyzed with SnowNLP. Result Categorization of the 12 factors identified by LDA showed that 5 factors were related to logistics; these 5 factors, which also included the most drug reviews, made up 38.5% of the reviews. The number of factors related to drug prices was second, with 3 factors, and reviews of drug prices made up 25.5% of the reviews. Customer service and drug effects each had two related factors, and a smaller percentage of these reviews (13.95%) were related to drug effects. Consumers still maintain positive opinions of JD Pharmacy and J1.COM. However, some opinions on logistics and drug prices are expressed. Conclusion The most important task for online pharmacies is to improve logistics. It is better to develop self-built logistics. Both types of B2C online pharmacies can improve consumer viscosity by implementing marketing strategies. With regard to customer service, focusing on improving employees’ service attitudes is necessary.
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Affiliation(s)
- Jingfang Liu
- School of Management, Shanghai University, 99 Shangda Road, Shanghai, 200444, China
| | - Yingyi Zhou
- School of Management, Shanghai University, 99 Shangda Road, Shanghai, 200444, China.
| | - Xiaoyan Jiang
- School of Economics & Management, Tongji University, Shanghai, China
| | - Wei Zhang
- School of Management, Shanghai University, 99 Shangda Road, Shanghai, 200444, China
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Hong YR, Hincapie-Castillo JM, Xie Z, Segal R, Mainous AG. Socioeconomic and Demographic Characteristics of US Adults Who Purchase Prescription Drugs From Other Countries. JAMA Netw Open 2020; 3:e208968. [PMID: 32579194 PMCID: PMC7315289 DOI: 10.1001/jamanetworkopen.2020.8968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Little is known about the current use of imported drugs and the factors associated with individual purchase of medications outside the US. OBJECTIVE To evaluate the proportion of the US adult population that purchases medications in other countries and the patient factors associated with the behavior. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study used data from the 2015-2017 National Health Interview Survey. The study sample included 61 238 individuals 18 years or older who reported use of prescribed medication by a physician or other practitioner. Data analysis was performed in November 2019. MAIN OUTCOMES AND MEASURES Self-reported experience of purchasing prescription drugs from countries outside the US in the past 12 months. Internet use behaviors for health care included searches for health information and filling of a prescription online. Medication-taking behaviors included skipping or delaying filling a prescription and using alternative therapies to save money. Survey design-adjusted analysis was used to estimate and compare characteristics between those who purchased medications outside the US and those did not. Multivariable logistic regression was fitted to examine the association of medication purchases with internet use and medication-taking behavior factors. RESULTS Among 61 238 US adults taking prescription medications (mean [SD] age, 50.5 [18.5] years; 56.5% female; 70.8% white), the estimated prevalence of purchasing of medication outside the US was 1.5% (95% CI, 1.4%-1.7%; 2.3 million US individuals). Those who purchased medications outside the US were more likely to be older (age >64 years; adjusted odds ratio [aOR], 1.68; 95% CI, 1.24-2.29), to be from Hispanic (aOR, 1.70; 95% CI, 1.23-2.35) or immigrant populations (aOR, 3.20; 95% CI, 2.44-4.20), and to have higher educational attainment (bachelor's degree; aOR, 1.79; 95% CI, 1.27-2.54), lower family income (low income; aOR, 1.41; 95% CI, 1.06-1.87), and lack of insurance (aOR, 3.14; 95% CI, 2.33-4.21). Data analyses indicated that online health information-seeking behavior (aOR, 1.62; 95% CI, 1.33-1.98) or use of an online pharmacy (aOR, 2.30; 95% CI, 1.83-2.90) was associated with a greater likelihood of medication purchases outside the US. Individuals who skipped medications (aOR, 3.86; 95% CI, 3.05-4.88) or delayed filling a prescription (aOR, 4.04, 95% CI, 3.23-5.06) also had higher odds of purchasing medication outside the US. CONCLUSIONS AND RELEVANCE The findings suggest that patients are not using prescription purchases outside the US to meet their medication needs. However, monitoring to promote safe administration of medications imported into the US should be continued.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Juan M. Hincapie-Castillo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Zhigang Xie
- Department of Health Services Research Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
| | - Arch G. Mainous
- Department of Health Services Research Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville
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46
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Counterfeit drugs: A major issue for vulnerable citizens throughout the world and in the United States. J Am Pharm Assoc (2003) 2020; 61:e93-e98. [PMID: 32471767 DOI: 10.1016/j.japh.2020.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023]
Abstract
Instruct clinicians on counterfeit drugs and their implications for patient health. Counterfeit drugs imperil patients around the globe, and their penetration into the United States, Canada, and Western Europe is only increasing over time. In addition to inserting counterfeit drugs in the legitimate drug supply, rogue Internet pharmacies and consumer purchases while traveling abroad allow counterfeit drugs to endanger patients. Pharmacists need to understand the nature and severity of the issue and directly counter it through personal actions to secure a legitimate drug supply, such as by using verified distributors and examining the shipment packaging, product packaging, the bottle, and the label for evidence to determine if it is counterfeit or has been tampered with. They can also indirectly counter it through patient education and by working with other key stakeholders in the health care system. Given the risk to patients, pharmacists have an important role to play in limiting patient use of counterfeit drugs.
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48
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Garcia JF, Diez MJ, Sahagun AM, Diez R, Sierra M, Garcia JJ, Fernandez MN. The Online Sale of Antibiotics for Veterinary Use. Animals (Basel) 2020; 10:E503. [PMID: 32192151 PMCID: PMC7143797 DOI: 10.3390/ani10030503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/29/2020] [Accepted: 03/15/2020] [Indexed: 11/16/2022] Open
Abstract
Antibiotics are essential medicines against infectious diseases in both humans and animals. An inappropriate use of antibiotics can impair animal health and enhance the risk of bacterial resistance, as well as its transfer from animals to humans. The objective of this study was to assess the possibility of purchasing antibiotics for veterinary use on the internet, to evaluate if a prescription is required, and to determine the availability of drugs classified as the highest priority critically important antimicrobials (HP-CIA). The Google and Bing search engines and both simple and complex search strings in Spanish and in English were used. The simple search string was "buy veterinary antibiotics". Complex searches used wildcards and specific syntax. The searches carried out in Spanish revealed that 50% of websites operated in South America, and 65% of websites did not require a valid prescription. Fluoroquinolones were offered in 84% of these websites (45% without prescription), macrolides were offered in 63% of these websites (43% without prescription), and 3rd- and 4th-generation cephalosporins in 54% of these websites (38% without prescription). For the searches in English, 57% of these websites operated in the United States of America (USA), and 55% of them did not require a prescription. Fluoroquinolones were offered in 79% of these websites (49% without prescription), macrolides were offered in 72% of these websites (45% without prescription), and 3rd- and 4th-generation cephalosporins were offered in 49% of these websites (27% without prescription). Therefore, it is easy to illegally access antibiotics via the internet.
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Affiliation(s)
- Juan F. Garcia
- Department of Mechanical, Informatics and Aerospatiale Engineering, University of Leon, 24071 Leon, Spain;
| | - M. Jose Diez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain; (M.J.D.); (R.D.); (M.S.); (J.J.G.); (M.N.F.)
| | - Ana M. Sahagun
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain; (M.J.D.); (R.D.); (M.S.); (J.J.G.); (M.N.F.)
| | - Raquel Diez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain; (M.J.D.); (R.D.); (M.S.); (J.J.G.); (M.N.F.)
| | - Matilde Sierra
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain; (M.J.D.); (R.D.); (M.S.); (J.J.G.); (M.N.F.)
| | - Juan J. Garcia
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain; (M.J.D.); (R.D.); (M.S.); (J.J.G.); (M.N.F.)
| | - M. Nelida Fernandez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain; (M.J.D.); (R.D.); (M.S.); (J.J.G.); (M.N.F.)
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Nayyar GML, Breman JG, Mackey TK, Clark JP, Hajjou M, Littrell M, Herrington JE. Falsified and Substandard Drugs: Stopping the Pandemic. Am J Trop Med Hyg 2020; 100:1058-1065. [PMID: 30860016 DOI: 10.4269/ajtmh.18-0981] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Falsified and substandard medicines are associated with tens of thousands of deaths, mainly in young children in poor countries. Poor-quality drugs exact an annual economic toll of up to US$200 billion and contribute to the increasing peril of antimicrobial resistance. The WHO has emerged recently as the global leader in the battle against poor-quality drugs, and pharmaceutical companies have increased their roles in assuring the integrity of drug supply chains. Despite advances in drug quality surveillance and detection technology, more efforts are urgently required in research, policy, and field monitoring to halt the pandemic of bad drugs. In addition to strengthening international and national pharmaceutical governance, in part by national implementation of the Model Law on Medicines and Crime, a quantifiable Sustainable Development Goal target and an international convention to insure drug quality and safety are urgent priorities.
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Affiliation(s)
| | - Joel G Breman
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Tim K Mackey
- School of Medicine, University of California, San Diego, La Jolla, California
| | - John P Clark
- Pfizer Pharmaceuticals, Pfizer Global Security, New York, New York
| | - Mustapha Hajjou
- Global Health Impact Programs, United States Pharmacopeial Convention, Rockville, Maryland
| | - Megan Littrell
- Public Affairs, Program for Appropriate Technology in Health (PATH), Seattle, Washington
| | - James E Herrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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50
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Leem JW, Kim MS, Choi SH, Kim SR, Kim SW, Song YM, Young RJ, Kim YL. Edible unclonable functions. Nat Commun 2020; 11:328. [PMID: 31949156 PMCID: PMC6965141 DOI: 10.1038/s41467-019-14066-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023] Open
Abstract
Counterfeit medicines are a fundamental security problem. Counterfeiting medication poses a tremendous threat to patient safety, public health, and the economy in developed and less developed countries. Current solutions are often vulnerable due to the limited security levels. We propose that the highest protection against counterfeit medicines would be a combination of a physically unclonable function (PUF) with on-dose authentication. A PUF can provide a digital fingerprint with multiple pairs of input challenges and output responses. On-dose authentication can verify every individual pill without removing the identification tag. Here, we report on-dose PUFs that can be directly attached onto the surface of medicines, be swallowed, and digested. Fluorescent proteins and silk proteins serve as edible photonic biomaterials and the photoluminescent properties provide parametric support of challenge-response pairs. Such edible cryptographic primitives can play an important role in pharmaceutical anti-counterfeiting and other security applications requiring immediate destruction or vanishing features.
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Affiliation(s)
- Jung Woo Leem
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, 47907, USA
| | - Min Seok Kim
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science Technology, Gwangju, 61005, Republic of Korea
| | - Seung Ho Choi
- Department of Biomedical Engineering, Yonsei University, Wonju, 26493, Republic of Korea
| | - Seong-Ryul Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, 55365, Republic of Korea
| | - Seong-Wan Kim
- Department of Agricultural Biology, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, 55365, Republic of Korea
| | - Young Min Song
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science Technology, Gwangju, 61005, Republic of Korea
| | - Robert J Young
- Department of Physics, Lancaster University, Lancaster, LA1 4YB, UK
| | - Young L Kim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, 47907, USA.
- Purdue University Center for Cancer Research, West Lafayette, Indiana, 47907, USA.
- Regenstrief Center for Healthcare Engineering, West Lafayette, Indiana, 47907, USA.
- Purdue Quantum Science and Engineering Institute, West Lafayette, Indiana, 47907, USA.
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