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Posted by Tygokinos on 2023-01-21

Finally, the medications themselves could be expired, counterfeit, or cut with other substances. Even genuine drugs purchased from NPOPs could lead to a number of adverse events, including death, if the user is unaware of dangerous drug combinations or contraindicated medical conditions [ 353237 ]. While the recent focus, appropriately, has been placed on the regulation of online pharmacies, there is very little systematic research outside of case reports on two potentially more important basic issues: 1 why consumers use online pharmacies in the place of legitimate medical channels; and 2 with such a variety of safety concerns, why consumers of drugs purchased from NPOPs have worse health outcomes than those who obtain the same the drugs through legitimate healthcare channels.

The study described in this paper was designed to address these issues. Since most online pharmacies offer dozens of drugs for purchase, we needed to narrow the focus to users of a single representative target drug. Tramadol was selected as the representative drug for this study because it is extensively prescribed the third most frequently used analgesic [ 38 ] and it is one of the most commonly offered authentic drugs from NPOPs with few restrictions on refills or quantity of tablets offered [ 810 ].

Tramadol has a demonstrated abuse profile [ 39 - 41 ], but its rate of abuse is not as high as other opioids hence its noncontrolled status in the Controlled Substances Act.

Like all drugs, there is also the potential for adverse side effects that can pose serious health risks. For example, tramadol not only has the potential to produce many of the same adverse events as other opioids pain meds online without doctor prescription, constipation and dependence [ 39 ]but also carries a serious risk of potentially fatal grand mal seizures, which are exacerbated by contraindicated medications and medical conditions [ 42 - 44 ].

In a prior report, we documented the ease of obtaining tramadol over the Internet, the authenticity of which was certified by a chemical analysis [ 8 ]. The purchase required the completion of a brief questionnaire that served as a medical examination. Subsequently, a virtual prescription was generated and filled by a pharmacy in Canada.

The tramadol was received within 24 hours, and numerous phone calls and emails were received almost immediately to refill the prescription some offers included up to pills in a single order and have continued on a monthly basis for over three years thus far. It has been widely documented that recruiting and administering surveys over the Internet is an acceptable and beneficial research methodology [ 45 - 46 ].

While pain meds online without doctor prescription methods provide quick access to thousands of people, they are not easily used to attract a targeted audience.

To circumvent this problem, we developed a recruitment program that directly targeted a population of tramadol users with access to the Internet. Thus, our advertisement only appeared to Internet users who had an interest in tramadol or tramadol-related topics, making our target population more likely to include potential participants ie, users of tramadol. When users clicked the ad, they were automatically directed to an online consent form and the subsequent survey hosted on an institutional website.

Prescription drugs purchased through the internet: Who are the end users?

Subjects were screened to be 18 years of age, users of tramadol in the past 30 days for any reason, and United States residents. Since this study represents a preliminary approach into this area of research, no standardized instruments could address all points of inquiry. As such, we developed a descriptive tool centered on our representative drug, https://canadaiandrugservices.com/9-prescription-drugs-prices-vefim.php which questions about dosage schedules, adverse events, etc, were specifically related to tramadol.

While we developed this descriptive tool to meet the objectives of this pilot study, we hope that the results can provide a basis for a more standardized instrument that can be used to investigate the same objectives for any number of drugs purchased from NPOPs in future studies. Other than demographics, the survey covered a broad variety of topics related specifically to tramadol, including the following: dosage schedule, intended use, comorbidity, legitimate and illegitimate drug use, and adverse events.

Participants who listed NPOPs as a source of tramadol were presented with a subset of questions to determine the underlying factors behind their use of online pharmacies.

A total of tramadol users qualified for and completed this study. Of these participants, indicated that they received tramadol solely through a valid prescription from their local doctor and filled it at a local pharmacy.

As shown in Table 1both traditional and nontraditional users pain meds online without doctor prescription primarily white and female. Traditional users were significantly older than nontraditional users. Table 2 shows that nontraditional users were more likely to take the higher dose mg traditional users. Nontraditional users were also considerably more likely to use tramadol more frequently 5 or more times per week.

All traditional users used tramadol for its indicated purpose ie, to treat painwith only 2. Nontraditional users experienced a much more severe adverse event profile than traditional users Figure 2.

Both groups had high rates of suddenly stopping their use of tramadol, but nontraditional users were significantly more likely to cease use abruptly traditional users: Upon cessation, nontraditional users experienced more severe withdrawal online cvs pharmacy than traditional users see Figure 3.

Health Outcomes in Patients Using No-Prescription Online Pharmacies to Purchase Prescription Drugs

Our data indicate that those who eschew the typical doctor-patient relationship to obtain tramadol through NPOPs do so primarily for reasons related to cost and accessibility and, most importantly, expose themselves to great health risks. We found that nontraditional users who used NPOPs had much higher pain meds online without doctor prescription of all recorded adverse events, particularly life-threatening seizures, than traditional users who obtained a prescription for tramadol from their physician.

While the precise mechanisms are unknown, seizures are more prevalent in people who take high doses of tramadol [ 4252 ], have predisposing medical conditions eg, history of head injuries [ 53 ], or take contraindicated medications eg, tricyclic antidepressants [ 54 - 55 ].

Physicians are trained to recognize such predisposing factors, but nontraditional users are likely to be unaware of these potential complications, leading to poor health outcomes.

Purchases of Narcotic Pain Medication Without Prescriptions We obtained hydrocodone from eight domestic Web sites on which we placed orders without. An online doctor can only prescribe you prescription medicines online if the doctor: The doctor needs to meet all these conditions to make a correct diagnosis.

Moreover, we found that nontraditional users experienced much more intense opioid withdrawal symptoms when they stopped taking tramadol. The most logical explanation for these findings is that the lack of physician oversight in monitoring dosage schedules, contraindicated conditions, and concomitant medications was responsible for the increased intensity and frequency of adverse events in nontraditional users. Nearly all nontraditional users in our study indicated that their tramadol use was motivated, at least in part, by a need to treat a health condition eg, pain that was not otherwise managed through legitimate health care channels.

It was this pain meds online without doctor prescription of their unmet medical need ie, inadequate pain management that drove them to use NPOPs. This finding raises an important question: Why were normal medical channels shunned in favor of an online pharmacy?

There appear to be pain meds online without doctor prescription distinct motivations for using online pharmacies: 1 inability to pay the costs associated with obtaining a legitimate prescription; 2 limited access to a doctor who would prescribe tramadol or prescribe it at doses sufficient to fully relieve pain; and 3 unwillingness, not inability, to use legitimate medical channels.

There are several possible interpretations of the latter motivation. Second, the physician denied the patient additional tramadol because the doctor incorrectly believed the pain was managed to the extent pharmacies shipping to usa ie, inadequate pain management.

Third, the physician was reluctant to prescribe opioid analgesics, even a weak one such as tramadol, at sufficient levels to adequately relieve pain due to the inherent fear of iatrogenic dependence. At this time, it is unclear which of these was the strongest motivation to use NPOPs, but lack of access to appropriate medical treatment appears to be a major factor.

This should not be surprising given the well-documented regional, social, and economic differences in access to medical care in the United States [ 56 - 59 ]. It is also possible that some NPOP users, while initially using tramadol for therapeutic purposes, had predisposing factors that led to the development of tramadol misuse or abuse.

This euphorigenic use, a health outcome itself, would have led to higher dosages and increased frequency of use, playing a role in the higher rates of adverse events. In a physician-patient relationship, however, a doctor may have recognized predisposing factors for misuse and not prescribed an opioid analgesic or, if already prescribed, recognized the signs of abuse and misuse and switched from tramadol to a less addictive drug.

Although we used tramadol as a prototype in these studies, there is no reason to believe that different results would be observed with dozens of equally accessible prescription drugs obtained through NPOPs that are used without the oversight of a physician. The dangers of overdose and other adverse events with these medications, especially when little to no information about contraindicated medications and medical conditions is included with purchase, have the potential to be more clinically significant with other medications than those we observed with tramadol.

As such, the geometric growth in the use of online pharmacies around the world, both legitimate and illegitimate, should prompt intense medical and regulatory discussion about their role, if any, in the provision of medical care. Currently there are several bills and regulations being discussed to control the use of online pharmacies, some of which ban the use of those located outside of the United States [ 2223 ], but the following two factors need to be considered.

First, the passage of online pharmacy regulations that promote verification programs [ 24 ], licensure and location disclosures [ 3 ], standardized criteria for Internet-based prescriptions [ 60 - 61 ], and a more thorough analysis of the advantages and disadvantages of online health care services eg, the ability of online pharmacies to detect interactions between medications instantly [ 5 ] may help integrate online pharmacies into health care utilization models.

The reality, however, is that regulating these legitimate online pharmacies is likely to have no effect on those using NPOPs. These users have already turned their back on typical medical channels and seem to be able to quickly adapt to any change in access to online pharmacies eg, shift of NPOPs to foreign countriesand no amount of regulatory oversight would likely change their drug-purchasing behaviors.

Second, so long as a licensed doctor provides a prescription and the pharmacy verifies the legitimacy of the prescription, it would be inappropriate, perhaps unethical, to ban a patient from shopping around to find the most economical and convenient means of filling their prescriptions. Whether this doctor-patient relationship needs to be on a physical basis merits further discussion. Research has shown that email and virtual consultations are just as good, if not better, at capturing patient information necessary for health care decisions [ 2162 ].

Because of aggressive marketing and pricing strategies, as well as the recent shift in patients becoming more involved in their own health care decisions, people using online pharmacies are in danger of unconsciously transforming from pain meds online without doctor prescription to consumers, and then back to patients again when they suffer from adverse effects from the use of the drug [ 1363 - 64 ].

Patients should be aware of the real possibility that while offshore pharmacies may be cheaper and easier to use, the medications received may not be what was advertised.

For this reason, recent US Food and Drug Administration FDA and WHO reports have advocated global drug safety, including international cooperation regarding the regulation of online pharmacies [ 1131 ].

Such an effort is badly needed because if one country attempts to ban online pharmacies, most users will simply try a website from another country. Clearly, in addition to regulatory activity, educational efforts are needed to ensure that patients and physicians understand the positive and negative aspects of online pharmacies.

Perhaps most importantly, more research is needed to better understand the motivations of people who, despite the availability of legitimate online pharmacies, continue to seek medications using NPOPs.

Inherent in this study are all of the limitations typical of epidemiological and survey research, most notably generalizability and veracity of information gathered. With regard to the latter, most studies indicate that the results obtained from self-administered surveys are comparable to those elicited by trained interviewers.

In our study, there were no right or wrong answers. There was no incentive or need to lie about any information because respondents were paid for their participation regardless of their answers. In terms of a biased sample, it is true that our subjects might have greater economic status and certainly more computer literacy than the average person, but these users would most likely to be exposed to advertisements touting online pharmacies.

Our data suggest that online pharmacies may have a role in supplying prescribed medications because they are convenient and may charge less than traditional brick-and-mortar pharmacies. However, from a public health perspective, the potential benefits of online medical care need to be balanced against the use of unregulated pharmacies that could sell counterfeit or adulterated drugs and the dangers inherent in pain meds online without doctor prescription without any physician supervision.

This study was financed with institutional funds and was approved by the Institutional Review Board at Washington University in St.

Edited by G Eysenbach; submitted pain meds online without doctor prescription Skip to Main Content Skip to Footer. Article Authors Cited by 18 Tweetations 10 Metrics.

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Original Paper. Louis Campus Box S. Euclid Ave. Table 1. Demographics and health information for traditional and nontraditional users. Table 2. Tramadol use among traditional and nontraditional users. Quality of global e-pharmacies: can we safeguard consumers? Eur J Clin Pharmacol Dec;58 9 Controversies and legal issues doctro prescribing and dispensing medications using the Internet.

Mayo Clin Proc Feb;79 2 Online pharmacies: safety and regulatory considerations. Int J Health Serv ;37 2 Buying prescription drugs on the internet: promises and pitfalls. Source of drugs for prescription opioid analgesic abusers: a role for the Internet? Pain Med Sep;9 6 Quality of online pharmacies and websites selling prescription drugs: a systematic review.

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Pharmacoepidemiol Drug Saf Sep;19 9 World Health Organization. Safety and security on the internet: challenges and advances in member states. The Partnership at Drugfree. Thirty-six million Americans have bought medications online without a doctor's prescription. Marketing and pricing strategies of online pharmacies.

Can I safely order medicines online without a prescription from an online doctor? | canadaiandrugservices.com

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You are here: Home Topics Medicines Question and answer Can I safely order medicines online without a prescription from an online doctor?

Background: Many prescription drugs are freely available for purchase on the Internet without a legitimate prescription from a physician. Scores of web sites do not require a prescription to buy narcotics, stimulants, and other controlled substances, a study shows.

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