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Published: December 2005

Prescribing and Buying Medicine on the Internet - A Risky Business

Information on this subject has been updated. Read the most recent information.

Prescriber Update 27(1): 12-13.
December 2005

Medsafe Pharmacovigilance Team

Based on the 'Medicine and the internet' chapter authored by Stewart Jessamine and published in Cole's Medical Practice in New Zealand (2006 edition).

The advent of the internet has given rise to a new environment in which prescribers are presented with challenges beyond those encountered in the consulting room.  Prescribers should be cautious when providing authorisation (such as a written prescription) to enable patients to obtain medicines over the internet.  Prescribers should take into consideration factors such as the appropriateness of the medicine as well as safety and quality issues.  Prescribers must also be aware that prescribing should only be for patients under their care and that prescribers are expected to provide the same standard of professional service to patients regardless of the communication method used.

The internet presents new challenges for prescribers
Think twice about assisting patients to obtain medicines over the internet

Know your legal and ethical responsibilities when prescribing for patients

Don't risk prosecution - seek advice if in doubt

References

The internet presents new challenges for prescribers

Due to increasing use of the internet by health consumers, it is inevitable that prescribers may be asked either to prescribe by e-mail for a patient, or to provide authorisation (such as a prescription) to enable a patient to obtain a medicine they have decided to buy over the internet.  The current New Zealand legislation does not permit prescriptions to be issued by e-mail, so prescribers should avoid this activity.  Additionally, in this country, it is illegal for consumers to be in possession of a prescription medicine unless it has been prescribed for them by a New Zealand-registered prescriber.  Prescription medicines purchased over the internet enter the country by post and are subject to Customs inspection.  Therefore, patients may be contacted and asked to provide evidence that a New Zealand-registered medical practitioner accepts responsibility for prescribing the medicine.  While there are no legal barriers to prescribing to enable a patient to import a medicine purchased over the internet, this issue raises a number of ethical and practical questions.

Think twice about assisting patients to obtain medicines over the internet

There is a risk that medicines purchased on the internet may be counterfeit and therefore prescribers need to consider whether they are prepared to facilitate patient access to a medicine delivered through the uncontrolled route of the internet before writing a prescription or providing authorisation.  In coming to this decision, prescribers should consider whether the patient actually needs the medicine, and then consider if they are able to satisfy themselves that the medicine being imported meets the necessary standards of safety, quality and efficacy or in fact even contains the stated active ingredient.  These are important considerations as a decision to facilitate access by providing a prescription or other authorisation may expose the medical practitioner to legal liabilities if harmful consequences arise from the patient's use of a medicine purchased on the internet.  Prescribers who have queries about their legal liabilities and duty of care to patients in this situation should contact their medical indemnity organisation for advice.  There are also guidelines provided by the New Zealand Medical Council (see http://www.mcnz.org.nz/portals/0/Guidance/Use%20of%20the%20internet%20and%20electronic%20communication.pdf).1 It would also be reasonable to warn consumers against purchasing their medicines from internet sites based offshore due to the risk of poor quality or counterfeit products being supplied.2  Consumers should be especially wary of web sites offering to provide prescription medicines without a prescription.

Know your legal and ethical responsibilities when prescribing for patients

The Medical Council of New Zealand's Statement on the use of the Internet1 contains guidance on internet and electronic etiquette, and appropriate prescribing practices.  This Statement is currently undergoing review by the Medical Council, who intend to strengthen the advice that prescribers are expected to provide patients with the same standard of care and prescribing practice regardless of the communication method or service delivery mechanism used by the prescriber.3  The Medicines Regulations 1984 (section 39) clearly state that medical practitioners can only prescribe prescription medicines for patients under their care.  Medsafe and the Medical Council interpret this as requiring a face-to-face consultation with the patient.  In circumstances where the patient has previously been seen or examined by the doctor, prescribing should only occur if the doctor is confident that a physical examination would not add critical information about the management of the patient.1

Don't risk prosecution - seek advice if in doubt

Medical licensing authorities such as the local Medical Council and the Federation of State Medical Boards of the United States Inc, as well as regulatory authorities including Medsafe, have indicated that they are prepared to prosecute doctors who provide internet-based medical services to patients not under their care.  Medsafe has already successfully prosecuted a New Zealand-based company that was supplying prescription medicines without a prescription to consumers in the United States.  Medsafe is also investigating several cases where doctors have signed, or countersigned, prescriptions for consumers located overseas so that the medicines could be dispensed from New Zealand pharmacies and posted back to the consumers.  This activity is contrary to best medical and pharmacy practice, and the Medical Council's Statement.  The recent decision by the Pharmacy Council to add a new clause to its Code of Ethics to prohibit pharmacists from selling medicines intended for the treatment of chronic diseases to patients outside of New Zealand is a further example of how the health professions are no longer prepared to tolerate these activities.

Before embarking on any scheme to prescribe over the internet prescribers should take legal advice on the potential liabilities in both New Zealand law and in the law of the countries where their patients reside.  Prescribers should also check that the terms of their medical practice (malpractice) insurance would cover them for care of patients in other countries.

Competing interests (authors): none declared.

References
  1. Medical Council of New Zealand. Statement on use of the internet, Wellington, March 2001. http://www.mcnz.org.nz/portals/0/Guidance/Use%20of%20the%20internet%20and%20electronic%20communication.pdf (accessed 21 November 2005 and 19 May 2006).
  2. Medsafe Pharmacovigilance Team. Counterfeit medicines - Don't fake concern. Prescriber Update 2005:26(1):15-17. www.medsafe.govt.nz/profs/PUarticles/counterfeit.htm
  3. Campbell J (Chair, New Zealand Medical Council). Internet Medicine - the way forward. New Zealand Doctor 2005(19 Oct):30.

 

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