Drug Abuse Amidst COVID-19 Pandemic: A Dark Side of Online Pharmacy
A B S T R A C T
Online pharmacy has been in the focus of heightened interest during this lockdown period due to COVID outbreak in Nepal and worldwide. This paper explains the issues relevant to online pharmacies that sell drugs with or without prescriptions to patients at the retail level online (through software apps or website). The online pharmacy industry has shifted its target abruptly during this pandemic period in developing as well as developed countries. The various aspects of online pharmacy practice are listed within this article. Issues like access, prescription, availability, misuse, and lack of awareness among the patients are described. The challenges and opportunities are discussed as well as the necessity of rules and regulation for online pharmacies on country level are elaborated. A proper advice to the patients and proper monitoring of online pharmacy should be offered for proper and safer way of purchasing drugs. The zero tolerance to the misuse or abuse of prescription and non-prescription drugs should be practiced.
Keywords
Online pharmacy, drugs, COVID, pandemic, lockdown, prescriptions
Introduction
The lockdown due to COVID-19 have affected halted the pace of the world. Low- and Middle-income nations (LMICS) as well as developed nations are all equally affected. It has become difficult for many people to grab a hold of their daily medication uninterruptedly. While pharmacies might not have big problems in stock and the delivery of medical supplies, but patients obviously face a huge obstacle refilling drugs by reaching pharmacy or seeing the doctor physically because of country lockdown and as we cannot step out also due to fear of contracting COVID.
Online Pharmacy
An online pharmacy, internet pharmacy, or online drugstore is a pharmacy that operates over the internet and sends orders to customers through mail, shipping companies by online pharmacy web portal. As of the year 2017 till now there is not any such legal provision of starting an online pharmacy in many LMICS including Nepal.
The main issue with online pharmacies in Nepal is the lack of awareness amongst a vast majority of consumers. There are numbers of pharmacies in markets that offer their products and services through online. There is no doubt that this figure is going to rocket within 2020 given the rise in need of such services in Nepal if this lockdown situation is continued.
Aspects of Ongoing Practice of Home Delivery for Drugs
Conventional National and International pharmacies in Nepal and other nations as well and usually have controlled drug distribution systems from the manufacturer, sufficient validation, and follows good distribution practices with health care provider in the loop. Home delivery of medicines can be a desirable convenience, but sometimes it can lead to problems with uncontrolled distribution and with apparently no health care provider in the loop. As the courier of drugs through the delivery guy is being commonly practiced during this Lockdown period. Sometimes, an online pharmacy may not have the medicines which are needed for the patients. For example, 90 out of 100 people in Nepal think they are using different drugs as prescribed from doctors because they are not aware of the generic name because generic name is not been practiced in the pharmacies.
During this lockdown, usually, online pharmacies sell prescription drugs only with a prescription, while some do not require a written prescription and those are mostly operated through social media. However, the prescription drugs once prescribed are not looked by the pharmacy regarding whether that prescribed drugs needs to be reviewed or renewed by the health care provider. While some customers order drugs from such pharmacies to avoid the doctor’s visit cost, or other inconvenience of visiting a doctor like waiting time or to obtain medications which their doctors are unwilling to prescribe. Some customers consider this to be more convenient than traveling to a drugstore because of this community spread stage of COVID-19 Pandemic, in the same way as ordering household goods online rather than going to a shop. There is also risk of Illegal or unethical pharmacies sometimes send outdated, substituted, or counterfeit medications to the person who ordered the drug instead of the real medication as there is seen invisible shortages of drugs due to global lockdown.
People living in the Nepal and other countries where prescription medications are taken as costly option has more potential of turning to online pharmacies to ‘save money’. Pharmacies in the United States where prescription medicine are costly so people turn to online pharmacies which are approved by the National Association of Boards of Pharmacy. Nepal has no such regulation of online pharmacies. It is not sure yet that websites or software applications for online pharmacy are offering medications with or without a prescription and doctor review for dosages of drugs. This practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit, and the suitability of a medication for a specific individual. Pharmacies offering medication without requiring a prescription, doctor review, or supervision are sometimes deceitful and may supply unauthentic, ineffective, and possibly dangerous way of medication.
These Online Pharmacies are now been able to deliver medical products to Patients/customers using top-notch safety precautions. But they should obtain precautionary measures which include: 1) Delivery person should wear gloves and masks and carry hand sanitizers with them. 2) Before they leave with the order every delivery professional are going through a 2 steps of medical check-up that includes recording their body temperature for possible fevers, and a Question and Answer session where the pharmacy should ask them questions to find out whether they have travelled to infected area or has been in close contact with infected person recently. 3) And pharmacies must train delivery person regarding the COVID-19 and WHO Pandemic Control Protocol (WHOPCP).
Prescription Drugs Abuse and Misuse
Due to current situation of COVID-19 lockdown and rise of Online Pharmacies in LMICS including Nepal are leading to misuse of prescription drugs. Most of the patients in current time are producing their drugs order with the prescriptions which are not been revised by the doctors, neither the dosage of drugs are revised which lead to over use of medicines or overdose of medicines. For example, patients taking steroids; as steroids are not like sedatives/painkillers/opioid drugs as a result it doesn’t require revised prescriptions strictly and hence pharmacies are providing steroids to patients at a ease but patients are too unaware of fact that steroids can be result to addiction if it is over used with lots of unwanted side effects.
Prescription drug misuse is also common in young population. Drugs like pain killers/sedatives are widely being misused by the young people for recreation purposes. Another best example is recent spike in shopping of chloroquine/hydro chloroquine medicine. This medicine has been in pharmacist stock since past several years. However, recent branding of this medicine as potential prophylactics for COVID-19, has let stocking and piling of this medicine through online. This has let even the artificial scarcity of the medicine which is genuinely used by the arthritis or malaria patients. As online Pharmacy trend is widely practiced in current lockdown situation, which just require photograph of prescription to order drugs not knowing who is ordering medicine from the other end of web portal. Every 8 out of 10 houses has a member who got prescription for sedatives/pain killers due to hardship and stress LMICS people go through, which can be misused by young members of the house (kids) as they can easily order these kind of addictive drugs from online portals and abuse/misuse it. The average range of age of first misuse/abuse is just 13-17 years old in LMICS. More than 75% of drug abusers start with common prescription of sedatives and these age groups kids get these prescription drugs usually from a friend or relatives. Overuse during lockdown for COVID-19 is very much alarming in LMICS including Nepal. Patients of Migraine (using painkillers), patients using steroids are at high risk of drug misuse/abuse crisis.
Conclusion
There should be proper regulation for drug sold by online pharmacies which should include proper prescriptions, timely renewed or at least reviewed by the health care provider(s) and if there is requirement of change in dosage, patients should consult their doctors then should produce to order the required medicine from the pharmacies. Pharmacy should act strict while receiving any orders from patients, which involves inspection of their prescription details and confirming their patient Id from the respective hospitals.
Article Info
Article Type
Short ReportPublication history
Received: Sat 09, May 2020Accepted: Fri 05, Jun 2020
Published: Mon 15, Jun 2020
Copyright
© 2023 Avinash Chandra. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.DOI: 10.31487/j.DDA.2010.01.01
Author Info
Corresponding Author
Avinash ChandraAnnapurna Neurological Institute and Allied Sciences, Nepal