Guide for educators to implement newly developed course on the risk of substandard and falsified medical products sold online

Dear Editor,

The use of online pharmacies and websites, which sell medical products, has grown significantly worldwide with the increasing use of the Internet and the rise of e-commerce.^1,2 A report by the International Pharmaceutical Federation (FIP) ³ defines that online pharmacy (also known as Internet or mail-order pharmacy) is an umbrella term for retailers of non-prescription and prescription medicines that dispense or sell medicines directly to patients via mail and provide information on their products and services via the Internet. There are three types of online pharmacies: (chain) pharmacies that maintain both offline and online presences, online pharmacies that operate solely online and brick-and-mortar pharmacies that have an online presence.^{3 –5}

Legitimate online pharmacies can provide more accessible services to people with limited mobility and to people in remote areas. ⁶ When they are well regulated and operated, online pharmacies can (1) promote interprofessional collaboration through telehealth service, (2) create a central repository of medical information for patients to enhance patient-centred care, (3) create increased ability to implement automated systems that will detect drug–drug interactions to ensure patient safety, (4) improve adherence to prescriptions through automatic periodic medication orders for rational medication use, (5) provide increased access to medicines, (6) lower transaction and product costs and anonymity, reduce overhead cost for the pharmacy and eliminate the need for multiple pharmacy outlets.^5,6 This is in line with FIP’s international strategies to promote interoperable digital technology in providing high-quality, patient-centred digital pharmaceutical care to ensure accessible, safe and rational use of effective medicines. ⁷

While online pharmacies provide benefits to patients and healthcare system, not all of these online platforms are legitimate or regulated and thus some sell unsafe and ineffective medications, such as substandard and falsified (SF) medical products. ⁸ Illegal online pharmacies are thriving in a digital environment that offers anonymity, leverages rapid advancements in technology and operates under insufficient international regulation, creating clear risk factors for SF medical products and an illegitimate drug supply chain. ² They can violate regulations by selling prescription medications without a valid prescription, adequate directions for safe use, required warnings, or clear safety and efficacy information. ⁶

In recent years, patients have increasingly used websites to obtain medical products. ⁸ Self-diagnosis, self-prescription and the demand to obtain medicines that are limited/restricted in the market have increased the use of illegal online drug sellers, where SF medical products are often sold. Identifying SF medical products is challenging for both patients and healthcare professionals. Similarly, distinguishing legitimate online pharmacies from illegal ones can be difficult for patients and healthcare professionals alike.

On the healthcare professionals’ side, there is a knowledge and skill gap. For example, undergraduate pharmacy curricula do not adequately cover the problem of SF medical products. ⁹ Pharmacists, the medication experts for patients and communities, must develop the necessary knowledge and skills to educate patients on identifying reliable websites and avoiding illegal online drug sellers. They should also be adept at recognizing SF medical products and illegal online drug sellers, as well as counselling patients on how to obtain safe and appropriate medical products online. According to the FIP statement of policy on digital health, pharmacists have a responsibility to ensure that the use of technologies such as online presence for community pharmacies, online counselling or remote patient adherence monitoring and/or telehealth are supported by strong regulatory and ethical frameworks. ⁷

Educating healthcare professionals, including pharmacists, is crucial to preventing the use of SF medical products. Several educational initiatives address this issue, including the FIP online course on SF medical products for pharmacy students, which was developed in 2021. ¹⁰

This course comprises of five new modules to be embedded in existing SF medical product curricula. The modules were developed by FIP and reviewed by the FIP expert advisory group to provide good-quality training materials for the educators. The course covers (1) the problem of unsafe medication use through Internet pharmacy, (2) the current regulations about online pharmacy, (3) the best practice regarding safe medication use: case study examples, (4) the ways to access safe and legitimate medicine in different regions of the world, (5) how to advise patients about the use of online pharmacy and the role of pharmacists to combat such unsafe medication use. ¹⁰ The curricula provide advocacy points for pharmacists who have a crucial role to avoiding SF medical products and ensuring public safety. ¹⁰ The modules are developed for pharmacy students, including materials for training the next generation of pharmacists, to be used by educators and trainers.

FIP advocates for the inclusion of modules and curricula focused on online pharmacy education within pharmacy programmes worldwide. These modules should be integrated into pharmacy education to equip students with the knowledge to address this issue effectively. We call on educators to recognize the importance of focusing on online pharmacies in their curricula, ensuring that students understand the risks associated with SF medical products sold online. We invite educators to incorporate lessons on the dangers of SF medical products into their teaching, raising awareness of this critical issue among future healthcare professionals. The modules can serve as a tool for educators to emphasize the online aspects of SF medical products, in pharmacy education worldwide.

Aysu Sellçuk Zuzana Kusynová International Pharmaceutical Federation, The Hague, The Netherlands John B HertigHertig Healthcare Advising, Indianapolis, IN, USAPurdue University, West Lafayette, IN, USA