October 21, 2022
Professors Sachiko Ozawa, Ph.D., M.H.S and Benyam Muluneh, PharmD., BCOP, CPP at the UNC Eshelman School of Pharmacy have published research into the online availability of chemotherapy medication. Their research details the risks patients may face when purchasing their medication online and strategies they can use to keep themselves safe.
Their work marks a special collaboration between DPET (Division of Pharmacotherapy and Experimental Therapeutics) and PACE (Practice Advancement and Clinical Education). “We don’t usually get to work across divisions as often as we would like,” said Ozawa. “This research served as a great opportunity for Benyam to offer clinical expertise and for me to guide the study working with two PharmD students.” Ozawa worked on the project with two former PharmD students, Catherine Yujiao Sun, now a PGY2 oncology resident at Moffitt Cancer Center and Adam Hendrix, now a PGY1 pharmacy resident at Memorial Hermann Health System.
For their research into online chemotherapy medications, Ozawa and Muluneh chose to investigate imatinib to see how easy the drug was to access online for a potential buyer. Using several online search engines, they found a sample of 44 websites that sold and shipped imatinib in the United States, making the drug very accessible. However, 13 of these websites did not require a prescription to purchase imatinib, and ¾ of websites did not allow patients to speak with a pharmacist.
“This is a significant concern for patient safety as patients bypassing interactions with providers are likely to face much greater risks of nonadherence, discontinuation, treatment failures and adverse events,” said Ozawa. “Patients who are not frequently monitored on treatment response may overdose or underdose on the medication, resulting in adverse events or treatment failures.”
“If patients are getting imatinib without a prescription, it may mean they are not getting close laboratory and clinical monitoring” added Muluneh.
Ozawa and Muluneh observed that many of these unregulated pharmacies (dubbed “rogue pharmacies”) would mimic the presentation of legitimate online pharmacies, making it difficult for patients to distinguish between them and reputable sources for medication. Rogue pharmacies touting cheaper prices can seem alluring to customers but without pharmaceutical oversight, patients can receive harmful medications that are substandard or falsified. Even if patients are receiving legitimate drugs from an unregulated pharmacy, they are doing so without a prescription, putting their health and safety at risk.
Ozawa and Muluneh believe that clinicians should take an active role in ensuring their patients are not purchasing medications from rogue pharmacies. The professors state that clinicians should educate their patients on reputable avenues to receive medication and warn them of the dangers that illegitimate online pharmacies can pose for their health. The LegitScript website (www.legitscript.com) and the Verify Before You Buy website (www.verifybeforeyoubuy.org) are two resources that Ozawa and Muluneh strongly recommend patients use anytime they buy medication online. These websites help verify if an online pharmacy is reputable, making sure that patients receive clinical monitoring and legitimate drugs.
For patients who may be struggling to pay for cancer medication, the professors believe that healthcare teams, including pharmacists and social workers, should provide options for financial assistance to disincentivize patients from turning to cheaper but riskier avenues to receive their medication. Options such as manufacturer or health system medication assistance programs, patient assistance programs and third-party foundation grants can help alleviate the burden of expensive cancer medication for patients.
Ozawa and Muluneh hope that their attention their research has been receiving will have positive outcomes for patients in the future. “I hope our research raises awareness so that patients will not obtain imatinib from illicit online pharmacies and that patients will always see pharmacists to monitor their clinical outcomes,” said Ozawa.
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