Τόμος 30 (2012) – Τεύχος 2 – Άρθρο 1 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 30 (2012) – Issue 2 – Article 1 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

Τίτλος – Title	Πλεονεκτήματα και Ιατρικοί Κίνδυνοι από την Προμήθεια Φαρμάκων μέσω του Διαδικτύου Advantages and Medical Risks Posed by Purchase of Drugs through the Internet
Συγγραφέας – Author	Σπύρος Μπάτζιος, Ελένη Παπακωνσταντίνου, Φανή Γκόμα, Γιώργος Καρακιουλάκης Α’ Εργαστήριο Φαρμακολογίας, Ιατρική Σχολή, Αριστοτέλειο Πανεπιστήμιο, Θεσσαλονίκη, Ελλάς Spyros Batzios, Eleni Papakonstantinou, Fani Goma, George Karakiulakis 1^st Laboratory of Pharmacology, School of Medicine, Aristotle University, GR-54124 Thessaloniki, Hellas
Παραπομπή – Citation	Μπάτζιος, Σ., Παπακωνσταντίνου, Ε., Γκόμα,Φ., Καρακιουλάκης,Γ. : Πλεονεκτήματα και Ιατρικοί Κίνδυνοι από την Προμήθεια Φαρμάκων μέσω του Διαδικτύου, Επιθεώρηση Κλιν. Φαρμακολ. Φαρμακοκινητ. 30: 81-90 (2012) Batzios, S., Papakonstantinou, E., Goma,F., Karakiulakis,G. : Advantages and Medical Risks Posed by Purchase of Drugs through the Internet, Epitheorese Klin. Farmakol. Farmakokinet. 30: 81-90 (2012)
Ημερομηνία Δημοσιευσης – Publication Date	20 Ιουνίου 2012 – 2012-06-20
Γλώσσα Πλήρους Κειμένου – Full Text Language	Ελληνικά – Greek
Παραγγελία – Αγορά – Order – Buy	Ηλεκτρονική Μορφή: pdf (15 €) – Digital Type: pdf (15 €) pharmakonpress[at]pharmakonpress[.]gr
Λέξεις κλειδιά – Keywords	Διαδίκτυο, αγορά φαρμάκων Internet drug sales
Λοιποί Όροι – Other Terms	Άρθρο Article
Περίληψη – Summary	Το διαδίκτυο αποτελεί στις ημέρες μας ένα σημαντικό μέσο επικοινωνίας, ενημέρωσης, ψυχαγωγίας, αλλά και εμπορίου, το οποίο επηρεάζει το σύνολο των δραστηριοτήτων του σύγχρονου ανθρώπου. Με την εμφάνιση των διαδικτυακών φαρμακείων η επίδρασή του στον τομέα υγείας πέρασε από την εποχή της απλής διάθεσης πληροφοριών, σε αυτή της άμεσης παροχής υπηρεσιών υγείας. Η αγορά φαρμάκων από διαδικτυακούς τόπους επίσημων και νόμιμων φαρμακείων προσφέρει στον ασθενή το πλεονέκτημα της ανωνυμίας, καθώς και της εξοικονόμησης χρημάτων, χρόνου και ενέργειας. Παρόλα αυτά, ο συγκεκριμένος τρόπος διακίνησης των φαρμάκων από παράνομα φαρμακεία του διαδικτύου ενέχει σοβαρούς κινδύνους, όχι μόνο γιατί παραμερίζει την παραδοσιακή σχέση μεταξύ ιατρού και ασθενούς, αλλά γιατί ευνοεί την κατάχρηση των φαρμακευτικών ουσιών και την πρόκληση ανεξέλεγκτων αλληλεπιδράσεων και ανεπιθύμητων και τοξικών ενεργειών. Επίσης, η αύξηση, που έχει παρατηρηθεί στην παράνομη διακίνηση φαρμάκων, τα οποία στην πλειονότητα των περιπτώσεων είναι αντίγραφα και δεν πληρούν τις προϋποθέσεις της ασφαλούς κατανάλωσης, αποδίδεται σε σημαντικό βαθμό στην αγορά φαρμάκων από παράνομα φαρμακεία του διαδικτύου. Στη λίστα των δημοφιλέστερων φαρμάκων που διακινούνται με τον τρόπο αυτό συγκαταλέγονται αντιμικροβιακά, εμβόλια, ορμόνες, αναλγητικά, διεγερτικά του ΚΝΣ, αλλά κυρίως τα ονομαζόμενα lifestyle φάρμακα. Οι επιπτώσεις από την παράνομη πώληση των ουσιών αυτών έχουν προσλάβει εξαιρετικά ανησυχητικές διαστάσεις για την υγεία των ασθενών, αυξάνοντας σε σημαντικό βαθμό τη νοσηρότητα και τη θνησιμότητα. Επιπρόσθετα, το ηλεκτρονικό εμπόριο φαρμάκων και η ηλεκτρονική διαφήμιση αφορούν τομείς που δημιουργούν σωρεία νομικών ερωτημάτων. Πρόκειται για καινοφανείς τομείς στη Νομική, οι οποίοι, παρά την απαγόρευση του πρώτου στις περισσότερες έννομες τάξεις και την περιοριστική ρύθμιση του δεύτερου τομέα, έχουν εισβάλλει στη ζωή μας σε παγκόσμιο επίπεδο και συνεχίζουν να εισχωρούν, γεγονός που δικαιολογεί, αλλά και επιβάλλει, μια όσο το δυνατόν πληρέστερη αντιμετώπισή τους. Για όλους τους παραπάνω λόγους, απαιτείται εγρήγορση των αρμοδίων φορέων εμπορίου και δικαιοσύνης, ιδιαίτερα δε των φορέων υγείας για το σχεδιασμό στρατηγικών πρόληψης, καθώς και σωστή ενημέρωση των ασθενών από τον ιατρό τους. The Internet is an ever expanding means for information, communication, entertainment and trade. With greater and greater frequency, patients are using the Internet to access health related information and purchase of drugs. The benefit is that on line sales of drugs by legal, reputable pharmacies has provided significant lowering of cost to patients. On the other hand, numerous online drug websites present serious health risks to patients and unique challenges to regulators, law enforcement officials and policy makers. The patient who purchases prescription drugs in cyber-space cannot easily distinguish between legal and illegal pharmacies. There is an increasing amount of evidence being published that illegal pharmacies sell drugs for which there is no quantitative or qualitative control of the active substance or the excipients they contain, that they are contaminated, and that there are no controls for their efficacy. This lack of control results to increased adverse reactions and/or decreased efficacy, and may lead to increased morbidity and mortality. There is need of institutional authorities for trade, justice and health, at national and international level to increase their vigilance and implement risk-based strategies to protect public health, regardless of the jurisdiction that a patient resides or an illegal cyber-space pharmacy is located.
Αναφορές – References	1. Forman R.F., Marlowe D.B., McLellan A.T.: The Internet as a source of drugs of abuse. Curr. Psychiatry Rep. 8: 377-382 (2006) 2. Goldsmith J.: How will the Internet change our health system? Health Aff. (Millwood) (1): 148-156 (2000) 3. Henney J.E.: Cyberpharmacies and the role of the US Food And Drug Administration. J. Med. Internet Res. 3(1): E3 (2001) 4. Orizio G., Schulz P., Domenighini S., Caimi L., Rosati C., Rubinelli S., Gelatti U.: Cyberdrugs: a cross-sectional study of online pharmacies characteristics. Eur. J. Public Health: 1-3 (2009) 5. Levy J.A., Strombeck R.: Health benefits and risks of the Internet. J. Med. Syst. 26: 495-510 (200) 6. Castronova J.R.: Operation cyber chase and other agency efforts to control internet drug trafficking. The “virtual” enforcement initiative is virtually useless. J. Leg. Med. 27: 207-24 (2006) 7. Dorsey P.J., Hellstrom W.J.C.: The Illicit Sale of Medications for the Treatment of Erectile Dysfunction. Available at: http://www.medscape.com. Accessed on 20/02/09 8. Lowes R.: Are online pharmacies good for your patients–and for you? Med. Econ. 77(11): 77-80, 84-86 (2000) 9. Weiss A.M.: Buying prescription drugs in the Internet: promises and pitfalls. Cleve Clin. J. Med. 73: 282-288 (2006) 10. Eysenbach G.: Online prescribing of sildenafil (Viagra) on the world wide web. J. Med. Internet Res. 1(2): E10 (1999) 11. Bessell T.L., Anderson J.N., Silagy C.A., Sansom L.N., Hiller J.E.: Surfing, self-medicating and safety: buying non-prescription and complementary medicines via the internet. Qual. Saf. Health Care 12(2):.88-92 (2003) 12. Royal Pharmaceutical Society of Great Britain. Half of Internet Viagra could be counterfeit new research shows. News from the British Pharmaceutical Conference. September 28, 2004. Available at: http://www.rpsgb.org.uk/ Accessed 13. Kelesidis T., Kelesidis I., Rafailidis P.I., Falagas M.E.: Counterfeit or substandard antimicrobial drugs: a review of the scientific evidence. J. Antimicrob. Chemother. 60: 214-236 (2007) 14. World Health Organization: Department of Essential Drugs and other Medicines. Guidelines for the development of measures to combat counterfeit drugs. Geneva (Switzer-land): World Health Organization; 1999. Publication No.: WHO/EDM/QSM/99.1. Available at: http://www.who.int/en/ Accessed on 17/02/09 15. World Health Organization: Counterfeit Medical Pro-ducts. Sixty-First World Health Assembly. W.H.O.; 7 April 2008. Publication No.: WHO/EDM/QSM/99.1. Available at: http://www.who.int/en/ Accessed on 17/02/09. 16. Juillet Y., Vlasto A.: Counterfeiting of medicinal drugs: issues and threats. Fundam. Clin. Pharmacol. 19: 621-624 (2005) 17. Food and Drug Administration. Combating Counterfeit Drugs: A report of the Food and Drug Administration. February 2004: http://www.fda.gov/oc/initiatives/ counterfeit/report02_04.html. 18. Roger B., Boateng K.: Bad medicine in the market. World Hosp. Health Serv. 43(3): 17-21 (2007) 19. Burns W.: WHO launches taskforce to fight counterfeit drugs. Bull. World Health Organ 84: 689-690 (2006) 20. Rudolf P.M., Bernstein I.B.G.: Counterfeit drugs. N. Engl. J. Med. 350: 1384-1386 (2004) 21. Cockburn R., Newton P.N., Agyarko E.K., Akunyili D., White N.J.: The global threat of counterfeit drugs: why industry and governments must communicate the dangers. PLoS Med. 2(4): E100 (2005) 22. World Health Organization. Fact sheets. Counterfeit Drugs – November 2003. Available at: http://www.who.int/en/ Accessed on 17/02/09. 23. Deisingh A.K.: Pharmaceutical counterfeiting. Tools and Resources. Analyst 130: 271-279 (2005) 24. Gratz S.R., Flurer C.L., Wolnik K.A.: Analysis of undeclared synthetic phosphodiesterase-5 inhibitors in dietary supplements and herbal matrices by LC-ESI-MS and LC-UV. J. Pharm. Biomed. Anal. 36: 525-533 (2004) 25. Laing Q., Qu J., Lou G., Wang Y.: Rapid and reliable determination of illegal adulterant in herbal medicines and dietary supplements by LC/MS/MS. J. Pharm. Biomed. Anal. 40: 305-311 (2006) 26. Scher C.S., Torres A., Wieder S.Y.: Internet drug access runs rampant. Anesth. Analg. 105:1868-1869 (2007) 27. Forman R.F., Woody G.E., McLellan T., Lynch K.G.: The availability of web sites offering to sell opioid medications without prescriptions. Am. J. Psychiatry 163: 1233-1238 (2006) 28. Forman R.F.: Innovations: Alcohol & drug abuse: Narcotics on the net: the availability of Web sites selling controlled substances. Psychiatr. Serv. 57(1): 24-26 (2006) 29. Schepis T.S., Marlowe D.B., Forman R.F.: The availability and portrayal of stimulants over the Internet. J. Adolesc. Health 42: 458-465 (2008) 30. Schifano F., Deluca P., Baldacchino A., Peltoniemi T., Scherbaum N., Torrens M., et al.: Drugs on the web; the Psychonaut 2002 EU project. Prog. Neuropsychopharma-col. Biol. Psychiatry 30: 640-646 (2006) 31. Manchikanti L.: National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician 10: 399-424 (2007) 32. Wilkinson E.: Is the online drugs market putting patients at risk? Nurs. Times 102(46): 23-24 (2006) 33. Fung C.H., Woo H.E., Asch S.M.: Controversies and legal issues of prescribing and dispensing medications using the Internet. Mayo Clin. Proc. 79:188-194 (2004) 34. Henney J.E., Shuren J.E., Nightingale S.L., McGinnis T.J.: Internet purchase of prescription drugs: buyer beware. Ann. Intern. Med. 131:861-862 (1999) 35. Korcok M.: Internet pharmacy: the tug-of-war intensifies. CMAJ. 170: 946-947 (2004) 36. Vredembregt M.J., Blok-Tip L., Hoorgerbrugge R., Barends D.M., de Kast D.: Screening suspected counterfeit Viagra and imitations of Viagra with near-infrared spectroscopy. J. Pharm. Biomed. Anal. 40: 840-849 (2006) 37. Bostwick J.M., Lineberry T.W.: Do cheap internet drugs threaten the safety of the doctor-patient relationship? Expert Opin. Drug Saf. 6(1): 9-13 (2007) 38. Buying Prescription Medicines Online: A Consumer Safety Guide. Food and Drug Administration Web site.: http://www.fda.gov/cder/consumerinfo/ brochureHiRez.pdf. 39. Amrutkar P., Sansgiry S.S.: Use of the Internet for medication purchases and health information: can we make it safer? Mayo Clin. Proc. 80: 704; author reply 704-705 (2005) 40. Ten Ham M.: Health risks of counterfeit pharmaceuticals. Drug Saf. 26: 991-997 (2003) 41. Montoya I.D., Jano E.: Online pharmacies: safety and regulatory considerations. Int. J. Health Serv. 37: 279-289 (2007) 42. Larson B.S.: Medications through the Internet: what clinicians and patients need to know. J. Pain Palliat. Care Pharmacother. 16(2): 49-57 (2002) 43. Ziance R.J.: Roles for pharmacy in combatting counterfeit drugs. J. Am. Pharm. Assoc. 48(4): 71-88 (2008)

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1. Forman R.F., Marlowe D.B., McLellan A.T.: The Internet as a source of drugs of abuse. Curr. Psychiatry Rep. 8: 377-382 (2006)

2. Goldsmith J.: How will the Internet change our health system? Health Aff. (Millwood) (1): 148-156 (2000)

3. Henney J.E.: Cyberpharmacies and the role of the US Food And Drug Administration. J. Med. Internet Res. 3(1): E3 (2001)

4. Orizio G., Schulz P., Domenighini S., Caimi L., Rosati C., Rubinelli S., Gelatti U.: Cyberdrugs: a cross-sectional study of online pharmacies characteristics. Eur. J. Public Health: 1-3 (2009)

5. Levy J.A., Strombeck R.: Health benefits and risks of the Internet. J. Med. Syst. 26: 495-510 (200)

6. Castronova J.R.: Operation cyber chase and other agency efforts to control internet drug trafficking. The “virtual” enforcement initiative is virtually useless. J. Leg. Med. 27: 207-24 (2006)

7. Dorsey P.J., Hellstrom W.J.C.: The Illicit Sale of Medications for the Treatment of Erectile Dysfunction. Available at: http://www.medscape.com. Accessed on 20/02/09

8. Lowes R.: Are online pharmacies good for your patients–and for you? Med. Econ. 77(11): 77-80, 84-86 (2000)

9. Weiss A.M.: Buying prescription drugs in the Internet: promises and pitfalls. Cleve Clin. J. Med. 73: 282-288 (2006)

10. Eysenbach G.: Online prescribing of sildenafil (Viagra) on the world wide web. J. Med. Internet Res. 1(2): E10 (1999)

11. Bessell T.L., Anderson J.N., Silagy C.A., Sansom L.N., Hiller J.E.: Surfing, self-medicating and safety: buying non-prescription and complementary medicines via the internet. Qual. Saf. Health Care 12(2):.88-92 (2003)

12. Royal Pharmaceutical Society of Great Britain. Half of Internet Viagra could be counterfeit new research shows. News from the British Pharmaceutical Conference. September 28, 2004. Available at: http://www.rpsgb.org.uk/ Accessed

13. Kelesidis T., Kelesidis I., Rafailidis P.I., Falagas M.E.: Counterfeit or substandard antimicrobial drugs: a review of the scientific evidence. J. Antimicrob. Chemother. 60: 214-236 (2007)

14. World Health Organization: Department of Essential Drugs and other Medicines. Guidelines for the development of measures to combat counterfeit drugs. Geneva (Switzer-land): World Health Organization; 1999. Publication No.: WHO/EDM/QSM/99.1.

Available at: http://www.who.int/en/ Accessed on 17/02/09

15. World Health Organization: Counterfeit Medical Pro-ducts. Sixty-First World Health Assembly. W.H.O.; 7 April 2008. Publication No.: WHO/EDM/QSM/99.1.

Available at: http://www.who.int/en/ Accessed on 17/02/09.

16. Juillet Y., Vlasto A.: Counterfeiting of medicinal drugs: issues and threats. Fundam. Clin. Pharmacol. 19: 621-624 (2005)

17. Food and Drug Administration. Combating Counterfeit Drugs: A report of the Food and Drug Administration. February 2004: http://www.fda.gov/oc/initiatives/ counterfeit/report02_04.html.

18. Roger B., Boateng K.: Bad medicine in the market. World Hosp. Health Serv. 43(3): 17-21 (2007)

19. Burns W.: WHO launches taskforce to fight counterfeit drugs. Bull. World Health Organ 84: 689-690 (2006)

20. Rudolf P.M., Bernstein I.B.G.: Counterfeit drugs. N. Engl. J. Med. 350: 1384-1386 (2004)

21. Cockburn R., Newton P.N., Agyarko E.K., Akunyili D., White N.J.: The global threat of counterfeit drugs: why industry and governments must communicate the dangers. PLoS Med. 2(4): E100 (2005)

22. World Health Organization. Fact sheets. Counterfeit Drugs – November 2003. Available at: http://www.who.int/en/ Accessed on 17/02/09.

23. Deisingh A.K.: Pharmaceutical counterfeiting. Tools and Resources. Analyst 130: 271-279 (2005)

24. Gratz S.R., Flurer C.L., Wolnik K.A.: Analysis of undeclared synthetic phosphodiesterase-5 inhibitors in dietary supplements and herbal matrices by LC-ESI-MS and LC-UV. J. Pharm. Biomed. Anal. 36: 525-533 (2004)

25. Laing Q., Qu J., Lou G., Wang Y.: Rapid and reliable determination of illegal adulterant in herbal medicines and dietary supplements by LC/MS/MS. J. Pharm. Biomed. Anal. 40: 305-311 (2006)

26. Scher C.S., Torres A., Wieder S.Y.: Internet drug access runs rampant. Anesth. Analg. 105:1868-1869 (2007)

27. Forman R.F., Woody G.E., McLellan T., Lynch K.G.: The availability of web sites offering to sell opioid medications without prescriptions. Am. J. Psychiatry 163: 1233-1238 (2006)

28. Forman R.F.: Innovations: Alcohol & drug abuse: Narcotics on the net: the availability of Web sites selling controlled substances. Psychiatr. Serv. 57(1): 24-26 (2006)

29. Schepis T.S., Marlowe D.B., Forman R.F.: The availability and portrayal of stimulants over the Internet. J. Adolesc. Health 42: 458-465 (2008)

30. Schifano F., Deluca P., Baldacchino A., Peltoniemi T., Scherbaum N., Torrens M., et al.: Drugs on the web; the Psychonaut 2002 EU project. Prog. Neuropsychopharma-col. Biol. Psychiatry 30: 640-646 (2006)

31. Manchikanti L.: National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician 10: 399-424 (2007)

32. Wilkinson E.: Is the online drugs market putting patients at risk? Nurs. Times 102(46): 23-24 (2006)

33. Fung C.H., Woo H.E., Asch S.M.: Controversies and legal issues of prescribing and dispensing medications using the Internet. Mayo Clin. Proc. 79:188-194 (2004)

34. Henney J.E., Shuren J.E., Nightingale S.L., McGinnis T.J.: Internet purchase of prescription drugs: buyer beware. Ann. Intern. Med. 131:861-862 (1999)

35. Korcok M.: Internet pharmacy: the tug-of-war intensifies. CMAJ. 170: 946-947 (2004)

36. Vredembregt M.J., Blok-Tip L., Hoorgerbrugge R., Barends D.M., de Kast D.: Screening suspected counterfeit Viagra and imitations of Viagra with near-infrared spectroscopy. J. Pharm. Biomed. Anal. 40: 840-849 (2006)

37. Bostwick J.M., Lineberry T.W.: Do cheap internet drugs threaten the safety of the doctor-patient relationship? Expert Opin. Drug Saf. 6(1): 9-13 (2007)

38. Buying Prescription Medicines Online: A Consumer Safety Guide. Food and Drug Administration Web site.: http://www.fda.gov/cder/consumerinfo/ brochureHiRez.pdf.

39. Amrutkar P., Sansgiry S.S.: Use of the Internet for medication purchases and health information: can we make it safer? Mayo Clin. Proc. 80: 704; author reply 704-705 (2005)

40. Ten Ham M.: Health risks of counterfeit pharmaceuticals. Drug Saf. 26: 991-997 (2003)

41. Montoya I.D., Jano E.: Online pharmacies: safety and regulatory considerations. Int. J. Health Serv. 37: 279-289 (2007)

42. Larson B.S.: Medications through the Internet: what clinicians and patients need to know. J. Pain Palliat. Care Pharmacother. 16(2): 49-57 (2002)