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Opiates, antibiotics and Botox should be harder to get online, GPhC proposes

The GPhC is concerned about prescription and supply of certain drugs through online pharmacies, as patients have previously been put at risk owing to the inappropriate supply of medicines over the internet.

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The General Pharmaceutical Council has found that some online pharmacy services ‘undermine important safeguards’ that are in place to stop patients from accessing drugs that are clinically inappropriate for them.

Medicines including antibiotics and opiates could become more difficult to obtain online under proposals from the General Pharmaceutical Council (GPhC).

The regulator said it had become “increasingly concerned about the way some services appear to undermine the important safeguards that are in place to protect patients from accessing medicines that are not clinically appropriate for them” and it was “aware of situations where patients have been put at risk because of the inappropriate sale and supply of medicines on the internet”.

In the discussion paper published on 26 June 2018, the GPhC proposes that there are certain categories of medicines that may not be suitable to be prescribed and supplied online unless further action is taken to make sure that they are clinically appropriate for the patient, such as contacting the patient’s GP.

These medicines, it said, should include antibiotics where it is important to effectively manage their use; opiates and sedatives where there is a risk of addiction, misuse or overuse; medicines or medical products for chronic conditions, such as asthma and diabetes, and mental health conditions where ongoing monitoring is essential; and non-surgical cosmetic medicinal products, which should only be prescribed after a physical examination.

Sandra Gidley, chair of the Royal Pharmaceutical Society English Pharmacy Board, said she agreed with the regulator’s proposals for antibiotics and opiates.

“If we are serious about antimicrobial stewardship, it does seem to me that this is an area that we look at very closely — we don’t want to get into a situation where a GP says ‘you don’t need this antibiotic’ and for people to then go via the online system and get what they think they need,” she said.

“In terms of opiates, there is a lot of work going on to show there are other ways to manage pain.

“If it is easy to get these drugs online, we’re adding to the problem — we’re not helping people.”

However, for chronic conditions, such as asthma, Gidley said online pharmacies can provide some benefit for patients.

“If someone is away and forgets their inhaler, they can log in to one of the systems and get the medication they need. That is entirely sensible,” she said.

The GPhC is also asking whether it is appropriate for pharmacy websites to allow patients to choose a prescription-only medicine, and its quantity, before having a consultation with a prescriber. The paper highlights that, after filling in a number of questionnaires, some patients may learn which answers to give to get the medication that they want, which may result in inappropriate prescribing, or even harm the patient.

“Regulating healthcare services on the internet is complex, with different organisations and agencies responsible for different parts of the service,” said Duncan Rudkin, chief executive of the GPhC.

“We want to play our part in strengthening the safeguards in place for patients and the public through the guidance we set for pharmacy owners and through our inspections of online pharmacy services.

“We are also working closely with other regulators in Great Britain involved in regulating online prescribing services to make sure patients are protected at each stage.”

Other proposals in the paper include improving transparency to enable better patient choice and the responsibility of pharmacy owners to raise awareness among patients about what they should expect from a safe and effective pharmacy service. The GPhC is also seeking views on the regulatory oversight for services or prescribers not based in the UK.

“The GPhC is trying to do a bit of horizon scanning,” said Gidley, adding that this was “very important”, particularly in light of internet-based company Pharmacy2U’s recent briefing paper for MPs and policymakers, which claimed that online dispensing could save the NHS up to £400m a year.

“It will be interesting to see what other opinions come out of this consultation,” she added.

The discussion period will run for eight weeks — until 21 August 2018 — and the GPhC wants to hear from patients and the public, pharmacy professionals, pharmacy owners, charities, stakeholders and people particularly interested in pharmacy services and online primary care.

“We want to hear people’s views on these proposals, to make sure we have addressed all of the key issues in this rapidly changing area,” said Rudkin.

“We are particularly keen to hear the experiences of patients and the public who may have used online pharmacy services.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20205067

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