On 28 September 2019, The Times newspaper ran a front-page story on the “online opioids scandal”. The write-up was wearily familiar.
The report detailed the results of an undercover investigation that found five “registered internet chemists” that had prescribed and dispensed opioids without asking the patient for their GP’s contact details. In one case, 200 tablets of dihydrocodeine were dispensed to the same patient on two consecutive days.
This is the latest in a long line of ‘exclusives’ from national newspapers and broadcasters probing weak spots in the murky governance of online primary care services.
The online pharmacies in question were flouting guidance from the General Pharmaceutical Council (GPhC) published in April 2019, which says that medicines with the potential to be misused should not be dispensed online unless the patient’s GP has “confirmed to the prescriber that the prescription is appropriate”.
Much work has been put into stabilising prescribing of opioid analgesics, but there is a risk that this progress could be undone by irresponsible prescribing
The Times investigation indicates that this vital check is missing in some online providers and it is particularly disturbing that opioid analgesics were the medicines treated in this way. Much work has been put into stabilising prescribing of these medicines, but there is a risk that all this progress could be undone by such irresponsible prescribing, putting lives at risk.
However, these problems seem to be occurring in a minority of the 350 online pharmacies in the UK and issues with opioid prescribing are known to regulators.
In May 2019, the Care Quality Commission (CQC) — which regulates the prescribing part of the online primary process — released a report into online primary care services saying that the prescription of long-term opioid analgesics presented “a source of significant concern”. The CQC said that it was concerned about the volume of opioid analgesics being prescribed and the lack of information being shared with the patient’s GP by some providers, although it said there was not a “widespread” problem.
In September 2019, the GPhC — which is responsible for the dispensing part of the process — announced enforcement action against three online pharmacies (although not the providers investigated by The Times). The action comes after the GPhC published new guidance for all registered distance-selling pharmacies in April 2019.
However, despite this, it is worrying that national journalists on a fishing expedition are still able to land online pharmacies disregarding basic patient safety regulation so easily. The idiom “shooting fish in a barrel” comes to mind. Having analysed GPhC reports from online pharmacies, The Times found they were more than three times as likely to fail inspections as high street operators.
Regulators have been playing catch-up for too long on this issue. As the number of online pharmacies increases, it is time for a moratorium on the online prescription and dispensing of opioids and other medicines associated with misuse until the sector can show that it has cleaned up its act.