Revealed: loopholes that let addicts buy hundreds of opioid pills online

People with addiction problems are able to order hundreds of powerful opioid painkillers by taking advantage of a lack of proper checks with registered online pharmacies, the Guardian can reveal.

A number of online pharmacies that are regulated and operating legally have no alert system in place to identify when someone makes multiple orders to the same address.

The safeguarding loophole means people can order hundreds of tablets a month.

The online pharmacy regulator, the General Pharmaceutical Council (GPhC), is calling for stricter measures to be introduced and says it is consulting on whether online pharmacies should stop supplying opiates unless further checks are carried out.

David (not his real name) told the Guardian that his wife, who had an addiction, this year made four orders in a month for the strong opioid dihydrocodeine from the website Doctor-4-u after setting up multiple accounts. Hundreds of pills were delivered to the same address, but the unusual activity was not flagged on its system.

“Why do online pharmacies not have the capability to check various accounts linked to the same addresses?” he said. “This happens with insurance and many other industries.”

Doctor-4-u said it carried out thorough ID checks, but multiple orders to the same address were possible if someone used a different family member’s ID and credit card. It said this would not be flagged up on its system.

After the Guardian raised the issue, the company said it would put safeguarding measures in place to protect against this problem, “to demonstrate our commitment to making our online pharmacy as safe as possible”.

John Elliott, the IT director at Doctor-4-u’s owner Med Connections, said: “We are constantly investing in our systems to detect this kind of fraudulent activity.”

The GPhC said it was not aware of a study that showed the numbers using online pharmacies, but it is likely to be in the thousands. Last year, Pharmacy2U, which claims it is the UK’s largest online pharmacy, said it dispensed more than 200,000 items to patients in a month.

The Guardian has also discovered that Doctor-4-u and another leading online pharmacy, UK Meds, are being investigated by the GPhC, which regulates pharmacies operating online, although details of what concerns had been raised – even whether they related to multiple ordering – about them could not be revealed.

A UK Meds spokesperson said: “[We are] a regulated and responsibly run online healthcare portal, which is actively lobbying for the highest safety standards to be introduced across the industry. Patient care and safety is at the core of our business.”

The news comes as concerns grow about the rising number of people seeking help over prescription pills bought online. The Guardian reported this month that a clinic set up to help teenagers addicted to Xanax and other prescription drugs is being sought out by adults who use pills purchased online.

Yasir Abbasi, the clinical director for addiction services at Mersey Care NHS foundation trust, said: “If you are getting multiple prescriptions from one address in the UK, there should be an alert system to make it hard for this to go ahead, just as there are regulation[s] to make sure you cannot buy two boxes of paracetamol at one supermarket …

“If you buy something online you should have to go through one central system, regardless of which online pharmacy you visit online, so what you buy can be monitored.”

The GPhC said it investigated 17 cases involving online pharmacies in the year to June. Its main concerns were about how patients accessed medications online that may be subject to abuse and about the safety of the processes in place.

Duncan Rudkin, the chief executive of the GPhC, said: “We have set out actions we’re proposing that online pharmacy owners would be expected to take to meet our standards and make sure that people obtain medicines safely online. This includes identifying multiple orders to the same address or using the same payment details.”

The watchdog is holding a public consultation on proposed new safeguards, including whether online pharmacies should stop supplying certain drugs, such as opiates and opioids, unless further checks are carried out.

There are currently 445 pharmacies that bear the council’s logo. They can sell opiates and opioids medicines such as tramadol, co-codamol, codeine and dihydrocodeine, which if abused can lead to severe addictions.

David said his wife was able to order hundreds of pills using his credit card. She started doing so in 2016 after becoming addicted to the opioid hydrocodone, which she was given for a slipped disc.

She was able order medicines while she was pregnant by clicking a question on a form to say she was not pregnant, although in this instance the pills were not obtained from Doctor-4-u and David could not recall which website they came from.

“This meant when my son was born, he rated high on the Finnegan scale – basically children born who show signs of opiate addiction – but it did pass,” he said.

He added that addiction had had a huge impact on his family. “The checks are simply not good enough for medication issuing. I cannot go to doctor and say, ‘I want this medication’ – I tell them my symptoms and the doctor prescribes medication, but it’s the opposite way around with online pharmacies. You say ‘I want this’ and the doctors look at it,” he said.

Concerns have also been raised about websites allowing people to select medicines including opiates and opioids before a consultation. The GPhC said: “There are additional risks to patient safety when prescription-only medicines can be chosen before having an appropriate consultation with a prescriber.

“For example, if a patient simply has to answer questions before the healthcare professional makes their prescribing decision, they might fill in a number of questionnaires, learning what answers to give so they can get the medicine in question.”

Speaking anonymously, a former online pharmacy worker who left his employer recently due to concerns about safeguarding said that “even though there are procedures and safeguards put in place, customers are still able to make multiple orders using different email addresses and accounts”.

He added: “It’s not such a problem with some products, but for opioids it can be very dangerous.”

Abbasi said: “We are seeing an increase in drug-related deaths, and prescription drugs are playing a role more and more. Things are almost at a crisis point.”

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Anti-depressants: ‘I’ve lost my identity and who I am’

“I’ve lost my job, I’ve lost my social life, I’ve lost my career, I’ve lost my identity and sense of who I am.”

James Moore says he ‘doesn’t feel the same person as before’ since becoming hooked on anti-depressants that were prescribed to help ease panic attacks.

The former civil servant said if he had been given a proper warning of the risks, he would never have taken them.

The Welsh Government said it had put in an extra £4 million in psychological therapies in the past two years.

James has been been unable to stop taking the medication since starting it 2012.

The 46-year-old has suffered insomnia, panic, nausea, shaking spells and anxiety during the three times he has tried to come off anti-depressants.

“It has been a huge personal cost to me,” said the married father-of-one from Rogiet in Monmouthshire.

“I feel like I’m in the middle of a marathon and I really don’t know whether I’m going to get to the end and over the finish line intact or not.”

Campaigners in Wales say there is a lack of tailored support and treatment for people struggling with anti-depressant dependency.

People like James, unable to stop taking them, say they have to deal with “devastating” symptoms of withdrawal alone.

A psychiatry professor said the drugs were over-prescribed and patients are not fully aware of the potential risks.

The Royal College of General Practitioners Wales (RCGP), however, said GPs tried to prescribe “in the best interests of patients” and, used appropriately, anti-depressants can be “an effective part of treatment”.

But Dr David Healy, professor of psychiatry at Bangor University, said patients were often not told of the risks of dependency as doctors had not been told themselves.

“They haven’t been told, for instance, that you can get hooked to these drugs and it may be close to impossible to come off them,” he said.

“Back in the late 80s when the drugs came on, first the expectation was you’d be on them for three, maybe six months. The idea they’d be on them for a year, or five years or 10 years was inconceivable back then. But that’s what happened,” he added.

At the end of last year, campaigners brought a petition calling for action on prescription drug dependence and withdrawal to the Welsh Assembly. They want assembly members to urge the Welsh Government to act.

However, their concerns are disputed by other medical professionals. A major report has been published and found that for many patients, anti-depressants work, although it did not look at long-term use.

Dr Adarsh Shetty, of the Royal College of Psychiatrists in Wales, said: “I see in my routine clinical practice, people who have benefited from them tremendously.

“So I would really advise people to talk to their doctor, their GP or their psychiatrist if they have any worries about anti-depressants and any concerns about dependence on anti-depressants. It is really important to stress they are not addictive medications.”

Dr Jane Fenton-May, of the Royal College of General Practitioners Wales, said GPs always “endeavour to prescribe in the best interests of patients” and “engage patients in a discussion about what is best for them as an individual”.

The RCGP said it recognised there was a “lack of alternative treatments”, there “can be difficulties in obtaining the necessary support” and supported calls for improvements in this area.

The Welsh Government said “there are a wide range of treatments other than medication available for depression” and it had invested an additional £4m in psychological therapies over the past two years.

“Patients are encouraged to speak with their GP, who would be able to help them make informed decisions about their care”, the spokesman added.

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Babies die after mums given Viagra in Dutch trial

A Viagra in pregnancy trial has been urgently stopped after 11 newborn babies died.

Women taking part in the Dutch study had been given the anti-impotence tablets to improve growth of their unborn children because they had poorly developed placentas.

It appears the drug, which promotes blood flow, may have caused lethal damage to the babies’ lungs.

Experts say a full investigation is needed to understand what happened.

There is no suggestion that there was any wrong-doing.

Sick babies

Earlier trials in the UK and Australia and New Zealand did not find any evidence of potential harm from the intervention. But they also found no benefit.

At that time, in 2010, researchers said the treatment should be used only in trials.

Foetal growth restriction caused by an underdeveloped placenta is a serious condition that currently has no treatment.

It can mean babies are born prematurely, with a very low birth weight and poor chances of survival.

A medication that could improve weight or prolong the time to delivery could have significant advantages for these very sick babies.

Dummy drug

The latest Dutch study, which was due to run until 2020, was being carried out across 11 hospitals in the Netherlands, including the Amsterdam University Medical Centre.

In total, 93 women were given sildenafil (the non-brand name for Viagra) while the remaining 90 were given a dummy drug or placebo.

Twenty babies developed lung problems after birth – three in the placebo group and the rest in the treatment group.

Eleven in the sildenafil group died from lung complications.

Prof Zarcko Alfirevic, from the University of Liverpool, who led part of the UK research into sildenafil in pregnancy that found no benefit in terms of improving baby growth, said: “This finding in the Dutch study is unexpected.

“We need to be careful at this point to find out more.

“It needs a thorough investigation because the complications were not seen in the two other, similar trials that have already been done in the UK and Australia and New Zealand

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When antibiotics turn toxic

Commonly prescribed drugs called fluoroquinolones cause rare, disabling side effects. Researchers are struggling to work out why.

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In 2014, Miriam van Staveren went on holiday to the Canary Islands and caught an infection. Her ear and sinuses throbbed, so she went to see the resort doctor, who prescribed a six-day course of the popular antibiotic levofloxacin. Three weeks later, after she had returned home to Amsterdam, her Achilles tendons started to hurt, then her knees and shoulders. She developed shooting pains in her legs and feet, as well as fatigue and depression. “I got sicker and sicker,” she says. “I was in pain all day.” Previously an active tennis player and hiker, the 61-year-old physician could barely walk, and had to climb the stairs on all fours.

Since then, she has seen a variety of medical specialists. Some dismissed her symptoms as psychosomatic. Others suggested diagnoses of fibromyalgia or chronic fatigue syndrome. Van Staveren is in no doubt, however. She’s convinced that the antibiotic poisoned her.

She’s not alone. Levofloxacin is one of a class of drugs called fluoroquinolones, some of the world’s most commonly prescribed antibiotics. In the United States in 2015, doctors doled out 32 million prescriptions for the drugs, making them the country’s fourth-most popular class of antibiotic. But for a small percentage of people, fluoroquinolones have developed a bad reputation. On websites and Facebook groups with names such as Floxie Hope and My Quin Story,thousands of people who have fallen ill after fluoroquinolone treatment gather to share experiences. Many of them describe a devastating and progressive condition, encompassing symptoms ranging from psychiatric and sensory disturbances to problems with muscles, tendons and nerves that continue after people have stopped taking the drugs. They call it being ‘floxed’.

For decades, regulatory agencies and the medical profession were sceptical that a brief course of antibiotics could have such a devastating, long-term impact. But after persistent campaigning by patient groups, attitudes began to change in 2008, when the US Food and Drug Administration (FDA) announced the first of what would be a series of strong alerts about the side effects of fluoroquinolone drugs, including tendon rupture and irreversible nerve damage. In 2016, the agency accepted the existence of a potentially permanent syndrome that it calls fluoroquinolone-associated disability (FQAD), and recommended that the drugs be reserved for serious infections. That move has triggered other regulatory agencies to reassess the antibiotics: Health Canada warned doctors of rare cases of persistent or disabling side effects in January 2017, and the European Medicines Agency (EMA) is expected to publish the results of a safety review this year, after a public hearing planned for June.

Fluoroquinolones are valuable antibiotics, and safe for most people. Yet they are so widely prescribed that their side effects might have harmed hundreds of thousands of people in the United States alone, say scientists who are working with patients to unpick FQAD’s causes. Fluoroquinolone toxicity, they say, provides a compelling example of an emerging understanding that antibiotics don’t just harm microbes — they can severely damage human cells, too. Until recently, investigations into the side effects of antibiotics have focused on how the drugs disrupt the human microbiome, says James Collins, a medical engineer at the Massachusetts Institute of Technology in Cambridge. “Antibiotics are also disrupting our cells, and in pretty hefty ways,” he says.

The dark side of fluoroquinolones

Quinolone antibiotics, first developed in the 1960s, kill bacteria by blocking enzymes called class II topoisomerases, which normally untangle DNA during cell replication. These enzymes usually cut DNA’s double helix, pass another part of the strand through the gap, and then mend the cut. But quinolones bind to the enzymes, preventing them from mending their cuts. In the 1980s, researchers added fluorine atoms to the quinolones’ structures. This allowed the antibiotics to penetrate tissues throughout the body, including the central nervous system, and boosted their effectiveness against a broad range of bacterial infections.

Some FDA-approved fluoroquinolones were swiftly withdrawn from the market after severe adverse reactions and several deaths — trovafloxacin, withdrawn in 1999, damaged livers, for instance. But others became the drug of choice both for serious infections and for routine complaints, despite rare side effects. “These are heavily used drugs because they are very effective,” says Joe Deweese, a biochemist who studies topoisomerases at Lipscomb University College of Pharmacy in Nashville, Tennessee. In the 1990s, ciprofloxacin (cipro) was given to US troops serving in the Persian Gulf as prophylaxis in case of exposure to anthrax spores. And in 2001, sales of cipro surged after a series of terrorist attacks involving anthrax; the US Centers for Disease Control and Prevention (CDC) recommended a 60-day course for anyone at risk of being exposed.

Living with the mental and physical impact of medication.

Having worked with older and disabled people over the last 13 years in the third sector, my experience of clients knowledge and understanding of their prescribed medication can sometimes be astounding.

I essentially help people get their homes adapted, maintained and made safe so that they are able to live independently. This can also involve general advice and assisting with benefit and disability allowances applications.

Many of my clients are aged over 70 and come from an era where whatever their professional, whether it be a doctor, nurse or specialist say or prescribes, that is what they believe is right. They feel that it is disrespectful to challenge or refuse the medication. Very few will stand up and say they don’t agree.

Even if the medication they are taking makes them feel worse, very few will go against the advice of their GP.

I do not confess to be a medical expert but in my experience with older and vulnerable people, I can identify particular health problems and noted side effects. Long term pain killer use as well as being addictive also can cause memory loss. Many people don’t know that and worry that Dementia is setting in. Majority of people are on gastro pump inhibitors to prevent or heal ulcers and stomach problems. Usually originally caused by other medication. These should only be used short term as they in turn can cause other more serious health problems and coming off them can also experience extreme versions of what the medication was for.

When asking many of my clients which medication they are taking, the usual answer is “lots” or I’m rattling. If asked what each is for, many don’t actually know. They may have been told many years ago but can’t remember. When asked do they read the information leaflet, if they were interested at all some say it’s in too small print or they get the dosette box with no leaflet. This is probably not the case but as they get older it is taken for granted that their health is going to suffer, medication may make some things more bearable and so best not to know the effects or if it might be addictive. Even when medication is reviewed, many don’t like to admit to any problems. I find much of this out when applying for mobility allowances such as Attendance Allowance. This is possibly the only time they will be completely honest about all their health problems.

Even when medication is reviewed, many don’t like to admit to any problems. I find much of this out when applying for mobility allowances such as Attendance Allowance. This is possibly the only time they will be completely honest about all their health problems.

Why when in hospital are patients woken up to be given sleeping tablets?

Just because someone is getting older, their health problems should be diagnosed by listening to the problems not just throwing medication at it.

We know that we can learn about controlling some health issues by diet, exercise or relaxation therapies, why aren’t older people being offered more of this instead of them having to take 4 or more, some up to 15 different medications in one day.

How many of those medications are addictive or have extreme side effects or will be fatal if forgotten to be taken.

I always believed that we are told to understand our own bodies first then ask advice, but it seems if many people have the audacity to make their own opinion of their medication of diagnosis this will be frowned upon.

I have had occasions where I have had to leave homes of clients because their spouse has become irate even verbally abusive. The explanation is that it is the medication causing it or that I shouldn’t visit before a certain time in order to give the medication time to kick in. Again not being a medical expert I cannot say that these are true effects or if they are used as an excuse for behaviour. But if more education to the medication available and being prescribed was available and in simple terms and people were given more choices instead of told?

Many older people when they start suffering with physical health problems start to suffer with depression and anxiety or are diagnosed bi polar. I can see the downward spiral to many of these peoples lives when given medication rather than alternative therapies or counselling about lifestyle or even just changes to their daily routine. When asked about their health issues, they start with the mental health rather than the obvious physical problems. They feel powerless and give up. Those not taking up the medication can often combat this and mange to regain the control of their life, regain their social life and try and help others.

When asked about their health issues, they start with the mental health rather than the obvious physical problems. They feel powerless and give up. Those not taking up the medication can often combat this and mange to regain the control of their life, regain their social life and try and help others.

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Take a look at “Yellow Card Scheme”

The Yellow Card Scheme is vital in helping the MHRA monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and those that use them. Reports can be made for all medicines including vaccines, blood factors and immunoglobulins, herbal medicines and homeopathic remedies, and all medical devices available on the UK market. From the 20th of May 2016, the MHRA is also collecting reports of safety concerns associated with e-cigarette products through the Yellow Card Scheme.

The Scheme collects information on suspected problems or incidents involving

  1. side effects (also known as adverse drug reactions or ADRs)
  2. medical device adverse incidents
  3. defective medicines (those that are not of an acceptable quality)
  4. counterfeit or fake medicines or medical devices
  5. safety concerns for e-cigarettes or their refill containers (e-liquids)

It is important for people to report problems experienced with medicines or medical devices as these are used to identify issues which might not have been previously known about. The MHRA will review the product if necessary, and take action to minimise risk and maximise benefit to the patients. The MHRA is also able to investigate counterfeit or fake medicines or devices and if necessary take action to protect public health.

Side effects to a medicine, vaccine, herbal or complementary remedy

All medicines can cause side effects (commonly referred to as adverse drug reactions or ADRs by healthcare professionals).

Side effects reported on Yellow Card are evaluated, together with additional sources of information such as clinical trial data, medical literature or data from international medicines regulators, to identify previously unknown safety issues. These reports are assessed by a team of medicine safety experts made up of doctors, pharmacists and scientists who study the benefits and risks of medicines. If a new side effect is identified, the safety profile of the medicine in question is carefully looked at, as well as the side effects of other medicines used to treat the same condition. The MHRA takes action, whenever necessary, to ensure that medicines are used in a way that minimises risk, while maximising patient benefit.

See our animation below, developed as part of an EU wide social media campaign from the Strengthening Collaborations to Operate Pharmacovigilance in Europe (SCOPE) Joint Action project. It can also be viewed on MHRA’s YouTube channel here:

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Opioids: Why ‘dangerous’ drugs are still being used to treat pain – BBC

The widespread use of opioids to treat pain frequently prompts concerns about addiction and even deaths. So, why are these sometimes dangerous drugs still being given to patients?

Much stronger than many of the other options, opioids are among the world’s most commonly prescribed painkillers.

These drugs – including morphine, tramadol and fentanyl – are used to treat pain caused by everything from heart attacks to cancer.

But in the UK they were recently linked to the deaths of hundreds of elderly hospital patients, while the US is battling a well-documented opioid epidemic.

Why not just use other painkillers to avoid the risk of harm?

A worldwide problem

Opioids work by combining with receptors in the brain to reduce the sensation of pain – and they are highly effective.

However, opioid receptors are present in areas of the brain responsible for breath control and high doses can dangerously reduce the rate of breathing – the cause of almost all opioid deaths

full article on the BBC

More than 70,000 children prescribed anti-depressants in last 12 months

More than 70,000 under-18s, including nearly 2,000 children of primary school age, were prescribed anti-depressants in England last year, it has been reported. Experts have called for caution in giving the drugs to youngsters, warning that potential long-term effects on developing brains are not fully known. Mental health campaigners say access to other treatments, such as ‘talking therapies’, should be made more widely and easily available as a first resort.

GPs have said the prescription figures are evidence of youngsters seeking treatment, which is encouraging, but have backed calls for greater access to other therapies. NHS data obtained by The Times through freedom of information requests showed 7.3 million people were given at least one antidepressant prescription in England in 2017.

The drugs were used by one in six adults, the statistics suggested, with the total number marking an increase of nearly 500,000 since 2015.

The number of anti-depressant prescriptions has more than doubled in the last decade. A psychiatrist at Oxford University, Andrea Cipriani, said that doctors needed to be careful of prescribing anti-depressants to the developing brain. ‘We don’t know the long-term consequences,’ he said.


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