Warning over internet painkillers

Celecoxib was one of the drugs found to be available online

UK experts have warned of the dangers of purchasing drugs online in response to a study showing wide availability of strong painkillers over the internet.

A team at Edinburgh University found 35 websites selling prescription-only pain drugs to UK customers without requiring a prescription.

Government regulators warned that buying medicines online may have "deadly" consequences.

The results appear in the British Journal of Clinical Pharmacology.

By trawling for online pharmacy sites through Google and Yahoo search engines, the researchers found almost 100 selling medicines to UK consumers.

Almost half of those sold prescription-only painkillers but 76% did not require the customer to provide a valid prescription.

Six asked for a prescription but accepted a fax or email copy which the researchers said could be forged or modified.

Side-effects

The drugs available included opioids such as tramadol and non-steroidal anti-inflammatories, such as naproxen and celecoxib, commonly prescribed for conditions such as arthritis.

They can have severe side-effects and some should not be taken in conjunction with other medicines or in people with certain conditions, the researchers said.

At best you will be wasting your money and at worst they could be deadly Spokeswoman, MHRA

Co-proxamol - a drug which has been removed from the market in the UK due to concerns over the risk of overdose - was available from three websites.

The researchers did not take the final step of actually buying the medicines as they felt it would not be ethical.

Study author Professor David Webb, an expert in clinical pharmacology at the University of Edinburgh, said these were drugs that people should not be taking without advice from a doctor, but they were available with a couple of clicks of the mouse.

"We were surprised at how many sites you could go to and find, in some cases, quite potent painkillers that have addictive potential and that you could get them without prescription."

He added: "The regulators are very aware of this problem and it is not one they can easily manage.

"But there certainly needs to be some sort of international agreement."

Illegal sales

A spokeswoman for the Medicines and Healthcare Products Regulatory Agency, said although the sale of prescription only medicines without a proper patient consultation was illegal it was not illegal to buy medicines online.

"But we strongly advise people that buying drugs or slimming products from the internet is not a good idea, unless buying from a website that has a Royal Pharmaceutical Society of Great Britain (RPSGB) internet pharmacy logo.

"At best you will be wasting your money and at worst they could be deadly.

"You don't know what these products contain and you don't know in what conditions they have been made."

The RPSGB launched their logo scheme for bone fide pharmacy websites at the beginning of 2008.

Priya Sejpal, RPSGB head of professional ethics, said: "Internet pharmacy undoubtedly offers patients easy access and choice, but it also brings increased risk.

"There are a growing number of unregulated suppliers operating online with no professional qualifications or healthcare expertise.

"In many cases, medicines purchased from such suppliers are counterfeit, substandard or unapproved new drugs."

Thousands of patients head abroad for cosmetic operations

The NHS is having to pick up the tab for cosmetic surgery performed abroad that has gone wrong, doctors say.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons said many patients were turning to the health service for follow-up care.

A poll of 203 NHS surgeons found that more than a third knew of cases where complications followed surgery abroad.

The government warned people that the NHS was only there to deal with emergency complications in such cases.

And it urged those thinking about going abroad for operations to be careful.

It is estimated that up to 100,000 people a year are heading abroad for cheap cosmetic surgery such as breast enlargements, tummy tucks and face-lifts.

What may seem like a bargain could cost them their health Vivienne Nathanson, of the British Medical Association

BAPRAS said the growing demand was being fuelled by the availability of cheap flights, but warned that the trend was leading to problems.

It said its members had seen a range of complications including blood poisoning, wound infections and blood clots, as well as patients who were not happy with the results of the surgery.

And the association warned that the extra work being caused by having to see these patients could end up delaying other NHS work.

It said patients should be made to pay for rectifying treatment except where there was a life life-threatening situation or if the patient was suffering from acute pain.

Complications following UK-based cosmetic surgery is the responsibility of the private clinic.

Anthony Armstrong, a leading member of BAPRAS, said: "Cosmetic operations involve major surgery.

"Anyone considering cosmetic surgery abroad must make sure they are fully aware of the potential complications that can occur and consider how these will be dealt with.

"They should not assume that the NHS will pick up the pieces and they may find themselves having to pay privately for follow-up surgery here."

Risks

But the British Medical Association said it was against patients being barred from NHS care.

Dr Vivienne Nathanson, head of ethics at the BMA, added: "It is essential that patients are warned about the potential risks of any surgery, and the specific risks of managing complications after having surgery overseas.

"What may seem like a bargain could cost them their health."

Katherine Murphy, of the Patients Association, agreed it would be wrong to withhold treatment.

She said patients needed better information about treatment available abroad.

A spokesman for the Department of Health said it had already made clear that the NHS was only there to deal with emergencies in such cases.

The spokesman added: "People are free to have cosmetic or other private surgery abroad if they wish to.

"However, we strongly advise people to do their research and make sure that they are clear about prices, procedures, recovery times, aftercare and what happens in the event that the treatment goes wrong."