Online pharmacies have been charged with failing to conduct proper ID checks and using inappropriate marketing tactics to sell strong and dependent opiates, the Guardian finds.
At least two major online pharmacies – registered with the UK regulator – send e-mails to consumers, asking them to order drugs, arguing that stocks are running out or telling them that their "borders" have been removed and can now buy more codeine pills.
Online pharmacies have a limit on the amount of prescription drugs that can be ordered in a given period of time.
There is growing concern at international level about the increased use of opioid medicines, such as morphine, fentanyl, oxycodone, tramadol, and codeine. The pharmacy regulator in England, Scotland and Wales has recently introduced new rules to protect people from buying inappropriate drugs online.
The Doctor-4-U website is contacting a buyer to buy a codeine that costs £ 84.99 for 200 30g tablets, writing: "What are you waiting for? … This item goes fast, so grab them while you still can. "
Another online retailer, MyUKDoctor, warned clients when they could order large drug addicts for opiates, saying their "border" was removed. "Please click here again to change your medication again," it says.
Ashes Sonny, chairman of the Royal Pharmaceutical Society, said he was astounded by marketing.
"It is, for me, something that needs to be firmly explored by regulators, it's horrible. It really is – turn around and say" the limitation of that product is now abolished if you want to buy something more, please go and do it. "That's something you will never expect from renowned pharmacists."
Dr Jane Quinlan, consultant for anesthesia and pain management at Oxford University Hospitals Trust Foundation NHS, described tactics as "truly shocking."
Both MyUKDoctor and Doctor-4-U have been approved by the regulatory agency for medicines and health products, both displaying the joint EU logo with the message "click to check if this site is legally working."
Yasir Abbasi, clinical director of addiction services in the confidence of the Mersey Foundation, described marketing as aggressive.
He said: "When it comes to opioid medicines, there should not be direct marketing to the consumer, and if there is then then there should be clear regulations and directions about it."
A Doctor-4-U spokeswoman said the message was not marketing email, but was sent when a person ordered a warrant, but left it before paying.
"This is not a marketing tactic, and we would point out that it is not possible to buy opioids through the website without a doctor's approval," the spokesman said.
However, the company confirmed that it will stop sending the message "in an attempt to make our policy clearer on this issue."
MyUKDoctor did not respond to the Guardian's request for comment.
Opioids tend to be prescribed for chronic lower back pain and arthritis, although studies have shown that drugs are not the most effective way to treat such pain. There is concern about increased levels of prescription due to increased overdose and increased dependence and dependence on prescription drugs.
Codeine itself is only available on a prescription, with unauthorized possession being unlawful. Small amounts of the medicine are in some drugs that can be bought without a prescription, but only in pharmacies.
Quinlan said: "We are trying to reduce the number of patients who are prescribed opioids for chronic pain because we know that they do not work for the majority of patients and are trying to support those who now depend on the prescribed high doses of opioids and taken with good intent.
"However, this online opioid sale is an invisible drug addiction population, with what appears to be minimal checking and mismanagement, risking patient safety."
The Guardian was able to get 200 codeine tablets in two weeks by ordering 100 30g tablets from the UK Meds website like David Smith, but with a card registered under another name. Another 100 tablets were obtained from PillDoctor, using the same nickname "David Smith" and a payment card under another name. Similar photographs were placed instead of proof of identity card and proof of address. Both websites say that customers need to use their name and card.
Abbasi said: "The method and the management of drug treatment should cause great concern in the UK."
PillDoctor, based in London, but using EU doctors for consulting and recipes, said the order went wrong due to a "human error".
"This does not reflect our practice … The human error contributed to this and now we have taken quick measures to avoid such mistakes in the future," the spokesman said.
UK Meds, based in Nottingham, stated that its products were prescribed by doctors regulated by the General Medical Council or by other licensed doctors and issued by the Pharmaceutical Council regulated by the Pharmaceutical Council.
"The company recognizes and is alive to the reality that the potential for abuse of service is an ever-present risk that needs to be resolved. It is constantly striving to establish rigorous procedures, operating in accordance with applicable laws, which try to limit the potential for abuse of their service, "they said.
Professor Helen Stokes-Lampard, president of the Royal College of Physicians, said the findings were of great concern.
She added: "Codeine is opioid and is well known to be very dependent and therefore its use should be closely monitored. Doctors are experts in prescribing and will be extremely cautious about starting a patient with opioids, but they will also be sure they are closely monitored and regularly reviewed. "
A customer said he had received medication for more than three years from various websites, calling on the same condition each time. "I ordered from one website, because every time I quote the same condition (lying basically, saying I have removed a pylonic cyst) and they never questioned it and only sent me medication … This would be unheard of for any operation the doctors ".
The use of online pharmacies has rapidly increased in recent years, but problems have arisen over the regulation.
Concerns have also been raised around a law hole that allows people to buy strong painkillers from doctors based in Europe. It comes after the death of 51-year-old Jennifer Ann Lacey, who was found dead last summer at the Travelodge Hotel in Morden, south London.
The coroner concluded (pdf) Lacey killed herself after overdosing tramadol and alcohol. She took 210 tablets, half of which she bought online.
The doctor who gave 100 tablets of 50mg tramadol is located in Prague, the Czech Republic. He had never seen her and had no access to her medical records, nor did he talk to her doctor. Lacey simply fill up an online form.
Ending the inquiry into her death, Coroner Fiona Wilcox said she was worried as potentially dangerous and dependent drugs were so freely available online.