JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic has increased online purchases and heightened interests in existing treatments. Dexamethasone, hydroxychloroquine, and lopinavir-ritonavir have been touted as potential treatments for COVID-19.

Objective:

To assess the availability of three potential COVID-19 treatment options online and evaluate the safety and marketing characteristics of websites selling these products.

Methods:

A cross-sectional study was conducted in June-August 2020 searching the first 100 results on Google, Yahoo, and Bing, mimicking a US consumer. Unique websites were included if they sold targeted medicines, were in English, offered U.S. shipping, and were free to access. Identified online pharmacies were categorized as rogue, unclassified or legitimate based on LegitScript classifications. Patient safety characteristics, marketing techniques, price, legitimacy, internet protocol (IP) addresses, and COVID-19 mentions were recorded.

Results:

We found 117 websites, 30 selling dexamethasone, 39 selling hydroxychloroquine, and 48 selling lopinavir-ritonavir. This included 89 unique online pharmacies: 62 (70%) rogue, 20 (22%) unapproved, and 7 (8%) legitimate. All rogue pharmacies selling dexamethasone (n=19) did not require a prescription. Half of the rogue online pharmacies selling hydroxychloroquine (50%, n= 11) and lopinavir-ritonavir (61%, n= 20) did not require a prescription. Rogue sites rarely offered pharmacist counseling (3-9%). Drug warnings were unavailable in 86% of unapproved dexamethasone sites. Illegitimate pharmacies were more likely to offer bulk discounts and claim price discounts; yet dexamethasone and hydroxychloroquine were more expensive online. An inexpensive generic version of lopinavir-ritonavir that is not authorized for use in the US was available online. Some websites claimed hydroxychloroquine and lopinavir-ritonavir were effective COVID-19 treatments despite lack of evidence. In comparing IP addresses to locations claimed on the websites, only 8.5% matched their claimed locations.

Conclusions:

The lack of safety measures taken by illegitimate online pharmacies endanger patients, facilitating access to medications without appropriate monitoring by healthcare providers of clinical response, drug interactions, and adverse effects. Health care professionals must urgently educate the public of the dangers of purchasing drugs from illegitimate websites and highlight the importance of seeking treatment through authentic avenues of care.