A nationwide web-based survey of a sample of Italian community pharmacists' perceptions and opinions about online sales of medicines and falsified drugs
Background: Throughout Europe, legal online pharmacies increasingly sell online drugs as well as other products such as dietary supplements. Online sale of pharmaceuticals however is closely connected to the phenomenon of drug falsification.
Objective: The aim of this study was to assess the opinions of a sample of Italian community pharmacists towards the sale of pharmaceuticals on the web, as well as their knowledge and experience with falsified drugs.
Methods: A self-administered questionnaire was distributed by means of an online platform between October 2016 and January 2017. Collected information included: demographics, workplace and role, opinions towards the online sale of pharmaceuticals, whether the pharmacy has a website, knowledge and opinions about falsified drugs.
Results: A total of 668 community pharmacists completed the questionnaire (mean age: 48.5, SD 12.4 years, 52.3% women). Favourable opinions about online sale of pharmaceuticals were expressed by 4.9% of participants for prescription drugs, 25.4% for nonprescription drugs, and 51.6% for other products. Favourable opinions occurred more often among males and owners/directors of pharmacies in comparison to females and employees, and among pharmacists working in pharmacies with websites doing e-commerce. Knowledge about falsified drugs was limited, with 24.5% of respondents failing to indicate that falsified drugs may contain less or different ingredients, 46.4% less and/or different excipients, and 72.3% ignoring that falsified drugs may be lethal. One in 3 respondents didn't know about falsified drugs in Italy, however 51 participants had previous experience with falsified drugs and 21 provided specific information.
Conclusions: Italian community pharmacists have low confidence in the online sale of pharmaceuticals, as well as alarmingly limited knowledge about falsified drugs, even if many of them reported previous experiences. Results may support targeted interventions to increase pharmacists' knowledge about pharmaceuticals and the web, as well as concerning falsified drugs, and suggest community pharmacies as key components of integrated systems aimed at monitoring falsified drugs.
Council of the European Union and the European Parliament. Directive 2011/62/EU of the European Parliament and of the Council of 8 June 2011 amending Directive 2001/83/EC on the Community code relating to medicinal products for human use, as regards the prevention of the entry into the legal supply chain of falsified medicinal products. Official Journal of the European Union 2011; L 174: 74-87. Available at: https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:174:0074:0087:EN:PDF (accessed Jun 15, 2019).
Decreto Legislativo n. 17, 19 febbraio 2014. Attuazione della direttiva 2011/62/UE, che modifica la direttiva 2001/83/CE, recante un codice comunitario relativo ai medicinali per uso umano, al fine di impedire l'ingresso di medicinali falsificati nella catena di fornitura legale. Gazzetta Ufficiale della Repubblica Italiana, Serie Generale 2014; Mar 7, 55. Available at: http://www.gazzettaufficiale.it/eli/id/2014/03/07/14G00027/sg%20 (accessed Jun 15, 2019).
Levaggi R, Orizio G, Domenighini S, Bressanelli M, Schulz PJ, Zani C, Caimi L, Gelatti U. Marketing and pricing strategies of online pharmacies. Health Policy. 2009;92(2-3):187-96. https://doi.org/10.1016/j.healthpol.2009.03.010
Orizio G, Schulz P, Domenighini S, Caimi L, Rosati C, Rubinelli S, Gelatti U. Cyberdrugs: a cross-sectional study of online pharmacies characteristics. Eur J Public Health. 2009;19(4):375-377. https://doi.org/10.1093/eurpub/ckn146
Cordaro FG, Lombardo S, Cosentino M. Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the Internet. Scand J Med Sci Sports. 2011;21(6):e247-e259. https://doi.org/10.1111/j.1600-0838.2010.01263.x
Orizio G, Merla A, Schulz PJ, Gelatti U. Quality of online pharmacies and websites selling prescription drugs: a systematic review. J Med Internet Res. 2011;13(3):e74. https://doi.org/10.2196/jmir.1795
U.S. Food & Drug Administration. Counterfeit Medicine. Available at: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/CounterfeitMedicine/ (accessed Jun 15, 2019).
World Health Organization. Counterfeit medicines: the silent epidemic. Available at: http://www.who.int/mediacentre/news/releases/2006/pr09/en/ (accessed Jun 15, 2019).
World Economic Forum, Global Risks, Sixth edition, An Initiative of the Risk Response Network, 2011, p. 23. IRACM 2015. Available at: http://reports.weforum.org/global-risks-2011/ (accessed Jun 15, 2019).
Przyswa E. Counterfeit medicines and Criminal Organisations. International Institute of Research Against Counterfeit Medicines (IRACM), September 2013. Available at: http://www.iracm.com/flip2/english/IRACM.html (accessed Jun 15, 2019).
Interpol. Millions of medicines seized in largest INTERPOL operation against illicit online pharmacies. 25 September 2017. Available at: https://www.interpol.int/News-and-media/News/2017/N2017-119 (accessed Jun 15, 2019).
Italian Ministry of Health. Soggetti autorizzati al commercio online di medicinali. Available: http://www.salute.gov.it/LogoCommercioElettronico/CercaSitoEComm (accessed Jun 15, 2019).
Federfarma. La farmacia italiana nel 2016. Available: https://www.federfarma.it/Documenti/farmaci_italiana2016.aspx (accessed Jun15, 2019).
Lombardo S, Cosentino M. [Pharmacy on line: evolution, regulatory and orientative framework normativo of the pharmacists working in Lombardia.] RagiuFarm 2013;137:14-22.
Burke A. Il flop delle farmacie online: pochi bollini rilasciati e ostacoli dalle regioni. Farmacista 33 2016, December 1. Available: http://www.farmacista33.it/il-flop-delle-farmacie-online-pochi-bollini-rilasciati-e-ostacoli-dalle-regioni/politica-e-sanita/news--38250.html (accessed Jun 15, 2019).
Sadasivam R, Kinney R, Lemon S, Shimada S, Allison J, Houston T. Internet health information seeking is a team sport: analysis of the Pew Internet Survey. Int J Med Inform. 2013;82(3):193-200. https://doi.org/10.1016/j.ijmedinf.2012.09.008
Ybarra M, Suman M. Help seeking behavior and the Internet: a national survey. Int J Med Inform. 2006;75(1):29-41. https://doi.org/10.1016/j.ijmedinf.2005.07.029
Andreassen HK, Bujnowska-Fedak MM, Chronaki CE, Dumitru RC, Pudule I, Santana S, Voss H, Wynn R. European citizens' use of E-health services: a study of seven countries. BMC Public Health. 2007;7:53. https://doi.org/10.1186/1471-2458-7-53
Lombardo S, Cosentino M. Internet Use for Searching Information on Medicines and Disease: A Community Pharmacy-Based Survey Among Adult Pharmacy Customers. Interact J Med Res. 2016;5(3):e22. https://doi.org/10.2196/ijmr.5231
Zucco R, Lavano F, Anfosso R, Bianco A, Pileggi C, Pavia M. Internet and social media use for antibiotic-related information seeking: Findings from a survey among adult population in Italy. Int J Med Inform. 2018;111:131-139. https://doi.org/10.1016/j.ijmedinf.2017.12.005
Holtgräfe C, Zentes J. Multifaceted determinants of online non-prescription drug information seeking and the impact on consumers' use of purchase channels. Health Informatics J. 2012;18(2):95-110. https://doi.org/10.1177/1460458212439487
Donaldson C. The number of people buying medicine online. J R Soc Promot Health. 2008;128(6):284. https://doi.org/10.1177/14664240081280061203
Jena AB, Goldman DP, Foster SE, Califano JA Jr. Prescription medication abuse and illegitimate internet-based pharmacies. Ann Intern Med. 2011;155(12):848-850. https://doi.org/10.7326/0003-4819-155-12-201112200-00008
Barbaranelli C, Podio Guidugli S, Di Giorgio D, Gramazio M. Personal determinants of purchasing of pharmaceuticals products online. Test Psychometr Methodol Appl Psychol 2015; 22: 1-19. https://doi.org/10.4473/TPM22.1.1
Barbaranelli C. Analysis of data on market/customers profiling. Deliverable 2.3 of the Fakeshare II Project Co-funded by the Prevention of and Fight against Crime Programme of the European Union (http://www.fakeshare.eu/ (accessed Oct 18, 2019).
Bell M, Douglas J, Cutts C. How pharmacy's adoption of social media can enhance patient outcomes. Integrated Pharm Res Pract 2014;3:39-47. https://doi.org/10.2147/IPRP.S42774
Law E, Youmans SL. Combating counterfeit medications: The California pharmacist perspective. J Pharm Pract. 2011;24(1):114-21. https://doi.org/10.1177/0897190010380745
Taleb YA, Madadha RA. Pharmacists' Awareness about Counterfeit Medications in Jordan. J Roy Med Serv 2013;20:57-70. https://doi.org/10.12816/0000079
Shahverdi S, Hajimiri M, Pourmalek F, Torkamandi H, Gholami K, Hanafi S, Ashrafi Shahmirzadi N, Javadi M. Iranian pharmacists' knowledge, attitude and practice regarding counterfeit drugs. Iran J Pharm Res. 2012;11(3):963-968.
Al-Worafi YM. Pharmacy practice and its challenges in Yemen. Australas Med J. 2014;7(1):17-23. https://doi.org/10.4066/AMJ.2014.1890
Alfadl AA, Hassali MA, Ibrahim MI. Counterfeit drug demand: perceptions of policy makers and community pharmacists in Sudan. Res Social Adm Pharm. 2013;9(3):302-310. https://doi.org/10.1016/j.sapharm.2012.05.002
Sholy L, Gard P, Williams S, MacAdam A. Pharmacist awareness and views towards counterfeit medicine in Lebanon. Int J Pharm Pract. 2018;26(3):273-280. https://doi.org/10.1111/ijpp.12388
Di Giorgio D. Il fenomeno del crimine farmaceutico e le attività di contrasto. Roma, 17 October 2017. Available: http://www.salute.gov.it/portale/temi/documenti/usmaf/formazione2017/Il_fenomeno_del_crimine_farmaceutico_e_le_attivita_di_contrasto.pdf (accessed Jun 15, 2019).
Agenzia Italiana del Farmaco. Operazione PANGEA IX. 13 June 2016. Available at: http://www.aifa.gov.it/content/operazione-pangea-ix (accessed Jun15, 2019).
Federfarma. [Pharmacy is fememine – data from Federfarma]. Farma7 2017;9:23.
Federfarma. La farmacia italiana 2016. Available at: https://www.federfarma.it/Documenti/farmaci_italiana2016.aspx (accessed Jun 15, 2019).
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