Internet prescription drugs: A comparative negligence hazard

September 9, 2010

Dan Tennenhouse, MD, JD, FCLM

Dan TennenhouseDo your clients buy their prescription drugs on the Internet at a fraction of the pharmacy price? If so, it could cost them more than they expect.

Your clients may choose a safe-sounding Canadian Internet pharmacy. Too bad many of those websites aren’t actually located in Canada. The drugs often arrive in unmarked packages, perhaps mailed from Eastern Europe. Some originate in China, India or Southeast Asia. Some are from Mexico. All are in violation of federal law.

What’s in the package?

The pills or capsules your clients receive may be about the same size, shape and color as the drugs they ordered. Are they the right drugs? Maybe.

If they are, the seller could be saving money by obtaining outdated drugs and changing the labels. The seller could also be storing them in the shed out back where daytime temperatures exceed 120 degrees.

If the drugs come as pills, they might be made of colored talc pressed into pill shapes. Or it could be a different drug that’s about the same size, shape and color as the drug ordered.

If the drugs come in capsules, sellers can double their supply at no added cost by mixing in a filler of starch powder or whatever else is handy. They might add some inexpensive but strong drug or toxic substance to the capsules so their buyers will think the drug is really potent. If your clients think they’re getting a strong drug for their money, they might order more from the seller – and tell their friends about the great deal they got.

No prescription limits

Best of all, your clients might say, they can order as much as they want without a prescription. Internet sellers outside the United States don’t need one. Do your clients want to double their doses? Now they can.

Clients who buy prescription drugs from unreliable sources in order to save a few bucks appear not to care much about their own health. If your client’s condition isn’t improving, maybe it’s because he or she is not taking the prescribed drug or is taking a sub-potent form of it. Or perhaps some of your client’s symptoms are due to unknowingly ingesting some unknown drug or a toxic contaminant from a counterfeit drug. There will be plenty for opposing counsel to talk about in the courtroom.

Comparative negligence

Medical expert witnesses will probably call your client medically non-compliant. That means you’re also dealing with comparative negligence.

To best protect your client’s interests, find out early where their prescription drugs are being purchased. Warn of both the medical and legal dangers of Internet drugs. You should also ask about non-prescription drugs, herbal medicines, and nutritional supplements obtained from Internet suppliers.

If you’re the opposing counsel, investigate the plaintiff’s drug sources. Any drug obtained from the Internet can make proof of damages unexpectedly interesting.

Read more in Attorneys Medical Deskbook, 4th, § 38: 2.1, Counterfeit and reduced potency drugs.

Dan Tennenhouse, MD, JD, FCLM, is a graduate of the University of Michigan School of Medicine and the University of California Hastings College of the Law. He teaches legal medicine at the University of California San Francisco School of Medicine and practices as a medical legal consultant for attorneys. Dr. Tennenhouse is the author of Attorneys Medical Deskbook, now in its fourth edition.