The web is home to an illegal bazaar of abortion pills. The FDA is ill-equipped to stop it.

“Counterfeit criminals go where there is demand – and there is demand and there are access issues,” said Libby Baney, senior adviser to the Alliance for Safe Online Pharmacies, a group defense of the abortion pill market. “This creates a criminal opportunity and a major risk to patient safety.”

Google says it is generally unable to determine when sites are breaking the law, but will remove them from search results when the government asks.

Cytotec, the brand name version of misoprostol, is an FDA-approved prescription drug for the treatment of stomach ulcers. It is also one of two pills used to terminate a pregnancy. According to a statement from drugmaker Pfizer, Cytotec is a target for counterfeiters.

But in states where abortion is restricted, patients have reported problems getting their prescriptions filled. for matters unrelated to abortion.

Experts said people go online to get drugs whenever there is an obstacle to obtaining it legally. In the case of abortion, these barriers can take the form of state regulations, but also pressure from family, friends and community leaders to maintain a pregnancy. Other times, people turn to the web thinking they can get a drug for less.

While there are legitimate telemedicine operations and online pharmacies helping connect people online in states that restrict abortion, they sometimes struggle to promote their services. Illicit pharmacies, on the other hand, know how to circumvent Google’s rules and climb to the top of search results.

For example, there is a very active online black market for Viagra, the erectile dysfunction drug, because people are too ashamed to ask a doctor for it. Men seeking HIV prophylaxis sometimes go online if they don’t want to be seen at a sexual health clinic. During the pandemic, people bought hydroxychloroquine, an antimalarial drug touted by former President Donald Trump, and ivermectin, a parasiticide, from shady websites despite FDA warnings against their use.

“Any time you create a fractured healthcare system or a fractured supply chain, that confusion will be exploited by criminals,” said John B. Hertig, associate professor of pharmaceutical practice at Butler University College of Pharmacy and Health Sciences.

An emerging black market

State laws restricting abortion already limit access to drugs that can end pregnancies, even when a patient is taking them for other reasons.

Patients have complained that pharmacies are not filling prescriptions for methotrexate, which is used to treat the immune disorder lupus, as well as other illnesses, but which can cause miscarriage.

Although the Biden administration has told pharmacies that failing to administer a patient’s medication is a crime, pharmacies may still be able to limit access. Some allow individual pharmacists not to fill orders if they have conscientious objections. At least one state, Texas, actively restricts the supply of abortifacients.

The price is also an issue. The scam sites sell Cytotec for around $4 per pill, a bit below the typical cost of Drugs.com, a New Zealand price-tracking company. More than half of abortions in the United States are already induced by drugs, according to the Guttmacher Institute, a research group that supports abortion rights. This share will likely increase following the Supreme Court’s ruling, providing a huge market to tap into.

Extralegal, though legitimate, organizations have sprung up overseas to help connect people to medical abortion in states where it is illegal. For individuals, it can be difficult to tell which sites are safe.

“There is a majority of American consumers who believe that if they see medical care listed on Google on the first page, it has been verified or validated by an authority in the United States,” Hertig said. “And that’s absolutely not the case at all.”

All of these problems create market opportunities for unauthorized online sellers.

Online searches for medical abortion skyrocketed after POLITICO published the Supreme Court’s draft opinion that preceded the overturning of Roe vs. Wade.

What they find is often labyrinthine. Of the approximately 35,000 online pharmacies worldwide, 95% operate illegally, according to the National Association of Boards of Pharmacy.

“In our experience, these rogue pharmacies are marketers and they will turn to any drug that is in the news and is popular, using it as a marketing tool to try to funnel business. to their website,” said David Khalaf, a spokesperson for LegitScript, an Oregon-based company that validates online health services and works with government agencies and businesses to identify illegal operations.

The execution problem

The pandemic offers a recent example of how an atmosphere of fear and confusion can empower criminals. Between January 2020 and March 2020, scammers produced 190,000 domain names related to Covid-19, said Dan Burke, senior director of operations at the FDA’s Office of Criminal Investigations, during a June webinar on pharmacies. thugs.

While scientists were still struggling to understand the new virus, these sites promised cures. “We were drinking from a fire hose,” Burke said.

FDA criminal investigators are tasked with prosecuting illegal pharmacies and counterfeit drug operations. It is a difficult task. Online, drug dealers can cover their tracks and disappear in an instant. Additionally, the office lacks the enforcement tools necessary to take down sites, especially when it comes to uncooperative domain registrars.

“You can register a domain name anonymously from anywhere in the world and submit just about anything you want to it – and good luck trying to shut down this site, because you don’t know who’s running it “said Baney of the Alliance for Secure Online Pharmacies.

The European Union imposed its General Data Protection Regulation in 2018 in an attempt to protect the privacy of Internet users. But regulations have also made it harder to prosecute fraudulent sites. Domain registrars, which operate globally, have stopped publishing the identity of website owners in order to comply. Now, some domain registry services won’t give information to regulators in the United States without a subpoena and won’t remove illegal sites without a court order, Baney said.

The FDA has no subpoena power and must instead rely on the Department of Justice, which faces its own legal hurdles.

“As a public health agency, we’re in a no-win situation,” Burke said during the webinar. “We can’t show network reach without subpoenas, but we can’t get grand jury subpoenas without showing reach.”

Baney said the Domain Reform Act for Illegal Drug Sellers, a Senate bill introduced in December by Florida Republican Marc Rubio, aims to hold domain registrars accountable. The bill would require a domain registrar to lock and suspend a domain name associated with illegal conduct once notified by the FDA or the Department of Justice.

Locking a domain name prevents its owner from transferring it to a new registrar and continuing its operations.

The FDA also recently lobbied the Internet Corporation for Assigned Names and Numbers, a nonprofit organization that oversees the entire domain name registry industry, to ensure that registrars adhere to its accreditation requirements, which include responding to reports of illegal activity and abuse. .

Consumers can learn about what a dishonest pharmacy might look like. According to the FDA, people should avoid any site offering to sell drugs without a prescription. LegitScript also has a domain checker on its website that can check if a site is legit. Plan C, a project of the National Women’s Health Network, provides a list of approved resources for abortion pills.

Baney would like to see search engines take more responsibility. “The algorithm is controllable,” she said. “You can prioritize legitimate, licensed sellers and online pharmacies.”

A Google spokesperson said the company works to return high-quality sources to the top of search results and to remove malicious pharmaceutical websites from results when the FDA determines they are in violation of the law and asks Google to do it.

Still, rogue sites find a way through and patients should proceed with caution, Hertig said. “When you’re a patient in difficulty, because he can no longer access care, whether it’s an abortion or whatever, it’s natural that he Googles it, and that’s a proposition very risky.”

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