Online prescribing ‘must get safer’

More deaths could occur unless action is taken to protect people when obtaining medications from online health providers, says a UK coroner

This is an edited version of an article first published by the BBC

Nigel Parsley has written to health secretary Matt Hancock highlighting the case of a woman who died after obtaining opiate painkillers online. Debbie Headspeath, 41, got the medication, dispensed by UK pharmacies, after website consultations. Her own GP was unaware of what she had requested from doctors on the internet.

The Suffolk coroner has now written to the Department of Health asking for urgent action to be taken.

The General Pharmaceutical Council – the independent regulator for pharmacies – said it was responding to the coroner’s report and would continue to take necessary action to make sure medicines are always supplied safely online.

Debbie’s story

Debbie, from Ipswich, died from lung problems triggered by damage to her pancreas – which had been caused by the large amounts of codeine medication she had been taking.

The inquest heard how Debbie’s own GP started prescribing opiate painkillers for back pain in 2008. The family doctor tried to wean her off the tablets, but she was able to buy more medication, prescribed by doctors she accessed on UK online pharmacy websites, as well as continuing to get some of the medication from her GP. The coroner at the inquest said there had been ‘regulatory gaps’ that allowed the tragic events to happen.

Debbie’s mother, Elaine Gardiner, said she had found bank statements showing that Debbie had spent more than £10,000 on online pharmacies and had taken out pay day loans to cover the costs. Mrs Gardiner said she decided to investigate her daughter’s death and wrote to the online providers.

“I was horrified such a thing could happen. I never thought for a minute that you could go online and just order an opiate drug and be given it, just like that, without the doctor knowing anything about you, anything about your medical history or having met you,” she said.

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The coroner’s report highlighted particular areas of concern:

  • There is no single database that allows a prescribing clinician to identify what has already been prescribed to a patient. For opiate drugs, such as codeine, there is no analysis of how many drugs are being prescribed outside of the NHS.
  • Some online companies change their business model to avoid regulation by the health watchdog, the Care Quality Commission, – eg. move their headquarters outside of England – so the doctor’s services can not be regulated.
  • The General Pharmaceutical Council issued new guidance in April 2019 about online pharmacies saying that, for high-risk medication such as opiates, a check had to be done by these pharmacies with the patient’s family doctor prior to medication being prescribed and dispensed. The coroner heard evidence which questioned whether this was only advisory, rather than compulsory.

Tim Ballard, of the Care Quality Commission, told the inquest that, since they started their round of inspection of online providers of online doctors’ services in 2017, many companies had moved abroad, typically to Romania, which meant their care could not be regulated.

The inquest heard that the coroner’s office had written to several doctors, employed by Romanian companies, who had prescribed to Debbie via the UK online pharmacy websites; all these letters came back as ‘return to sender’.

Duncan Rudkin, chief executive of the General Pharmaceutical Council, said, “Failure to follow the guidance would be evidence that the pharmacy is not meeting our standards, and enforcement action may be taken.

“We have, so far, taken enforcement action against 16 online pharmacies which have supplied high-risk medicines to patients inappropriately. This includes some online pharmacies working with prescribers based outside the UK. In most of these cases we have imposed conditions restricting the sale or supply of opioids and other controlled drugs by the pharmacy.”

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