A review by the Care Quality Commission in the UK has said it has "significant concerns" about the safety of patients using online pharmacies.
The CQC's investigation uncovered online services that were cutting corners when providing medicines to patients, not doing enough to check "whether they are appropriate, meaning that patients could be at risk of harm."
The regulator examined 11 Internet-based prescription services and found that while some were run well, there were serious failings in clinical oversight others, with its report citing two websites - HR Healthcare's treated.com and MD Direct's assetchemist.co.uk – for particular attention.
"There were no effective systems in place for recording, reporting and learning from significant events or safety alerts," says the CQC, adding that "risks to patients were not appropriately assessed or managed."
Among the deficiencies noted were: absent or minimal safety checks; no way of identifying whether or not patients lacked capacity to consent or understand their prescribed treatment or medical advice, or if there were any safeguarding concerns; and a lack of communication with the patient's GP even when the medicine prescribed required monitoring or follow-up.
According to Prof Steve Field, chief inspector of general practice at the CQC, online pharmacies "can present convenient ways for people to access advice, treatment and medication."
"However some services may be putting patients at risk," he continued. "As with conventional GP surgeries, these online companies and pharmacies are required to provide safe, high-quality and compassionate care and must adhere to exactly the same standards."
CQC's inspection of HR Healthcare was prompted by a BBC investigation last year which looked at online sale of antibiotics from the company.
While the risks associated with fly-by-night, rogue pharmacies are well-established, both the websites singled out by the regulator were registered online pharmacies bearing the Registered Pharmacy logo issued by the General Pharmaceutical Council and UK Medicines and Healthcare products Regulatory Agency (MHRA).
Immediately after the inspections, CQC suspended the registration of HR Healthcare, while MD Direct responded to its concerns by voluntarily cancelling its registration. Both providers have stopped providing services to patients in England.
In 2014, a survey of UK pharmacists has found that 80 per cent have come across patients self-diagnosing and treating themselves with medicines bought over the Internet without a prescription, raising the risk that they may be exposed to counterfeit or substandard drugs, and the recommendation was that consumers use only registered online pharmacies and not "diagnose with Dr Google".
Mike Isles of the EU arm of the Alliance for Safe Online Pharmacy (ASOP) told SecuringIndustry.com that the investigation" has exposed yet another vulnerability. It is important the public understands that as well as these websites offering advice and ultimately medicines, there is the whole other world where people go online and are exposed to over 30,000 illegally operating websites selling medicines."
ASOP EU and its partners are helping to raise awareness across Europe and will be running Google AdWord campaigns in France, Germany, Italy, Spain and the UK, he added.
"Those clicking on the advertisement will be routed to educational websites that will alert the public to illegally operating sites and offer advice as to how to recognise legitimate, genuine websites," said Isles.