Just how safe are prescription drugs?Depressed? Click on Prozac. Overweight? Order a course of Xenical. Can't get it up? Viagra's just a hyperlink away. It's easy - and legal - to buy prescription drugs online. But that doesn't mean it's safe. Maxine Frith reports
They are the multimillion pound products that cure serious illnesses and prevent thousands of deaths a year. But now some of the world's bestselling prescription drugs are not simply being taken by the sick but are also increasingly being used as "lifestyle medications".
The easy availability of virtually every kind of drug over the internet has meant that many people are now simply bypassing their doctor and self-prescribing medicines which they hope will improve their looks, job performance or prowess in the bedroom rather than treat a specific disease or condition.
Drugs designed to treat heart disease among the middle-aged are being used as slimming aids by young women; attention-deficit pills for children are taken by adults to concentrate in the boardroom; and even powerful injections for Aids patients are snapped up by people wanting an instant face-lift.
Doctors are becoming increasingly concerned at the ease with which patients can obtain such drugs via websites without any real checks on their medical history or claims to need the medication.
Patients who are refused an anti-depressant such as Prozac from their GP can simply buy supplies online. This is not illegal if the online company has a prescribing doctor on board. Whether that doctor takes a full medical history is hard to check up on.
Young women with eating disorders can, at the click of a button, obtain access to weight-loss products such as Xenical that are only meant for the morbidly obese.
There is an even darker side to the "lifestyle drugs" industry. Many of the drugs sold online are fakes that at best will not have any effect and at worst could kill.
The counterfeit drugs industry is worth an estimated £20bn a year. The Government's Medicines and Healthcare Products Regulatory Agency (MHRA) seizes more than £3m worth of stolen or faked Viagra every year.
In 2003, 24-year-old Liam Brackell killed himself after becoming addicted to a plethora of powerful prescription drugs that he bought off the internet. He had begun by buying Prozac online to counter the effects of his recreational use of ecstasy. By the time of his death, he had tried 23 different drugs. It was later found that what he thought were codeine tablets - a common painkiller - were counterfeits that had been cut with morphine.
Another problem is that pharmaceutical companies are desperate to find the holy grail of the drugs world - a product that can be sold to as many people as possible for as long as possible. So "lifestyle" drugs that don't just treat one condition but have other, beneficial side effects are being aggressively marketed by the industry.
Prozac, ELI LILLY
Chemical name: Fluoxetine hydrochloride.
What it costs: A pack of 30 tablets will set you back about £20 from online pharmacies.
Uses: More than 3.5 million people in Britain take antidepressants, with Prozac among the most widely prescribed of its type. It is one of a class of drugs called SSRIs (selective serotonin reuptake inhibitors), which are highly effective in treating depression as well as having low toxicity levels compared to older antidepressants.
Abuses: Prozac is also one of the most popular drugs sold on the internet. But there are concerns that the websites are creating a dependency on Prozac and allow people to increase their dosage without seeing a doctor or trying "talking therapies" instead of chemical cures. There have also been reports of clubgoers "self-medicating" with Prozac to counter the come down from taking ecstasy. In 2003, 81 deaths were attributed to overdoses of SSRIs and there have been reports of the drugs causing some people to commit suicide.
Chemical name: Orlistat.
What it costs: About £65 for 85 capsules on the internet.
Uses: Marketed as a potential panacea for the obesity epidemic afflicting much of the Western world, Xenical works in a different way from most weight-loss pills, which simply suppress appetite. Instead, Xenical blocks the activity of enzymes called lipases that break down the fat molecules in food. The drug excretes the fat out of the body. It is highly effective but can have unpleasant side effects such as loss of bowel control.
Abuses: Some doctors are concerned that people may be taking Xenical on its own, rather than in conjunction with switching to a healthy diet. It is recommended only for obese people who have tried other weight-loss programmes, but its availability online has raised fears that sufferers of eating disorders may have easy access to it. It is only available on prescription in the UK, although it is on offer at Boots for people who sign up to the high street chemist's own weight-loss programme.
Chemical name: Diazepam. First manufactured by Roche, it is now no longer protected by patent, but produced in generic form by other companies.
What it costs: About £50 for 30 tablets online.
Uses: Dubbed "mother's little helper" when it began to be widely prescribed to women with anxiety or depression in the 1960s, Valium was once one of the world's best-selling drugs. Roche stopped making the drug in 2002 after its patent expired, but it is still produced in unbranded, generic forms by other pharmaceutical companies and is widely available on the internet. The little blue pills are in a class of drugs called benzodiazepines. Concerns about their addictive properties and the emergence of the new class of SSRI antidepressants led to a fall in popularity of Valium in the 1990s.
Abuses: Recently, doctors have begun reporting a rise in the number of young women using the drug to sleep after taking cocaine or amphetamines. They are buying it online or obtaining it through the same dealers selling them illegal drugs. The Priory Hospital in Roehampton estimates that up to one in 10 patients at its addiction centre is now hooked on Valium.
Chemical name: Methylphenidate.
What it costs: About £20 for 60 tablets.
Uses: Ritalin has proved to be a highly successful but controversial treatment for Attention Deficit Hyperactivity Disorder (ADHD) among children. But there are concerns that the drug is being used as a "chemical cosh" and prescribed to too many children. More than 30,000 youngsters are taking the drug in Britain.
Abuses: It has a chemical formula similar to cocaine and because it is an appetite suppressant, young girls and teenagers have been known to take it to keep slim. There have been reports of children selling their supplies to others in the playground, while students and businessmen take it to improve their attention and concentration in exams and the boardroom. Last month, the US Food and Drug Administration ordered that Ritalin and other similar drugs should carry "black box" warnings about an increased risk of heart attacks.
Chemical name: Sildenafil Citrate.
What it costs: About £50 for four genuine tablets.
Uses: It was designed to treat impotence, but many people are buying it in the belief that it will boost their sexual performance.
Abuses: The most widely sold prescription drug on the internet, Viagra nets more than £1bn a year for Pfizer and many more millions for the thousands of counterfeit copies that are available. While genuine, branded Viagra tablets will cost around £10, fakes are available for as little as £2 each. Doctors are concerned that it has also become a "clubbers drug" with people mixing it with illegal substances such as ecstasy despite warnings that it can carry risks of heart problems.
Chemical name: Atorvastatin.
What it costs: About £40 for 30 tablets online.
Uses: Lipitor is a statin that lowers cholesterol and - by a very wide margin - is the world's bestselling drug. More than 11 million prescriptions for the drug are issued in Britain every year. Statins are generally considered to be very safe, but they do carry risks of digestive problems and liver toxicity in a small number of patients.
Abuses: Britain was the first country in the world to allow a statin (not Lipitor) to be sold over the counter because of the clear benefits of reducing cholesterol, but there are concerns that the drug is being abused. There have been reports of it being misused as a slimming aid, particularly by women.
Last year, more than 120,000 packets of fake Lipitor found their way into pharmacies across Britain, highlighting the huge and dangerous trade in counterfeit drugs.
Chemical name: Somatropin.
What it costs: About £6 for one injection.
Uses: It is used to help build up the strength of Aids patients who suffer debilitating weight loss. The injectable growth hormone has few side effects and quickly improves muscle tone - but it is now the victim of a burgeoning black market.
Abuses: The easy availability of Serostim highlights the way in which the internet has transformed access to powerful and potentially highly dangerous prescription drugs and turned them into lifestyle medications. Body builders are buying it online to bulk out muscle and it also enables them to recover faster from work-outs. Women are even injecting it in an effort to combat the effects of ageing and there have been reports of people in the film industry using it to make their skin look tighter and younger. Fake versions have led to severe side effects in some Aids patients in the US.
Provigil, CEPHALONChemical name: Modafinil.
What it costs: About £90 for 30 tablets online.
Uses: Provigil is marketed as a treatment for narcolepsy, a condition that causes excessive sleepiness and can make it impossible for people to stay awake. It has also been useful for multiple sclerosis patients who are often affected by extreme fatigue.
Abuses: Strict regulations on prescribing Provigil in the UK were eased two years ago. Unlike amphetamines that were previously used to treat sleep problems, and caused jittery side effects, Provigil works by targeting the neurones involved in wakefulness. But it is also increasingly being used as a lifestyle drug by people who do not have sleep problems. Suggestions that it could also help boost weight loss and mood have made it even more popular. Clubbers are using it to keep partying through the night, while businessman are buying it to help them through long days in the office, and students are taking it to keep revising. Doctors have warned that the drug can be psychologically addictive and can induce headaches and nausea.
The Good Drug Guide
mental health in the third millennium
Drug Company Sites
Online Pharmacy Risks
Medicines at the Millennium
International Pharmacies 2006
Big Pharma and Madison Avenue
The FDA and the Drug Companies
'Off-label' Prescription Drug Marketing
Pharmaceutical Roulette or Consumer Freedom?
Drug Companies and the Marketing of Depression