There is an illegal market for abortion pills on the web. The FDA is ill-equipped to stop this.

“Counterfeiting criminals go where there is demand — and there is demand, and there are access issues,” said Libby Baney, senior adviser for the Safe Online Pharmacy Alliance, an advocacy group for the abortion pill market. “This creates opportunities for crime and a serious risk to patient safety.”

Google says it usually can’t tell when sites are breaking the law, but will remove them from search results when asked to do so by the government.

Cytotec, the brand name for 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 drug maker Pfizer, Cytotec is a target for counterfeiters.

But in states where abortion is illegal, patients report problems getting prescription drugs. on issues not related to abortion.

Experts say that people go online for medicines every time there is a barrier to getting them legally. In the case of abortion, these barriers can take the form of government regulation, as well as pressure from family, friends, and community leaders to keep the pregnancy going. In other cases, people turn to the Internet thinking they can get medicine at a lower price.

While there are legitimate telemedicine surgeries and online pharmacies helping people connect online in states where sometimes there are difficulties promoting your services. Meanwhile, illegal pharmacies are able to bypass Google’s rules and rise to the top of search results.

For example, there is a thriving black market for Viagra, an erectile dysfunction drug, because people are too ashamed to ask a doctor for it. Men seeking HIV prevention 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, an antiparasitic drug, from dubious websites despite FDA warnings about their use.

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

Emerging black market

State anti-abortion laws already restrict access to drugs that can terminate a pregnancy, even if the patient is taking them for other reasons.

Patients complain that pharmacies won’t write prescriptions for methotrexate, which is used to treat immune-compromised lupus, as well as other conditions, but can cause miscarriage.

While Biden administration told pharmacies that it is a crime not to dispense medicine to a patient, pharmacies can still restrict access. Some allow individual pharmacists not to fulfill orders if they refuse to do so for reasons of conscience. At least one state, Texas, actively limits provision of abortifacients.

Price is also an issue. The scam sites are selling Cytotec for about $4 a pill, which is slightly below the usual price from Drugs.com, a New Zealand firm that tracks prices. According to the Guttmacher Institute, a research group that supports the right to abortion, more than half of abortions in the United States are already performed with medication. This share is likely to rise after the Supreme Court ruling, providing a huge market to exploit.

Extralegal, though legal, organizations overseas have sprung up to help people get medical abortions in states where it’s illegal. It can be difficult for individuals to tell which sites are safe.

“Most consumers in the US believe that if they see medical services on Google on the first page, then they have been reviewed or approved by some authority in the US,” Hertig said. “And that’s not true at all.”

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

Internet search for medical abortion flew up to the sky following the publication by POLITICO of the draft decision of the Supreme Court preceding the repeal Rowe vs. Wade.

What they find is often a maze. Of the approximately 35,000 online pharmacies worldwide, 95% operate illegally. National Association of Pharmaceutical Councils.

“In our experience, these scam pharmacies are adept marketers and they will use any drug that appears in the news and is popular, using it as a marketing tool to try and drive business to their website,” said David Khalaf, spokesperson LegitScript. and an Oregon-based firm that verifies online healthcare services and works with government agencies and companies to detect illegal transactions.

Law enforcement problem

The pandemic provides a recent example of how a climate of fear and confusion can empower criminals to act. Fraudsters created 190,000 Covid-19-related domain names between January 2020 and March 2020, Dan Burke, senior operations manager for the FDA’s Office of Criminal Investigations, said during a June webinar on fraudulent pharmacies.

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

FDA criminal investigators are responsible for investigating illegal pharmacies and counterfeit drug manufacturing operations. This is a difficult task. Online, drug dealers can cover their tracks and disappear in an instant. In addition, the office does not have the necessary tools to force shutdown sites, especially when dealing with non-cooperating domain registrars.

“You can anonymously register a domain name from anywhere in the world and offer just about anything you want on it – and good luck trying to shut down this site because you don’t know who runs it,” Baney of the Alliance for Safer Internet said. – pharmacies.

In 2018, the European Union introduced its General Data Protection Regulation in an attempt to protect the privacy of web users. But regulation has also made it harder to find fraudulent sites. Domain registrars operating around the world have stopped publishing information about website owners in order to comply. Some domain registrars now don’t release information to regulators in the US without a subpoena or take down illegal sites without a court order, Baney said.

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

“As a public health agency, we are in a catch-22 situation,” Burke said during the webinar. “We can’t show the scale of the network without a subpoena, but we can’t get a grand jury subpoena without showing the scale.”

Bani said that Domain reform law for illegal drug dealers, a Senate bill introduced in December by Florida Republican Mark Rubio aims to hold domain name registrars accountable. The bill would require a domain registrar to block and suspend a domain name associated with illegal behavior upon notification to the FDA or the Department of Justice.

Blocking a domain name prevents its owner from transferring it to a new registrar and continuing to work.

The FDA also recently required the Internet Corporation for Assigned Names and Numbers, a non-profit organization that oversees the large domain name registry industry, to ensure that registrars comply with its accreditation terms, which include responding to reports of illegal activity and abuse. .

Consumers can find out what a fraudulent pharmacy might look like. According to the FDA, people should avoid any sites that offer to sell drugs without a prescription. LegitScript also has a domain checker on its website that can check if the site is legit. Plan C, a project of the National Women’s Health Network, provides a list of verified sources of abortion pills.

Baini would like search engines to take on more responsibility. “The algorithm is manageable,” she said. “You may prefer legitimate, licensed providers and online pharmacies.”

A Google spokesperson said the company is working to keep high-quality sources at the top of search results and is removing fraudulent pharmaceutical websites from results when the FDA determines they are breaking the law and asks Google to do so.

However, scam sites are finding their way, and patients should tread carefully, Hertig said. “When you’re a patient who’s struggling because now they can’t find access to help, whether it’s an abortion or whatever, it’s natural for them to Google it, and that’s a really risky proposition.”