The hidden costs of online erectile dysfunction treatments

Counterfeit medicines claiming to treat erectile dysfunction (ED) are increasingly available on the internet. More and more men are purchasing ED treatments anonymously and cheaply from websites.1 While ED medications sold online are cheap and easy to purchase, there are many hidden costs, including potentially serious health risks.2 Proactive discussion of ED, comorbid conditions and the dangers of counterfeit ED drugs is needed with patients to help them avoid counterfeit online medications for ED.1

Online ED treatments – a lucrative business

Since the approval of phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of ED in the late 1990s, there is an increasing recognition of the effectiveness of pharmacological treatments for the disorder. A large legitimate market for the PDE-5 inhibitor-containing drugs has emerged and some 2.5 million European men now use genuine brands of PDE-5 inhibitors.¹

Alongside the increasing manufacture and sale of genuine PDE-5 inhibitors, there has been an increase of similar proportion in the manufacture and sale of counterfeit ED treatments, mostly over the internet. ED medications are expensive (even when sold cheaply online), making counterfeit manufacturing a lucrative business. Manufacturers are estimated to make as much as 2000% profit, or ten times more profit that heroin dealers.¹

Conservative estimates suggest at least 15,000 websites now market fake ED treatments. They receive 13 million hits and sell two million ED tablets a month. Around 2.5 million European men use counterfeit PDE-5 inhibitors, many of which are dangerous.¹

If it was purchased online, it’s probably fake

Like other counterfeits medicines, fraudulent treatments for ED usually differ significantly from the genuine medicines they claim to mimic. They may contain different amounts of the stated active ingredient, a different active ingredient or no active ingredient at all.²

The vast majority (90%) of ED treatments sold online differ significantly in composition from the medicines they claim to mimic. While these medications often look similar to the genuine article, laboratory analysis of tablets purchased online has revealed up to twice the stated dose of active ingredients in some medicines, substitute active ingredients in others, and even medications containing no active ingredient. Treatments claiming to be natural have been found to contain PDE-5 inhibitors and toxic substances such as commercial paint and printer ink have also been identified in tablets which purport to treat ED.¹

Patients don’t know what they’re swallowing

While counterfeit ED medicines differ markedly in composition, to the naked eye they often look the same as their genuine counterparts.¹

Patients who purchase medicines online or from other illegitimate sources are often unaware of the potential dangers of these medications. Many (30%) have not consulted a health professional about the erectile problems and do not have a prescription.¹

Even men who have prescriptions to buy legitimate drugs make use of internet sources. One study revealed 12% of men with prescriptions purchased products online because they were more convenient. 60% of men who purchased from online sources which did not require a prescription thought they would receive the same product as they purchased from the pharmacy.¹

The dangers of online medications include adverse reactions, poisoning and drug interactions. These dangers were brought to the attention of health professionals in Australia in 2010, when the first case of acute hypoglycaemia induced by counterfeit ED medicines was recorded in the country.³

Hypoglycaemia induced by fake ED treatments previously hospitalised 150 and killed four men in Singapore.⁴ These cases serve as a reminder to health professionals to consider the use of counterfeit drugs in the diagnosis of unexplained health conditions, and provide good evidence to highlight the dangers of fake treatments to patients.³

Buying online, circumventing the healthcare system

Even in the unlikely scenario that men do receive a safe, genuine product when they purchase online, the dangers associated with circumventing the health care system are considerable. Patients miss the opportunity to find out about contraindications to PDE-5 inhibitor use and to learn about potential drug interactions. They are not investigated for alternate aetiologies or common comorbidities.¹

Erectile dysfunction is known to be underpinned by endothelial dysfunction in the majority of cases. It usually occurs with other conditions associated with endothelial dysfunction including cardiovascular disorders and type 2 diabetes mellitus.¹

Patients presenting with erectile dysfunction are typically investigated for symptoms of comorbid conditions, and ED presentations are a good opportunity for health professionals to investigate the systemic health of male patients. Diagnosing and treating these conditions is important for optimal health, but also a key factor in optimising ED treatment outcomes.¹

Many men are embarrassed to discuss sexual problems, even with a doctor and some purchase dangerous medicines online so that they do not need to talk with a doctor. This highlights the need for proactive discussion of erectile function in clinical consultations, as well as the need for health professionals to alert patients to the dangers of online medications.¹

How to spot a fake

Patients may also need advice to help them identify fake medicines. One of the easiest ways to pick a counterfeit is by checking the website from which it was purchased. Websites which sell fake ED medicines overwhelmingly do not require a prescription for prescription only medicines (90%), do not name the pharmacist who is responsible for dispensing the drugs (94%) and do not provide physical contact details (85%). These websites should be avoided.¹

Offers which sound too good to be true should also be avoided. The age old wisdom ‘you get what you pay for’ certainly applies to online ED treatment.⁵

Don’t wait for your patients to speak up

PDE-5 inhibitors have increased treatment options for men with erectile dysfunction. When prescribed within the health care system, PDE-5 inhibitors are safe and effective treatments for the majority of men. However when purchased online, ED treatments are often fake and present considerable health risks.

Australian patients are purchasing fake medicines online. Health professionals must be aware of this phenomenon in order to inform patients of the dangers and encourage them to treat ED the right way – after medical investigations for comorbidities and with a doctor’s prescription.

More information

For more information, see Counterfeit Drugs for Erectile Dysfunction (ED).

References

1. Jackson G, Arver S, Banks I, Stecher VJ. Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks. Int J Clin Pract. 2010;64(4):497-504. [Abstract | Full text]
2. Fact sheet: Counterfeit medicines [online]. Geneva: World Health Organization; January 2010 [cited 20 October 2010]. Available from: URL link
3. Chaubey SK, Sangla KS, Suthaharan EN, Tan YM. Severe hypoglycaemia associated with ingesting counterfeit medicine. Med J Aust. 2010;192(12):716-7. [Abstract]
4. Kao SL, Chan CL, Tan B, et al. An unusual outbreak of hypoglycemia. N Engl J Med. 2009;360(7):734-6. [Full text]
5. FDA warns consumers about counterfeit drugs from multiple internet sellers [online]. Silver Spring, MD: US Food and Drug Administration; 1 May 2007 [cited 20 October 2010]. Available from URL link