Pakistani American Pharmaceutical Association

Federal law requires that "A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice" (21 CFR 1306.04(a». Every state separately imposes the same requirement under its laws. Under Federal and state law, for a doctor to be acting in the usual course of professional practice, there must be a bona fide doctor/patient relationship.

For purposes of state law, many state authorities, with the endorsement of medical societies, consider the existence of the following four elements as an indication that a legitimate doctor/patient relationship has been established:

·          A patient has a medical complaint

·          A medical history has been taken

·          A physical examination has been performed

AND - some logical connection exists between the medical complaint, the medical history, the physical examination, and the drug prescribed.

A patient completing a questionnaire that is then reviewed by a physician, hired by or working on behalf of an Internet pharmacy, does not establish a doctor/patient relationship. A consumer can more easily provide false information in a questionnaire than in a face-to- face meeting with the physician. It is illegal to receive a prescription for a controlled substance without the establishment of a legitimate doctor/patient relationship, and it is unlikely for such a relationship to be formed through Internet correspondence alone. However, this is not intended to limit the ability of practitioners to engage

in telemedicine.

For purposes of this guidance document, telemedicine refers to the provision of health care using telecommunication networks to transmit and receive information including voice communications, images and patient records. Some Internet sites recommend to the patient that they not take a new drug before they have a complete physical performed by a doctor. These sites then ask the patient to waive the requirement for a physical and to agree to have a physical before taking the drug they purchase via the Internet. An after-the-fact physical does not take the place of establishing a doctor/patient relationship. The physical exam should take place before the prescription is written. These types of activities by Internet pharmacies can subject the operators of the Internet site and any pharmacies or doctors who participate in the activity to criminal, civil, or administrative actions. For DEA registrants, administrative action may include the loss of their DEA registration. Additionally, providing false material information to obtain controlled substances could be considered obtaining a controlled substance by fraud and deceit, which is subject to Federal and State penalties.

What are the types of risks taken by individuals when ordering drugs via the Internet? How can those risks be minimized?

Persons considering purchasing drugs via an Internet pharmacy should exercise good common sense and scrutiny in selecting an Internet pharmacy. An "Internet pharmacy" site should provide a physical address for the pharmacy, in addition to the Internet address and a

telephone number for the pharmacy. Some common indicators that the "Internet Pharmacy" site may not be legitimate and should not be used as a source for controlled substances include the following:

 

The site is not a participant In any insurance plan and requires that all payments be made with a credit card.

·          The site requires that you waive some rights before they send you the drugs.

·          The site advises you about the law and why it is permissible for you to obtain pharmaceutical controlled substances from foreign countries via the Internet.

·          The site does not ask the name, address, or phone number of your current physician

·          The site advises you to have the drugs sent to post office boxes or other locations to avoid detection by U.S. authorities.

The site does not require that you provide a bona fide prescription issued by your personal physician or mid-level practitioner.

 

Can underage individuals acquire drugs on the Internet? How can this be prevented from happening?

Underage individuals can acquire drugs on the Internet in the same manner as an adult. The only way to prevent this is to restrict Internet access. In many instances, the young person will need a credit card to pay for the drugs. In these instances, parents can prevent drug purchases by withholding access to a credit card.

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