Most Americans think online drug purchasing can be dangerous, yet millions do it. Of the more than $220 billion a year spent on prescription drugs in the United States, the lion’s share is still spent in large chain stores such as CVS or Rite Aid, but the online market is worth at least $12 billion and increasing rapidly.

Purchasing drugs over the Internet offers significant benefits, including, as the U.S. Food and Drug Administration (FDA) acknowledges, a “convenient, private way to obtain needed medications, sometimes at more affordable prices.” The elderly, infirm, or geographically isolated can obtain prescriptions more quickly and easily. But deaths have been associated with such purchases. In July 2007, a 58-year-old Canadian, Marcia Bergeron, was poisoned by counterfeit antidepressants and acetaminophen she bought over the Web.

Opinion is divided on the overall safety of Internet-sourced drugs: do all sites sell good quality drugs, and if not, how does one differentiate the good from the bad? To try to answer these questions my research team assessed five popular drugs—Celebrex (pain relief), Lipitor (cholesterol), Nexium (acid reflux), Viagra (erectile dysfunction), and Zoloft (depression)—using 88 different samples from 26 websites. The FDA works with the National Association of Boards of Pharmacy (NABP) to assess such websites, as does the independent group PharmacyChecker. Drugs were purchased from a range of sites: those approved by NABP, those which are not approved by NABP but were legally compliant, and those which NABP discourages consumers from using.

The conditions of purchase, the price, and the product quality varied enormously.

The conditions of purchase, the price, and the product quality varied enormously. Some websites advertised single pills while others permitted the purchase of only large quantities. Many websites delivered incorrect drugs, some delivered no drugs at all; many websites shipped from multiple international locations and from locations that were different from those advertised on the websites. Some Indian products were marked up over 2,000 percent, others from Europe, possibly stolen, were sold at a significant discount to their face value.

Overall the news on quality is pretty good. Using the TruScan spectrometer, we compared the spectra of the procured drugs against established spectra of U.S. brand formulations of the five drugs. With the exception of fake Viagra, with packaging from China, none of the drugs failed our test. Having said this, in 20 percent of cases, a substitute drug was delivered, despite my request for brand name drugs only, and these drugs could not be tested accurately. Most of the substitutes produced spectra with evidence of the appropriate active pharmaceutical ingredient, but this does not mean that they are bioequivalent copies—true generics—of the innovator product. In other words, these substitute drugs may or may not work. With a few exceptions, most of the drug substitutes did not come from NABP-approved websites. Furthermore, none of the drug failures came from NABP-approved websites.

Convention has it that fake drugs are cheaper. The cheaper Viagra we procured was often but not always fake. Including delivery charges, we were able to purchase Viagra (or Viagra substitutes) ranging from $4.50 a pill to $41 a pill; the cheapest contained no active ingredient at all, and some of the pills that cost around $13 were also fake. But for the other four drugs, the approved sites were slightly cheaper than the others. Clearly, price is not a good indicator of whether a drug is real or not.

The World Health Organization reports that drugs from websites that conceal their physical address are counterfeit in more than 50 percent of cases. Our findings are consistent with WHO’s assessment.

The World Health Organization reports that drugs from websites that conceal their physical address are counterfeit in more than 50 percent of cases. Our findings are consistent with WHO’s assessment. All the drug failures came from websites lacking a physical address. Our research suggests that even non-approved websites that at least have a physical address will deliver decent brand–name drugs, though the sites break the law by selling drugs without a prescription.

These sites still may be risky. The ease with which I was able to procure drugs from non-approved websites without a prescription, or by using photocopies or faxed versions of prescriptions, suggests that there is ample opportunity for prescription drug abuse. I was able to procure several drugs from all 26 website pharmacies under the same consumer name within just a few months. For the websites that required prescriptions, I was able to use the same prescriptions multiple times because of the lack of insistence on original versions (many online pharmacies allow consumers to fax prescriptions without contacting the prescribing physician).

If you are going to buy drugs over the Internet, using NABP-approved websites lowers potential risk enormously. If you are determined to buy drugs without a prescription, at least make sure the pharmacy exists at the location given on the website, and examine the packaging to ensure the brand you ordered is the one delivered. The risk of not doing so could be lethal.

Roger Bate is the Legatum Fellow in Global Prosperity at the American Enterprise Institute.

FURTHER READING: Bate, Karen Porter, Kimberly Hess, and Robert Brush coauthored “Pilot Study of Internet Drug Availability, Pricing and Quality.”