Editorial: Internet pharmacies and the online pharmacy market: trends, perspectives and challenges

The online pharmacy market has emerged as a rapidly growing channel in the pharmaceutical supply chain since the turn of the century 1,2. Despite its growth, the actual size of the market remains elusive, with thousands of internet pharmacies accessible worldwide 3. While purchasing medications from legitimate online pharmacies is an accepted practice in developed countries and many studies around the world have documented significant changes in consumer demand for distance buying of medicines 4, the market is plagued by illegitimate vendors (also referenced as illicit or rogue online pharmacies), posing significant risks to patient safety 5–8. This research topic aimeds to frame the trends, perspectives and methodological considerations on the challenges associated with internet pharmacies and the online pharmacy market in the contributing articles. The primary emerging topics were market trends and consumer attitudes; the current and persistent challenges related to quality assurance and regulation; and the urgent need for a multi-stakeholder collaborative approach to resolve the issues related to this complex pharmaceutical supply channel.The trends in online pharmacy use and consumer attitudes have changed; consequently, online medication and health product purchases are becoming more prevalent in numerous regions. The COVID-19 pandemic has significantly accelerated the shift toward online pharmacies, and a substantial increase in the frequency of online medicine purchases was highlighted in a study by Fittler et al. focusing on Central European countries. However, despite this growth, the traditional “offline” drug supply chain will not be replaced by online platforms as most consumers still prefer traditional pharmacies, indicating persistent trust in brick-and-mortar establishments. A systematic review by Almomani et al. explored the reasons consumers opt to purchase prescription medicines online and identified factors such as convenience, cost, and privacy as major reasons. Twelve driving factors were detected by Limbu et al. in a review that shed light on factors that enhance customers’ buying of medications online. High income and education, and white American consumers were the most liable to such purchases. Existing literature covered in this review included 47 papers from 29 countries in Europe, North America, Australia, Asia, the Arabian Peninsula, and Africa, however, published studies carried out in South America are lacking. Despite the easily observable benefits, the risks associated with medicine purchases via the internet must also be considered, including the potential for counterfeit medicines and the lack of professional healthcare oversight. Accordingly, increased consumer awareness and regulatory measures to ensure safe online purchasing practices are necessary.Challenges in regulation and quality assurance have been persistent issues related to online health-related product purchases for a quarter of a decade since the first online pharmacies were established in 1999.9 The challenges of regulating online pharmacies are compounded by the global nature of the internet, varying national laws, and the complexity of product categories offered for sale. A UK-based research by Oriakhi et al. investigated the operations of online pharmacies, especially during the COVID-19 pandemic, revealing significant patient safety risks due to the prevalence of "rogue" pharmacies. This study found that 47% of the 116 online pharmacies assessed were rogue, often selling prescription-only medicines (POMs) without prescriptions or consultations and offering controlled medicines like alprazolam and diazepam. A study by Vida et al. on the safety and risks associated with cannabidiol (CBD) oils purchased online revealed quality issues related to discrepancies in CBD content and misleading health claims, pointing to broader issues related to patient safety. In addition to medications and dietary supplements, a study conducted by Garcia et al. on the online availability of anabolic agents in sports (e.g. oxandrolone, DHEA, and androstenedione) reveals that these substances are also easily accessible online, often without prescription. Chereches et al. evaluated the role of online pharmacies in providing Food for Special Medical Purposes (FSMPs) based on a survey of patients with cancer in Romania. The study revealed patient satisfaction with access, concerns about cost, and the need for information provided by healthcare professionals during FSMP selection. The authors underlined that digital solutions should complement and enhance, rather than replace, the traditional interactions and expert advice provided by healthcare providers. One of the main aspects of successful online pharmacy services is to apply a firm legal environment to regulate and prevent fraudulent transactions. Although the United States, the UK, Canada, Europe, and Australia have developed and implemented clear and comprehensive regulations, such measures are in progress in other parts of the world, such as The Gulf region. Alfageh et al. addressed the regulations in Saudi Arabia, Kuwait, the United Arab Emirates, Qatar, Bahrain, and Oman and found that the legal framework of internet pharmacy is somewhat comparable between the responding countries; however, it is still in its infancy, and online pharmacy service providers have limited awareness of the existing regulations. The authors of this paper emphasize the importance of establishing firm regulations by local authorities in the Gulf region that control online pharmacy services locally, as well as the import of medications for personal use. These findings highlight the urgent need for international harmonization of regulations and the establishment of robust and transnational verification systems to protect consumers.A multi-stakeholder approach and complex risk assessment methodologies are required to address the challenges of the online pharmacy market and guarantee its safety 10. This involves collaboration among organizations, patients, manufacturers, distributors, authorities, and search engine providers to ensure the integrity of the supply chain 11. By working together, these stakeholders can maximize the benefits of online pharmacies while minimizing the associated risks.In conclusion, the online pharmacy market has emerged as a dynamic and rapidly evolving segment of the pharmaceutical supply chain, significantly transforming how consumers access medications. This supply channel and the products offered to patients are unique in numerous aspects, including safety, efficacy, quality, regulation, and vulnerability. The research contributions on this topic provide valuable insights into the dynamics of the online pharmacy market and provide further evidence to create a take-home message that should be clear for all stakeholders, including regulators, health professionals, authorities, search engines and internet providers, and patients: “We must find the balance between convenience and safety”. As the market continues to evolve, supporting research that facilitates the publication of studies from various nations and disciplines is imperative, ultimately contributing to safer and more effective online pharmaceutical practices. Future research should focus on opportunities for developing global verification systems, enhancing quality assurance, introducing effective and ethical marketing practices, implementing and evaluating public awareness and education campaigns, developing and evaluating online pharmacy/telepharmacy services, and strengthening law enforcement to protect consumers in this rapidly evolving market and ultimately the advancement of digital health services.Author contributionsAF and NA conceived the idea for the editorial and wrote the initial draft. All authors have approved the final version.AcknowledgmentsWe greatly acknowledge the contribution of the authors submitting their articles to the Research Topic.Conflict of interestThe research was conducted without commercial or financial conflicts of interest.

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