Patients' lives are being put at risk because it is too easy to buy prescription-only medicines from online pharmacies, a leading pharmacist says.
A BBC investigation found 20 online pharmacies selling restricted drugs without checks - such as GP approval.
In total, we bought over 1,600 various prescription-only pills by entering false information without challenge.
Regulator the General Pharmaceutical Council says extra checks are needed when selling some drugs online.
The BBC's findings highlight the "wild west" of buying medicines on the web, says Thorrun Govind, a pharmacist, health lawyer and former chair of the Royal Pharmaceutical Society.
"The current guidance basically tells pharmacies to be robust, but do that in your own way, and we know that under this current system, patients have died," she says.
The parents of a woman who died in 2020, after accidentally overdosing on medicines she bought online, are among those calling for stricter rules.
Katie Corrigan, from St Erth in Cornwall, had developed an addiction to painkillers after experiencing neck pain.
"Katie needed help, she didn't need more medication," says her mum, Christine Taylor.
Her GP had stopped supplying the drug after realising she had been allowed to request new prescriptions prematurely and been prescribed too much.
Instead, Katie, 38, was able to buy a painkiller and a drug used to treat anxiety from multiple online pharmacies without notifying her GP.
The coroner at Katie's inquest confirmed her GP had not been contacted by any of the pharmacies to check the drug was safe for her. In his final report, he said the safety controls were inadequate.
Christine wants online pharmacies to obtain more background information. "It's far too easy - it's people's lives, and it's a disaster waiting to happen," she says.
Undercover experiment
Current guidance from the regulator, the General Pharmaceutical Council, (GPhC) says online prescribers must get "all the information they need" to ensure a medicine is safe and appropriate for an individual patient.
It also states that "high-risk, habit-forming medicines", like those Katie Corrigan was able to buy, should not be sold online without additional safeguards.
But some of the medicines she bought still appear to be readily available from some online pharmacies, the BBC has found.
We attempted to buy prescription-only drugs from regulated online pharmacies.
We selected three restricted drugs - including an anti-anxiety drug, a painkiller and a sleeping medication. We are not naming these drugs because they can be dangerous when taken without medical guidance.
Of the 20 businesses we identified selling one or more restricted drugs:
- We found nine pharmacies selling the anti-anxiety drug
- Three pharmacies sold the anti-anxiety medicine to us on the basis of our answers to an online questionnaire and did not require further checks
- In total, we were able to buy a potentially fatal dose of the anti-anxiety medicine
- We bought the painkiller from nine pharmacies based on online questionnaires
- We similarly obtained the sleeping medication from 14 pharmacies
But 13 online pharmacies which sold at least one of these drugs refused to sell to us without access to some medical records, proof that we had been prescribed them before by a doctor, or permission to contact our GP to carry out further safety checks.
Two pharmacies refunded our order after assessing our answers to the questionnaire.
We also found evidence of high-risk and potentially addictive medicines, including benzodiazepines and antidepressants, being sold on the basis of online questionnaires.
One online pharmacy sent a marketing email telling us we had "something fabulous" in our basket and to "buy before time runs out", referring to an addictive painkiller. This is language the regulator, which can disqualify a pharmacist from its register, says should not be used.
Five of the pharmacies that sold to us sent follow-up emails with more safety information and contact details if we had concerns or needed to ask any questions.
Every pharmacy that sold to us had a disclaimer urging us to alert our GP about the purchase.
'Vague guidance'
The BBC spoke to several other people who said they have been able to circumvent safety checks to buy medicines from online pharmacies.
One woman, who wanted to remain anonymous, said she bought a prescription-only weight loss drug in July by falsely claiming to be roughly double her real weight in a questionnaire.
The woman said she was asked to verify her identity by showing an image of her driving licence, but was not asked to provide any evidence of her weight.
There were no further checks to ensure the drug was suitable before it was dispatched.
"After taking it for a few days, I felt really bad - I couldn't eat, I was exhausted and basically stopped functioning," she said.
"If I'd had to send a picture, or any proof of my weight, I don't think I would have been prescribed it."
If you are affected by any of the issues raised in this story you can contact BBC Action Line here.
Unlike illegitimate, black market sellers, licensed online pharmacies are regulated by the GPhC and employ qualified pharmacists and prescribers.
They are expected to carry out risk assessments to determine which medicines can be safely sold online, and the regulator can take action if they are deemed to be practising dangerously.
But Ms Gorrund says the guidance from the regulator is too vague, and does not state clearly enough what checks online pharmacies should be conducting.
"This has led to such a variation, with some online pharmacies asking for checks like video consultations, while others seem to let you simply click on the drug you want and go forward to pay," she explains.
The Royal Pharmaceutical Society says the findings are "concerning", and it wants to see regulators take action where poor professional practice has been highlighted.
The GPhC issued renewed guidance in 2022 after it found hundreds of its investigations into whether pharmacies should be allowed to continue operating related specifically to online pharmacies.
In a statement, it told the BBC it expected pharmacy owners to carry out risk assessments to identify which medicines are safe to supply online and identify requests for medicines that are too large or too frequent.
A spokesperson said: "We have made it clear that medicines liable to abuse, overuse or misuse, such as opioids and sedatives, should not be sold online unless further safeguards have been put in place.
"We have taken regulatory action against online pharmacies which fell short of professional standards, including in some cases where 'high-risk, habit-forming' medicines were supplied on the basis of an online questionnaire."
