Nature of the Problem:

• The increasing number Internet Web sites that allow consumers to obtain prescription medications without the existence of a bona fide physician-patient relationship poses an immediate threat to public health and safety.

Threat to Public Health and Safety:

• The identity of prescribing practitioners, pharmacists, source of prescriptions, etc., is not disclosed, consequently, there is no mechanism for patients to contact the physician or pharmacists of any untoward event such as an adverse drug reaction, ineffective treatment, etc.
• Ability to obtain controlled substances illegally contributes to drug diversion and misuse and abuse of prescription drugs – a growing public health concern
• No patient evaluation - existing or contraindications for treatment may be unknown to patient when prescription drugs are prescribed and dispensed based on answers to an online questionnaire
• Lack of accountability for adverse patient outcomes

Health risks:

• Adverse drug reactions
• Misdiagnosis or delay in diagnosis
• Failure to identify complicating conditions
• No appropriate medical record

Problems for State Regulatory Boards:

• Difficult to determine the location of the Web sites; changing location is as easy as changing a Web address
• Prescribing practitioners and pharmacists are not identified, so it is difficult to determine if they are properly licensed and practicing within their scope of practice

Existing State Medical Board Regulation:

• Most states have statutes, rules, or policies that prohibit a physician from issuing a prescription without first conducting or obtaining a patient examination/evaluation sufficient to establish a diagnosis and identify underlying conditions and/or contraindications.
• Many states specifically prohibit prescribing based on responses to an online questionnaire.
• State medical boards generally require out-of-state physicians to be licensed in the state where the patient resides in order to provide medical treatment, including prescribing medications.