Institute of Criminal Justice Research

Buying Medicine from the Web

Lisa Sugiura, Catherine Pope, Craig Webber Web Science DTC University of Southampton

Background
Medicines and drugs are subject to national and state/federal regulation. The misuse, illegal consumption and purchase of drugs and medicines is not a new phenomenon, but it is one which the Web may enable or magnify, opening up as it does access to online information and purchasing. In the UK medicines are defined in three ways: !As prescription-only medicines which can be obtained from qualified prescribers (e.g. doctors, dentists, nurse or pharmacist). !pharmacy-only medicines (known colloquially as over the counter medicines) !and general sales list medicines which can be obtained without a prescription. The provision, purchase and supply of prescription only medicines are typically regulated by national or state law. This can vary between countries; each with their own licensing body (e.g. UK The Medicines and Healthcare products Regulatory Agency (MHRA) and the US The Food and Drug Administration (FDA). Current UK medicines legislation is comprised of the Medicines Act 1968 and approximately 200 statutory instruments. Much of this legislation has not kept up with developments online and the Web is notoriously difficult to police

Methods
As this research is concerned with individuals utilising the Web online methods will be employed, The study will comprise three stages: 1.! Virtual Ethnography: observation of web forums 2.! Online Survey designed and implemented with the assistance of the MHRA 3. Semi-Structured Interviews The research will draw on theories of deviancy established within criminology and sociology, to explore whether buying medicines on the web could be considered as a form of respectable deviancy.

Previous Findings
Our initial research has explored the use of public forums as a means to collect data. This study explored the purchase of unlicensed slimming drugs from the Web and investigated whether individuals who participate in this purchasing are engaging in deviancy (action which lies outside the expected rules of conduct slimmers are not meant to obtain medicines without prescription) and operating outside of regulation (this behaviour transcends a national regulatory and licensing framework). An ethnographic study using non-participant observation in virtual web communities was conducted, drawing on social theories used within criminology to inform the analysis of web purchasing of slimming medicines Three forums that are publicly viewable were purposively selected. Documentary information about the sites was catalogued and slimming related threads were collected using Wget and manual copying and pasting. After selecting only relevant data mentioning the chosen medicine specifically, the final data set was comprised of 163 posts. These posts were examined, coded and analysed thematically. Some forum members were surprisingly open about their illegitimate behaviour in their posts, implying that they were seeking to subvert regulation by recognising that the medicine was unavailable in the UK. The data suggest that some members of the slimming community are engaging in deviancy by obtaining medicines without prescription. This behaviour transcends a national regulatory and licensing framework.

The Role of the Web

The Web can make medicines accessible. People can view websites outside of the UK and may access to unregulated sites. The Web enables advertising including spam emails, and direct marketing when people are browsing other sites which may encourage purchasing of medicines online. The nature of online purchasing is impersonal and may be anonymous which can may encourage disregard for the law/regulation. Those who purchase medicines online may ignore possible health risks, and may not be as aware that they are breaking the rules as they would be in the real-world. This research sets out to explore the online purchase of prescription only medicines. While such purchases may not be criminal and are distinct from offline illegal drug purchasing and use they can contravene regulations and social norms. The Web appears to remove or bypass some of the sanctions and stigma associated with illegal drug purchasing and appears to offer a safe way to engage in deviant behaviour. Online purchasing of unlicensed medicines may therefore be an example of respectable deviancy. Risks Though there may be no risk of criminal prosecution, the purchase of unlicensed medicines via the Web breaches domestic regulation. The risks associated with such purchases may be health, legal and financial. Medicines purchased on the Web may be counterfeit or incorrectly formulated. They may be unsafe to use without medical supervision or fail to meet safety standards. Websites may be unregulated and expose the consumer to illegal medicines, credit card fraud or identity theft. Indeed, the uniqueness of this research is that those engaging in deviant activity are clearly and unambiguously both deviant and victims.

Fig.1. Representation of medicine purchasing

Impact / deployment
to procure them. What is legitimately available is constantly shifting and the Web does not always reflect this, allowing sales to be conducted outside authorised forms of supply. This work is undertaken in collaboration across different University Faculties and groups such as Electronics and Computer Science, Health Sciences, Social Sciences and Social Policy, and Law. This research will describe and understand the purchase of prescription only medicine from the Web and help to develop methods for analysing this phenomena.

Aims of the Research

This research seeks to explore the following questions:

!How and why do people buy medicines using the Web? !What affordances does the Web offer to purchase unlicensed medicines? !Does the purchasing of unlicensed medicines constitute a deviant behaviour? !Is it possible to establish new methodological approaches for online research?

This research is pioneering because there is currently no qualitative understanding of why individuals choose to purchase prescription only medicine from the Web. This will be the first study to apply sociological and criminological theories to Web phenomena of this type. Working closely with the UK regulatory agency, the MHRA, this project seeks to inform patient safety, policy decisions, regulation, and in particular to contribute to future public advise and advertising campaigns from this agency.

Acknowledgement: The Digital Economy Programme is a Research Councils UK cross council initiative led by EPSRC and contributed to by AHRC, ESRC and MRC