Success of rogue online pharmacies: sewage study of sildenafil in the Netherlands
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4317 (Published 02 July 2014) Cite this as: BMJ 2014;349:g4317
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The finding by Venhius and colleagues (1) that as much as 60% of sildenafil residues in sewage is not explained by the quantity of the drug that is known to be legitimately prescribed is interesting in its own right. The tentative conclusion is that the bulk of sildenafil used for erectile dysfunction (ED) is obtained illegally without a prescription from rogue online pharmacies. If confirmed this finding could lead to one of two policy responses. The first would be to clamp down on so called illegal prescriptions. The alternative would be to consider the demand for the drug, the reluctance of many people to seek a legitimate prescription, and their willingness to pay for it, and make the drug available over the counter, with suitable information about its most appropriate use and the precautions to take.
When sildenafil was first licensed and marketed as an effective treatment for ED, there was a widespread view that state funded health care systems such as the NHS could not and should not pay for a drug that merely enhanced a life experience. The UK Department of Health introduced guidelines (2) aimed at limiting the patients who would qualify for NHS funded prescriptions. Contrary to newspaper headlines (3), the availability of sildenafil in approved chemists' outlets does not constitute over the counter availability. The widespread availability of illegitimate sildenafil and other similar drugs really makes the case for taking it off the list of prescription only drugs and making it more easily available, in combination with information and advice.
If we are serious about the co-production of health in partnership with lay people then we should be trust people to make the right choices and decide their own trade-offs. As a drug, sildenafil is merely one of many lifestyle drugs that are both freely available and widely used and is by no means among the more dangerous.
(1) Venhius, BJ. et al. Around two thirds of the sildenafil taken may be illicit. BMJ 2014; 349:g4317.
(2) http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publication...
(3) http://www.theguardian.com/society/2009/jun/18/viagra-boots-sale
Competing interests: No competing interests
Correction to figure published in print
The figure for the letter by Venhuis and colleagues that is published online is correct, but the y axis of the figure for the letter that is published in the print issue of 5 July is incorrect by a factor of 1000. The points on the y axis should have read 50 000 mg/week to 300 000 mg/week [not 50 mg/week to 300 mg/week as published in print].
I apologise for this error.
Competing interests: No competing interests