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Why IsraelPharm doesn’t sell controlled substance drugs

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Gloved healthcare professional holding pillsDrugs that are especially addictive and have a high potential for harm or abuse are often grouped under the banner of ‘controlled substances.’ Being classified as a controlled drug doesn’t mean that it is illegal for a pharmacy to sell it, but rather that there needs to be special care taken in every step of the process of supplying it.  It’s essential to be clear about the differences between illegal substances and controlled substances. Illegal substances are also known as street drugs, and are not only forbidden for sale but also for possession and use. Some examples of illegal substances are heroin, cocaine, crystal meth, ecstasy, methamphetamine, and, in some states in the US, cannabis.  Controlled substances, on the other hand, are fundamentally different. They have some specific medical use for which they have received FDA approval. However, the inherent risks associated with the potential of dependency or abuse have made controlling patients’ access levels necessary. In every case, a controlled substance can only be sold by a pharmacy against a prescription from a registered and qualified physician. In many cases, the quantity and strength that can be prescribed are strictly limited, as well as the frequency with which repeat prescriptions can be issued. Again, it’s important to note that all of these drugs are approved by the FDA and legal for their intended use, provided a registered physician has prescribed them, and that they will be taken by the designated patient in the prescribed dosages.

Why doesn’t IsraelPharm.com sell controlled substances?

It’s simple – to avoid the potential for harm and abuse of these controlled medications, we believe that selling controlled substances via digital prescription out of state and through online pharmacies is not acceptable. The potential for misuse and abuse is too high.  We have legal and ethical responsibilities to our customer base and the larger community we serve. Because we cannot enjoy the face-to-face contact with our customers that local pharmacies do, we cannot verify whether the prescription we are servicing and the designated customer are the same people. Selling controlled substances online is not a safe practice. There is also a weakness in the overall system since no centralized control ensures that prescriptions are not being issued for non-clinical use. Additionally, we can’t be 100% certain that a customer is not obtaining multiple prescriptions by visiting more than one doctor at a time or that they are buying too frequently, and we aren’t able to intervene with harm reduction strategies and take steps to prevent addiction and abuse. All these reasons place a moral and ethical need to “do no harm,” even indirectly. For this reason, we decided to block the flow of controlled substances out of our website.

There is an opioid epidemic, and many lives are being lost due to bad regulation. 

The US Department of Health and Human Services SAMSHA website carries a lot of information about ongoing attempts to try and overcome the plague of abuse of and addiction to controlled substances. Much of the problem has arisen because patients were legitimately prescribed highly addictive painkillers such as opioids. Later, new guidelines cut these folks from further supply, but by then, they had become dependent – through no fault of their own. This regulatory move forced many people onto the street to try and buy their prescription drugs from dealers or start “doctor shopping.” Doctor shopping is defined as having “overlapping prescriptions written by different prescribers and filled at three or more pharmacies.”

The rationale behind controlling registered and applicable drugs 

The logic that sits behind the enforcement of drug control is twofold:
  • To avoid the chance of individual patients becoming addicted to or dependent on prescribed medication. The most common examples of highly addictive and dependent drugs are for pain relief, such as oxycodone, morphine, and fentanyl.  Another main class of addictive drugs is tranquilizers, primarily based on benzodiazepines, including Valium and Xanax. Doctors may prescribe a benzodiazepine for legitimate medical conditions such as anxiety, insomnia, alcohol withdrawal, control in epileptics, muscle relaxation, inducing amnesia before painful procedures, and as a pre-surgical anesthetic.
  • To control the volume of medications that can be abused by others (not the targetted patients) seeking access. Typical examples are cocaine, which is a local anesthetic that produces extreme ‘highs’ in quantity, and Adderall and methamphetamine, which are commonly prescribed to treat ADHD and narcolepsy, but which can be used as a stimulant by students and athletes (usually called ‘speed’). 

Understanding how drugs are classified by the Federal Drug Authority (FDA).

The FDA has established a hierarchy that classifies all drug forms into five levels that consider the drug’s acceptable medical use, its likelihood to create dependency, and its potential for abuse. The potential rate of abuse is the most critical factor in determining the schedule into which the drug will be placed. For example, Schedule I drugs have the highest potential for abuse and the potential to create severe psychological or physical dependence. The level of abuse potential diminishes at each scheduling level.  A listing of all classified drugs and their schedule can be found on the Controlled Substance Act (CSA) page. The site is intended for general reference and is not a comprehensive or legal listing of all controlled substances. The list describes the basic or parent chemicals and does not necessarily describe their chemical variations that could also be classified as controlled substances.  Schedule I Schedule I substances or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples are heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA/ecstasy), methaqualone, and peyote. Technically, marijuana (cannabis) is designated as Schedule I by the Federal government, but ownership, sales, and usage in many states are permitted. Schedule II Schedule II drugs are substances with a high potential for abuse, potentially leading to psychological or physical dependence. These drugs are also considered dangerous due to potential overdoses and increased risk of fatal outcomes. Some examples of these drugs are painkillers (‘downers’) like hydrocodone (Vicodin), methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), and fentanyl. Some others have the opposite effect of being ‘uppers’, like Dexedrine, Adderall, and Ritalin. Schedule III Schedule III drugs are defined as substances with a moderate to low potential for physical and mental dependence, including Tylenol with added codeine, ketamine and anabolic steroids. Schedule IV Schedule IV drugs have a lower potential for abuse and risk of dependence than level III, but there is still some significant potential and risk, so we do not offer them for sale on the website. Some examples are benzodiazepine tranquilizers like Xanax and Valium, muscle relaxants like Carisoprodol, and pain relievers like Darvocet. Schedule V Finally, schedule V drugs contain limited quantities of certain narcotics, generally prescribed for analgesic, antidiarrheal, and antitussive purposes. Some examples of these drugs we do not offer for sale are cough preparations with less than 200 mg codeine per dose, like Robitussin and Parepectolin, and antidiarrheals like Motofen. 

Summary

Controlled substances are legal drugs that can be dispensed by a pharmacy against a doctor’s prescription but carry a high risk for abuse and dependency. The FDA lists the levels of risk in a hierarchy running from Schedule I (maximum) to Schedule V (lowest). Here at israelpharm.com, we have adopted a rigid policy that does not offer any products designated as controlled Schedule I-IV substances.
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