Falsified Medicines Research Articles

Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance.

The World Health Organization and others warn that substandard and falsified medicines harm health and waste money, especially in low- and middle-income countries. However, no country has measured the market-wide extent of the problem, and no standardized methods exist to estimate the prevalence of either substandard or falsified medicines. This is, in part, because the task seems overwhelming; medicine markets are huge and diverse, and testing medicines is expensive. Many countries do operate some form of postmarket surveillance of medicine, but their methods and goals differ. There is currently no clear guidance on which surveillance method is most appropriate to meet specific public health goals. In this viewpoint, we aimed to discuss the utility of both case finding and risk-based sentinel surveillance for substandard and falsified medicines, linking each to specific public health goals. We posit that choosing the system most appropriate to the goal, as well as implementing it with a clear understanding of the factors driving the production and sale of substandard and falsified medicines, will allow for surveillance resources to be concentrated most efficiently. We adapted principles used for disease outbreak responses to suggest a case-finding system that uses secondary data to flag poor-quality medicines, proposing risk-based indicators that differ for substandard and falsified medicines. This system potentially offers a cost-effective way of identifying “cases” for market withdrawal, enhanced oversight, or another immediate response. We further proposed a risk-based sentinel surveillance system that concentrates resources on measuring the prevalence of substandard and falsified medicines in the risk clusters where they are most likely to be found. The sentinel surveillance system provides base data for a transparent, spreadsheet-based model for estimating the national prevalence of substandard and falsified medicines. The methods we proposed are based on ongoing work in Indonesia, a large and diverse middle-income country currently aiming to achieve universal health coverage. Both the case finding and the sentinel surveillance system are designed to be adaptable to other resource-constrained settings.

Perspective on Criminalization of Smuggling of Goods

The article examines the perspective on criminalization of smuggling of goods arising in connection with the Draft Law of Ukraine «On Amendments to the Criminal Code of Ukraine and the Criminal Procedure Code of Ukraine on criminalization of smuggling of goods and excisable goods and inaccurate declaration of goods» (№ 5420). The Draft Law provides for the following criminal offenses: smuggling (Article 201); transporting across the customs border of Ukraine out of customs control or with concealment from customs control of timber or lumber of valuable and rare species of trees, unprocessed timber, as well as other timber prohibited for export out of the customs territory of Ukraine (Article 201-1); smuggling of goods (Articles 201-2); smuggling of excisable goods (Articles 201-3); smuggling of narcotic drugs, psychotropic substances, their analogues or precursors or falsified medicines (Article 305). They form a homogeneous group of actions, between which there must be systemic connections. It follows that the reasons for formulating the peculiar title of Article 201-1 are missing. The title of this article should be formulated as follows: «Smuggling of timber or lumber of valuable and rare species of trees, unprocessed timber, as well as other timber prohibited for export out of the customs territory of Ukraine». It was found that Article 201-2 of the Draft Law provides for the general description of a criminal offense, and the description of criminal offenses specified in Articles 201, 201-1, 201-3 and 305 of the Draft Law are peculiar. In this regard, it seems appropriate to swap the Criminal Law provisions of Articles 201 and 201-2 of the Draft Law. In Section 4 of Article 201-4 of the Draft Law, the phrase «assistance in any form by a customs official to commit such acts with the use of power or official position» is not a qualifying feature, but an independent structure. If there is a need to criminalize this act, it may be provided for in a separate article or should be specified in a separate section of Article 201-4 of the Draft Law as an independent act. It is established that on the one hand, the criminalization of smuggling of goods is an urgent need in Ukraine, on the other side the present Draft Law of Ukraine cannot effectively address this issue, as it requires additional elaboration.

Sounding out falsified medicines from genuine medicines using Broadband Acoustic Resonance Dissolution Spectroscopy (BARDS)

The trade in falsified medicine has increased significantly and it is estimated that global falsified sales have reached $100 billion in 2020. The EU Falsified Medicines Directive states that falsified medicines do not only reach patients through illegal routes but also via the legal supply chain. Falsified medicines can contain harmful ingredients. They can also contain too little or too much active ingredient or no active ingredient at all. BARDS (Broadband Acoustic Resonance Dissolution Spectroscopy) harnesses an acoustic phenomenon associated with the dissolution of a sample (tablet or powder). The resulting acoustic spectrum is unique and intrinsic to the sample and can be used as an identifier or signature profile. BARDS was evaluated in this study to determine whether a product is falsified or genuine in a rapid manner and at lower cost than many existing technologies. A range of genuine and falsified medicines, including falsified antimalarial tablets from south-east Asia, were tested, and compared to their counterpart genuine products. Significant differences between genuine and falsified doses were found in their acoustic signatures as they disintegrate and dissolve. Principal component analysis was employed to differentiate between the genuine and falsified medicines. This demonstrates that the tablets and capsules included here have intrinsic acoustic signatures which could be used to screen the quality of medicines.

Anti-counterfeiting protection, personalized medicines − Development of 2D identification methods using laser technology

Counterfeiting of the products for healing is as old as trading, and it is difficult to quantify the magnitude of the problem. It is known that substandard and/or falsified (SF) medicines are a growing global threat to health, and they cause serious social and economic damage. The EU has a strong legal framework for medicines, it is mandatory to meet the requirements of Directive 2011/62/EU. Serialisation prevents SF medicinal products from entering the legal distribution chain. The present study is an extension of the original idea and aims to develop a laser technology-based method to mark an individual traceable code on the surface of the tablet, which technology can also be used for marking personalized medicines. The method is based on the ablation of the upper layer of a double-layer, differently coloured coating. The 2D code should be formed without harming the functional layer, and anyone with a smartphone integrated with a camera should be able to authenticate these drugs with a suitable application. The present findings confirmed that KrF excimer laser and Ti:sapphire femtosecond laser are efficient and reliable for marking. These should be promising candidates for pharmaceutical companies that would like to have additional protection against drug counterfeiters.

Small-scale dissolution test screening tool to select potentially substandard and falsified (SF) medicines requiring full pharmacopoeial analysis

The purpose of this study was to design a convenient, small-scale dissolution test for extracting potential substandard and falsified (SF) medicines that require full pharmacopoeial analysis. The probability of metronidazole samples complying with the US Pharmacopoeia (USP) dissolution test for immediate-release tablet formulations was predicted from small-scale dissolution test results using the following criteria: (1) 95% confidence interval lower limit (95% CIlow) of the average dissolution rate of any n = 3 of n = 24 units of each sample, and (2) average and minimum dissolution rates for any n = 3 of n = 24 units. Criteria values were optimized via bootstrap sampling with Thinkeye data-mining software. Compliant metronidazole samples in the USP first-stage and second-stage dissolution test showed complying probabilities of 99.7% and 81.0%, respectively, if the average dissolution rate of n = 3 units is equal to or greater than the monograph-specified amount of dissolved drug (Q; 85% of labeled content for metronidazole). The complying probabilities were 100.0% and 79.0%, respectively, if the average dissolution rate of n = 3 units is 91% or higher and the minimum dissolution rate is 87% or higher. Suitable compliance criteria for the small-scale dissolution test are: average dissolution rate of n = 3 units is Q + 6% or more and minimum dissolution rate is Q + 2% or more.

The current state of the pharmaceutical market of Ukraine, quality assurance and falfication of medicines

The aim of our article was the study of the current state of the pharmaceutical market of Ukraine in the context of the quality assurance of medicines and preventing the spread of falsified medicines (FM), the identification of the main problems in the field of circulation of medicines and the ways to solve them. It is established that the dynamic development of the pharmaceutical market and its high profitability cause problem of drug quality, increasing threats to the spread of FM in circulation and require the implementation of effective mechanisms for regulation of quality and safety of medicines. Analysis the annual official statistics of the State Service of Ukraine on Medicines and Drug Control for the period of 2008–2019 on the number of detected FM in circulation showed a steady trend of increasing FM and insufficient implementation of effective measures to combat them. The creation of effective quality assurance system of drugs and preventing the spread of FM need to improve the organization of state control of drug quality, strengthening criminal liability for falsification of drugs and optimization of the system of their detection.

Detection Method of Falsified Medicines by Using a Low-Cost Raman Scattering Spectrometer Combined with Soft Independent Modeling of Class Analogy and Partial Least Squares Discriminant Analysis.

There are many reports of falsified medicines that may cause harm to patients. A rapid and simple method of identifying falsified medicines that could be used in the field is required. Although Raman scattering spectroscopy has become popular as a non-destructive analysis, few validation experiments on falsified medicines that are actually distributed on the market have been conducted. In this study, we validated a discriminant analysis using an ultra-compact, portable, and low-cost Raman scattering spectrometer combined with multivariate analysis. The medicines were three types of erectile dysfunction therapeutic tablet and one type of antifungal tablet: tadalafil (Cialis), vardenafil hydrochloride (Levitra), sildenafil citrate (Viagra), and fluconazole (Diflucan), which is sometimes advertised as female Viagra. For each medicine, the authentic standard product and products obtained by personal import via the internet (genuine or falsified) were used. Discriminant analyses were performed on the Raman spectra combined with soft independent modeling of class analogy (SIMCA) and partial least squares discriminant analysis (PLS-DA). It was possible to identify all falsified samples by SIMCA using the standard product model for all four products. Using the PLS-DA using the PLS models of the four standard products, falsified Levitra and Diflucan samples were classified correctly, although some falsified Cialis and all Viagra samples also belonged to the standard class. In this study, SIMCA might be more suitable than PLS-DA for identifying falsified medicines. A spectroscopic module that combines the low-cost Raman scattering spectroscopy with SIMCA might contribute to the rapid identification of falsified medicines in the field.

Implementing pharmaceutical track-and-trace systems: a realist review

IntroductionOne way to prevent falsified medical products from entering the regulated pharmaceutical supply chain is to implement a pharmaceutical track-and-trace system (PTTS). Such systems in the most extensive versions generally...

Identification of Substandard and Falsified Medicines: Influence of Different Tolerance Limits and Use of Authenticity Inquiries.

ABSTRACTSubstandard and falsified medicines have severe public health and socioeconomic effects, especially in low- and middle-income countries. The WHO has emphasized the need for reliable estimates of the prevalence of such medicines to efficiently respond to this problem. In the present study, we used 601 medicine samples collected in Cameroon, the DR Congo, and Malawi to assess the rates of substandard and falsified medicines based on different criteria. Based on the specifications of the U.S. Pharmacopoeia for the amount of the active pharmaceutical ingredients, the rate of out-of-specification medicines was 9.3%. By contrast, this rate ranged from 3.3% up to 35.0% if the tolerance limits of other pharmacopoeias or recently published medicine quality studies were used. This shows an urgent need for harmonization. Principal methods to assess the rate of falsified medicines are packaging analysis, chemical analysis, and authenticity inquiries. In the present study, we carried out an authenticity inquiry for the aforementioned medicine samples, contacting 126 manufacturers and 42 distributors. Response rates were higher for samples stated to be manufactured in Asia (52.4%) or Europe (53.8%) than for samples manufactured in Africa (27.4%; P < 0.001). One sample had been identified as falsified by packaging analysis by the local researchers and two additional ones by chemical analysis. Notably, seven additional falsified samples were identified by the authenticity inquiries. The total rate of falsified medicines resulted as 1.7%. Considerations are discussed for assessing the rates of “substandard” and “falsified” medicines in future medicine quality studies.

Analysis of the effectiveness of regulatory legal acts on counterfeiting of medicines in Ukraine

The problem of medicines counterfeiting is relevant for all countries of the world, without exception. At the same time, the effectiveness of combating the spread of counterfeit medicines (CM) in different countries, as well as the volume of counterfeited medical products, varies. Any state that aimed to ensure highly effective control over the circulation of medicines has to elaborate a comprehensive solution to this problem, primarily to adopt high-quality national legislation. The executive authorities should not only pay attention to neutralizing CM problem, but also take the most active part in this process. The primary role here should be played by law enforcement authorities. There is a need for coordinated work by law enforcement authorities to investigate the cases of falsified medicines and clandestine production, as well as by regulatory bodies to identify such products. It is also necessary to systematize the investigative and judicial practice on this issue, create an unified system for recording the facts of identifying the counterfeit drugs. The need for systematic monitoring and analysis of regulatory legal acts regarding the counteraction to the circulation of the CM in order to assess their effectiveness, as well as the adoption of appropriate measures by the authorized bodies, determine the relevance of the study.&#x0D; The aim of the work was to analyze the laws and regulations of CM adopted in Ukraine after the Declaration of Independence had been signed (1991), to assess their effectiveness in terms of bringing perpetrators to justice for pharmaceutical counterfeiting.&#x0D; Materials and methods. Scientific publications on the problem of CM, as well as the Laws of Ukraine and legal acts adopted by various authorities to combat the spread of falsified medicines, reports of law enforcement agencies, the General Prosecutor’s Office, the State Judicial Administration, court decisions included in the Unified State Register of Court Decisions (USRCD) under Article 321-1 of the Criminal Code of Ukraine. The analysis of the respective norms of the legislation adopted during 1991–2020 is carried out.&#x0D; Results. Having analyzed the reports of law enforcement agencies, the State Statistical Office, and the Prosecutor General’s Office, the authors established that none of the people who had been convicted under Article 321-1 of the Criminal Code of Ukraine, after the entry of the guilty verdict into force, was in places of deprivation of liberty. There are many information sources that provide various forms of statistics, but understanding them is quite a challenge. A large number of criminal proceedings have been investigated for a long time, and since the USRCD is inaccessible, and is available only for the pre-trial investigation bodies and the prosecutor’s office, it is impossible for a private person to get information regarding the end of the pre-trial investigation in certain cases.&#x0D; Conclusions. Despite the large quantity of regulatory legal acts adopted in Ukraine to prevent the spread of counterfeit medicines, the severity of the sanctions of Article 321-1 of the Criminal Code, which criminalizes the falsification and circulation of medicines, as well as the importance of medicines’ counterfeiting for public health, the effectiveness of measures to combat this phenomenon is dramatically low.

Device-Independent Discrimination of Falsified Amoxicillin Capsules Using Heterogeneous Near-Infrared Spectroscopic Devices for Training and Testing of a Support Vector Machine.

The objective of this work is to demonstrate the potential of near-infrared spectroscopy for common screening of falsified medicines in the field by means of a device-independent universal discrimination approach. In order to provide a useful discrimination tool to protect people from low-quality medical products, not only is a low-cost and portable screening device necessary, but a reference library is also essential. The authors believe that a device-dependent reference library inhibits near-infrared spectroscopy from becoming a popular screening tool. In this study, to develop a device-independent method, discrimination performance is evaluated using different devices for training and testing. The training data sets for the reference library were prepared using a bench-top Fourier transform near-infrared spectrophotometer, and predictive discrimination was performed using the spectral data by a low-cost and portable wavelength dispersive near-infrared spectrophotometer. A near-infrared spectrum-based support vector machine was used for these purposes, but the screening resulted in low accuracy thought to be caused by the intrinsically device-dependent features of the spectra data. Thus, principal component analysis was performed to collect the proper components to discriminate low-quality products from standard products. The principal component score-based support vector machine was able to produce highly accurate results, identifying falsified products with no false positive cases.

Pixel-based Raman hyperspectral identification of complex pharmaceutical formulations

Hyperspectral imaging has been widely used for different kinds of applications and many chemometric tools have been developed to help identifying chemical compounds. However, most of those tools rely on factorial decomposition techniques that can be challenging for large data sets and/or in the presence of minor compounds. The present study proposes a pixel-based identification (PBI) approach that allows readily identifying spectral signatures in Raman hyperspectral imaging data. This strategy is based on the identification of essential spectral pixels (ESP), which can be found by convex hull calculation. As the corresponding set of spectra is largely reduced and encompasses the purest spectral signatures, direct database matching and identification can be reliably and rapidly performed. The efficiency of PBI was evaluated on both known and unknown samples, considering genuine and falsified pharmaceutical tablets. We showed that it is possible to analyze a wide variety of pharmaceutical formulations of increasing complexity (from 5 to 0.1% (w/w) of polymorphic impurity detection) for medium (150 x 150 pixels) and big (1000 x 1000 pixels) map sizes in less than 2 min. Moreover, in the case of falsified medicines, it is demonstrated that the proposed approach allows the identification of all compounds, found in very different proportions and, sometimes, in trace amounts. Furthermore, the relevant spectral signatures for which no match is found in the reference database can be identified at a later stage and the nature of the corresponding compounds further investigated. Overall, the provided results show that Raman hyperspectral imaging combined with PBI enables rapid and reliable spectral identification of complex pharmaceutical formulations.

Medicine Shortages: From Assumption to Evidence to Action - A Proposal for Using the FMD Data Repositories for Shortages Monitoring.

Medicine shortages may negatively impact patient care and the patient experience. Shortages should be a priority of industry, supply chain stakeholders and national competent authorities, and deserve more than empathy or “lip-service” but serious engagement and action. Under the overarching principle that without correct measurements in place there cannot be any improvement in overall performance (1), stakeholders in the pharmaceutical supply chain, notably pharmaceutical manufacturers have made the call for all relevant sources of information to be used in order to provide additional intelligence about the root causes and drivers of shortages, including the identification of bottlenecks in the supply chain. This paper outlines a proposal for using the data stored in the interoperable network of national repositories being set up in the context of the Falsified Medicines Directive (Directive 2011/62/EU) and its Delegated Regulation 2016/161/EU on safety features for providing additional intelligence in monitoring shortages. The paper analyses the potential feasibility and readiness of using this data for monitoring shortages as well as the strengths and weaknesses of the approach. We explore also what are some of the other complementary data sources that could be analyzed in conjunction with the data in the repository system to sharpen the overall analysis. Lastly, we provide a theoretical but concrete use case for using the abovementioned data for better informing decisions to prevent and mitigate shortages. In doing so, we explain the interlink between patient needs at country level, demand from economic actors, intra-EU parallel trade and manufacturer-imposed supply quotas and propose a mechanism for collaboration between national competent authorities and supply chain stakeholders for early detection and action to prevent medicine shortages from occurring.

Quality and composition of Albendazole, Mebendazole and Praziquantel available in Burkina Faso, Côte d'Ivoire, Ghana and Tanzania.

BackgroundEven though the international combat against Neglected Tropical Diseases such as schistosomiasis or soil-transmitted helminthiases depends on reliable therapeutics, anthelminthic pharmacovigilance has been neglected on many national African drug markets. Therefore, quality and composition of Albendazole, Mebendazole and Praziquantel locally collected in Burkina Faso, Côte d’Ivoire, Ghana and Tanzania were analysed.MethodsSamples of 88 different batches were obtained from randomly selected facilities. Sampling took place in Northwest Tanzania, Western Burkina Faso, Southeast Côte d’Ivoire and Southwest Ghana. Visual examination of both packaging and samples was performed according to the WHO ‘Be Aware’ tool. Products were then screened with the GPHF Minilab, consisting of tests of mass uniformity, disintegration times and thin-layer chromatography (TLC). Confirmatory tests were performed according to international pharmacopoeiae, applying assays for dissolution profiles and high-performance liquid chromatography (HPLC).FindingsDespite minor irregularities, appearance of the products did not hint at falsified medicines. However, 19.6% of the brands collected in Ghana and Tanzania were not officially licensed for sale. Mass uniformity was confirmed in 53 out of 58 brands of tablets. 41 out of 56 products passed disintegration times; 10 out of the 15 failing products did not disintegrate at all. Evaluating TLC results, only 4 out of 83 batches narrowly missed specification limits, 18 batches slightly exceeded them. Not more than 46.3% (31 / 67) of the tablets assayed passed the respective pharmaceutical criteria for dissolution. HPLC findings confirmed TLC results despite shifted specification limits: 10 out of 83 tested batches contained less than 90%, none exceeded 110%.ConclusionIn the four study countries, no falsified anthelminthic medicine was encountered. The active pharmaceutical ingredient was not found to either exceed or fall below specification limits. Galenic characteristics however, especially dissolution profiles, revealed great deficits.

FALSIFICATION OF MEDICINES AND DISTRIBUTION OF FALSIFIED MEDICINES IN UKRAINE: CRIMINALISTIC MEANS OF DETECTION AND COUNTERACTION

The aim: To formulate criminalistic recommendations to increase the effectiveness of combating falsification and contribution of falsified medicines. To accomplish analyze of the current state and trends in combating this criminal offense, to create the basis of criminalistic characteristics and methods of their investigation, taking into account the results of the generalization of judicial investigative practice and foreign experience. Materials and methods: The examine and analysis of results and generalization of 128 criminal proceedings of such criminal offenses, court decisions for the period 2012- 2020; questionnaires of practical workers (205 people); results of generalization and analysis of published materials of investigative and judicial practice; foreign experience in combating falsification of medicines, etc. In the process of conducting this research, general scientific and special research methods were also used. Results: Based on the results of the generalization of investigative and judicial practice, a criminalistic description of falsification and contribution of falsified medicines in the form of descriptive and statistical information model has been developed, its elemental composition was determined and analysed. Reasonable that in theoretical terms criminalistic characteristics are the basis for building appropriate criminalistic methods, and in practical terms is considered as a kind of guideline that can be successfully used by investigators in the conduct of specific criminal proceedings, which allows choosing the most effective directions and means of investigation. Conclusions: One of the priority areas of research in criminalistics is the development of criminalistic characteristics and basics of investigation methods of falsification and contribution of falsified medicines, which must be carried out on the basis of the modern general theory of criminalistics, current legislation and practice, results of generalizationand analysis of investigator of judicial practice and foreign experience.

Government to consult on national falsified medicines detection system

Government to consult on national falsified medicines detection system

Bill that could allow wider hub-and-spoke dispensing expected to become law in February 2021

Legislation paving the way for wider use of hub-and-spoke dispensing is expected to receive royal assent in February 2021, the Department of Health and Social Care (DHSC) has said. The Medicines and Medical Devices Bill will also lay the first steps towards building a replacement for the EU’s Falsified Medicines Directive (FMD) and supporting a […]

Determination of antiretroviral drugs for buyers' club in Switzerland using capillary electrophoresis methods.

Human immunodeficiency virus-acquired immunodeficiency syndrome continues to be a major global public health issue, having claimed almost 33 million lives to date. Due to the high cost of antiretroviral treatment, access to these drugs remains difficult for vulnerable populations, such as migrants and people living in prisons, who often do not have health insurance. These factors lead to poorer health outcomes and higher transmission rates. The personal importation scheme for unapproved generics from foreign countries is one option to access affordable human immunodeficiency virus treatment. However, the risk of importing falsified medicine remains high, and the quality control of unapproved drugs is lacking. In this context, three CE methods for the analysis of nine antiviral drugs found in commercial pharmaceutical formulations were evaluated. The selected compounds were emtricitabine, tenofovir disoproxil, tenofovir alafenamide, rilpivirine, efavirenz, raltegravir, dolutegravir, abacavir, and lamivudine. The developed methods were successfully applied to determine the active pharmaceutical ingredients of commercial formulations and unapproved generics. The quality control of unapproved generics by CE is an attractive approach due to its good standard of quality, low cost, ecofriendliness, and ease of implementation.

Discrimination of Falsified Erectile Dysfunction Medicines by Use of an Ultra-Compact Raman Scattering Spectrometer.

Substandard and falsified medicines are often reported worldwide. An accurate and rapid detection method for falsified medicines is needed to prevent human health hazards. Raman scattering spectroscopy has emerged as a non-destructive analysis method for the detection of falsified medicines. In this laboratory study, Raman spectroscopy was performed to evaluate the applicability of the ultra-compact Raman scattering spectrometer (C13560). Principal component analysis (PCA) was also performed on the Raman spectra. This study analyzed tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra) tablets. We tested the standard product and products purchased from the internet (genuine or falsified). For Cialis and Levitra, all falsified tablets were identified by the Raman spectra and PCA score plot. For Viagra, the Raman spectra of some falsified tablets were almost comparable to the standard tablet. The PCA score plots of falsified tablets were dispersed, and some plots of falsified tablets were close to the standard tablet. In conclusion, C13560 was useful for the discrimination of falsified Cialis and Levitra tablets, whereas some falsified Viagra tablets had Raman spectra similar to that of the standard tablet. The development of detection methods that can be introduced in various settings may help prevent the spread of falsified products.

The rise of electronic commerce in healthcare: The need to ensure consumer safety

The growth of e-commerce is revolutionizing access to health products, and offers of these products on the Internet are often attractive from the customer's point of view. However, it contributes significantly to the expansion of international trade in falsified medicines. The objective is to take stock of the significant growth in the online sale of health products with the health challenges encountered. We conducted a survey on the purchase of the most popular online health products in Morocco, and then examined the type of health products offered, the price of the most common drugs compared to conventional prices.49 websites and social network forums were identified, 37% of which had a specific address and 63% of which had a virtual interface. The sales strategies identified are numerous, the main ones being the availability of medical specialties not available in the country, the order to pay less and save time. The most common purchases concern so-called "comfort" medicines. The challenge for the health authorities is now to develop an appropriate regulatory approach to control the purchase of these products on the Internet and the implementation of measures to prevent and minimize the risks associated with this practice.