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Use: For the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

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I heard from two—one East Coast, one West Coast—each who knew loving middle-age mothers who lost adult sons to opioids. I heard from a Tennessee woman I knew whose teenage daughter had been in and out of rehab three times. I talked to her daughter as well, and she told me she was now clean—except for drinking, and occasionally smoking pot. Many I spoke with started their opioid journey with prescribed pain pills. Some would later leave their nice houses and find street drugs in back alleys and parts of town they never would have ventured before to feed their addiction.

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We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care. These medications include HIV drugs, benzodiazepines, and cholesterol medications, as well as lifestyle drugs, such as diet pills and erectile dysfunction medications. In fact, one study demonstrated the efficacy of utilizing an accredited online pharmacy to prescribe Viagra. They also provided a more complete medical history 21. To manage the increased use of online pharmacies, however, more regulations are being proposed, including the Online Pharmacy Safety Act and the development of state-run online pharmacy programs 22, 23.

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