Illegal online ads for medicines target an unwitting public

Consumers in Italy and Spain struggle to tell genuine advertisements for medicines from illegal ads, according to the CAPSULE Project led by Transcrime-Università Cattolica. The research, conducted in collaboration with the Italian Medicines Agency (AIFA) and supported by Michigan State University’s Center for Anti-Counterfeiting and Product Protection (A-CAPP), analysed consumer awareness of online purchases of illicit medicines.

Only half (53%) of online advertisements for medicines are correctly categorised as legitimate or illicit by Italian and Spanish consumers, posing a significant risk of purchasing substandard and falsified medicines (SFMs).

The illicit market for medicines has grown since the COVID-19 pandemic, exploiting vulnerable consumers through misleading online advertisements and websites. Existing efforts to combat the spread of SFMs online focus mainly on targeting online supply. The CAPSULE project instead focused on the demand side of the market, assessing the exposure and behaviour of consumers.

In January 2024, a survey was conducted among a representative sample of Internet users in Italy and Spain who were aware of the possibility of buying medicines online and had been exposed to online advertising or had bought at least one medicine online. The survey exposed them to a mix of legitimate and illegitimate online advertisements for medicines.

The results showed that consumers correctly categorised legitimate advertisements 63% of the time, but struggled significantly with illicit ads, correctly identifying them only 43% of the time in Italy and 42% in Spain. The most important factors influencing the decisions of the respondents are the absence of a label certifying authorisation by the Ministry of Health, followed by the absence of a drug description or the presence of errors.

The results of the study highlight the need for awareness campaigns tailored to different demographics and types of consumers: while older participants showed less capacity to detect illicit advertisements, younger participants expressed less trust in healthcare professionals and a higher propensity to rely on the Internet for obtaining healthcare information.

Most respondents were aware that legitimate online medicine sales in Italy and Spain are restricted to non-prescription medicines (73% in Italy and 66% in Spain). Only one third distinguished dietary supplements from medicinal products, underscoring the difficulty in distinguishing between products subject to different regulations.

Italian participants exhibited a higher rate of online purchases (69%) of medicines compared to Spain (52%). A substantial majority of Italians (85%) and Spaniards (75%) reported having seen at least one form of online advertisement for medicines.

In Italy, flu treatments were the most popular online purchases, followed by chronic pain and cholesterol management medicines. Spanish consumers mainly bought performance-enhancing and weight-loss products.

‘Given the overall increase in online purchases of medicines, the results highlight the need for better crime-proofing of legitimate advertising and selling channels to reduce the diffusion of substandard or fake medicines,’ said Dr Marco Dugato, researcher at Transcrime,  ‘This also requires a constant support from research in this area to monitor evolving consumer behaviour and market dynamics”.