Ali Schroer was just out of college when she started her first teaching job, but her new insurance plan didn’t cover her allergy medication.
"So this new allergist that I was seeing in Colorado had said, after several go arounds of me asking to take this medication, said, ‘Oh, well actually know that you can just get it online.”'
The doctor wrote a prescription and gave her the name of an online pharmacy to use. Schroer says it was saving her hundreds of dollars.
"I was like, “Oh, that's great," Schroer says. "The medication came to my house and looked exactly like it did when I got it before."
But it wasn’t long before Schroer started suffering stomach pains, migranes and chills. Over the course of several months, she saw specialists to no avail. She never questioned the allergy medication, because -- she thought -- she had taken it for years.
Then, over Christmas, she met up with her sister who was working in health policy. Schroer offhandedly mentioned ordering her prescription online.
"And she said, “Oh, you sure can't," Schroer says. "That is not safe.”
Schroer stopped taking the medication, and within weeks felt better.
"It is shockingly easy to be duped by this," Schroer says.
As many as 98% of online pharmacies are violating laws in some way, according to the Alliance for Safe Online Pharmacies. However, this can mean a range of different situations.
"For those sites, best case scenario is they're selling something that's legitimate product, but just not licensed to do so," says John Hertig, a Butler University professor and president of the board of directors of the Alliance for Safe Online Pharmacies. "But more often than not, they're actually selling what we would say is substandard, falsified, or counterfeit medications."
These bogus medications might have incorrect dosages of active ingredients -- or none at all. Another group, Partnership for Safe Medicines, found dangerous substances in these fake medications such as rat poison, antifreeze and fentanyl.
And now with COVID-19 sweeping the world, many of these online websites are using fear and confusion to their advantage. Some are even marketing “cures” or a “vaccine” for the virus, which does not exist.
"What we've been seeing with the pandemic is that there's just been no shortage of scams and frauds and all sorts of sorts of stuff going on," David Khalaf, communications manager with LegitScript, an organization that verifies online pharmacies, says.
In April, LegitScript saw over 10,000 new domains names that included COVID-19. In a report, they said these websites were 50% more likely to host malicious informaiton.
"Typically, the rogue pharmacies are marketing erectile dysfunction drugs, that's one of the top things but also various forms of pain medication, things like that," Khalaf says. "So yeah, they're absolutely pivoting to meet demand."
Shutting down these rogue pharmacies is tough -- close one and it’ll pop back up under a different name. Since most of these sites are based overseas, U.S. regulators have little influence.
"I don't think any one entity is going to be able to solve the problem of rogue internet pharmacies," Khalaf says. "It's going to be a combination of, you know, government interaction, private industry, and then, you know, nonprofit organizational advocacy."
Khalaf says this also includes internet registrars -- the places that distribute domains -- along with search engines, like Google and Bing, also hold some responsibility.
Right now, finding these rogue pharmacies doesn’t involve going to the hidden parts of the internet. Their websites often are listed on the first page of results from a search engine, and often look professional and legitimate. In fact, they can even fool doctors and pharmacists.
Hertig helped conduct a national study to see if medical professionals could spot rogue pharmacies.
"So if you put, you know three of these websites of ones legitimate ones illegitimate, roughly pharmacist will get it right about half the time," Hertig says.
Physicians and nurses got it right even less often.
"There are huge knowledge gaps that we identified as part of the study," Hertig says.
To check on a website, consumers can visit the FDA’s website to see a list of warning letters and other actions
There are of course legitimate online pharmacies -- like those operated by Costco and Express Scripts. Here’s how to help tell the difference -- they will always ask for a prescription. You can also verify the URL at Legit Script’s website.
This story was produced by Side Effects Public Media, a news collaborative covering public health.