The "prescription-only" gray area

A love letter to United Pharmacies

Willem van Mieris, Der Apotheker

People are surprised that prescription drugs aren’t illegal and you can just buy them. This seems to violate some sort of intuition about them – surely you’re not allowed to have them and thus they are forbidden to buy. This is sort of true; most countries don’t just let you buy them over the counter.

Medicines are usually split into different categories depending on how they can be sold and whether they need a prescription to be dispensed. In the UK, medicines can belong to one of a few categories:

• GSL (General Sales List), meaning they can be sold almost anywhere

• P (pharmacy), meaning they can be sold only by a licensed pharmacist

• POM (prescription-only medicine), meaning you need a prescription for them to be dispensed

(GSL is somewhat unusual; lots of countries won’t let you buy e.g. painkillers anywhere but as pharmacy. I’m often caught out by this when outside of the UK and can’t stock up on aspirin while doing my grocery shopping!)

Whether or not something can be sold with a script or not is orthogonal to whether it’s a controlled substance. Some medicines are both: stimulants like Ritalin, benzodiazepines like Valium, and opioids like tramadol, are controlled substances (class C in the UK), which makes them illegal to possess without a valid prescription. Often pharmacies are a bit more strict about dispensing them for this reason.

It would be illegal for someone to sell you a prescription-only medicine without a prescription. But they’re not illegal to buy or possess without one. You’re also allowed to import them, curiously, usually with restrictions on how much you can buy and on the proviso that it’s for personal use only.

This leads to a curious grey area, where you’re able to go online and buy prescription-only medicines and import them for personal use but you can’t buy them locally.

Other countries aren’t as permissive as the UK in this regard. In Germany for example, you can’t have prescription medicines posted to you. But you can bring them in across a border, provided it’s for personal use and not more than a three-month supply.

This doesn’t make much sense to me. If I can import something legally then why shouldn’t I be able to buy it locally? It’s not clear what purpose this inconsistency holds. (Another similar one is the situation with anabolic steroids in the UK: although they’re class C, they have a specific carve-out that makes them legal to possess for personal use.) It’s led to a proliferation of gray market pharmacies, usually in Asia (but quite a few in Bulgaria, curiously) who will cheerfully and legally sell you all sorts of wares.

It’s a useful safety valve. If you look online for lists of gray market pharmacies, they’re often found on medical forums for people with poorly-understood conditions like ME/CFS or subreddits for trans people looking to self-treat. In both cases I can imagine people struggling to get the attention they need from medical professionals.

It also breaks the irritating strictures that the medical profession puts on getting access to medicine – often doctors are unwilling to e.g. give you more than a month’s supply of medicine if you’re going travelling, leaving patients in the lurch. Likewise, patients often get dropped between specialists and general practitioners, with each pointing the finger at the other for accessing an ongoing supply of medication.

There are good reasons for some drugs being prescription-only and controlling their availability – overuse of antibiotics is medically inappropriate and has negative externalities like increased antibiotic resistance. But where there isn’t a high risk of harm, informed consumers should have the right to other channels to access medicine.