Home Affairs correspondent
Investigators are cracking down on the multi-million pound trade in fake and unlicensed medicines, as concerns grow over potential health risks. BBC News joined investigators on one of their raids.
More people are diagnosing their medical problems and buying medicines online - boosting the growing trade in fake and illegitimate drugs supplied without a prescription.
Enforcement agencies warned that those taking the drugs are risking their health, as they launched an international operation to tackle the problem.
The Medicines and Healthcare products Regulation Agency (MHRA) says more than a million doses of medicines worth approximately £2m have been seized from the UK's postal service and ports during its latest crackdown.
An additional 100,000 doses were discovered in raids by police and investigators - with a value of at least £200,000.
Valium and Viagra - described by the MHRA as lifestyle drugs - are the most commonly sold.
But the agency warns that the counterfeiters are starting to offer drugs for cancer, heart conditions, epilepsy, asthma and depression.
BBC News joined a dozen MHRA officers as they moved in on an alleged drug-retailing operation in Brighton.
Although the MHRA has discovered a pharmaceutical drugs factory in London, the drugs it seizes are usually manufactured in China or India, so in this raid they are looking for evidence of imported "product".
The investigation begins with intelligence gathered from monitoring a website advertising Kamagra - an Indian version of Viagra not licensed for sale in Britain.
Accompanied by police officers, the team raids an address on a housing estate and arrests one man.
Senior enforcement investigator Danny Lee-Frost says: "No-one involved in those websites is medically qualified. None of the products are licensed or tested.
"They are selling them to you as a drug dealer would, they are not interested in your health, they are interested in taking your money. And the money is big."
The house is searched, documents and computers seized, several safes sliced open with angle-grinders and more than £1,000 in cash discovered - but no drugs.
The investigators switch their focus to paperwork in the house which suggests the owner has been paying rent on a further two storage spaces. A team heads off to the first to investigate.
It turns out to be a room in a small office building. Again nothing is found. But upstairs, one of the MHRA's investigators discovers a box, half-full of pills.
They are Valium tablets - quite possibly counterfeit, according to Mr Lee-Frost.
It is a small but useful find for the investigators, meaning the man they arrested can potentially be prosecuted. Pleased with their work so far, they drive over to the other address.
A rundown house in a residential area, it has bars on the windows and a bolted door. Using keys seized earlier, the investigators open the door.
Inside a grubby front room is a pile of boxes containing green tablets in sheets of blister packs.
The pills are Kamagra, according to Mr Lee-Frost. This version of Viagra is popular in India but illegal to sell in the UK - and certainly illegal to supply without a prescription.
The drug is easily distinguishable from legitimate Viagra, which is normally blue. It has been sent from Pakistan.
Just how safe are prescription drugs obtained off the internet?
Depressed? Click on Prozac. Overweight? Order a course of Xenical. Hyper well Ritalin is just a Hyperlink away! It's easy - and legal - to buy prescription drugs online. But that doesn't mean it's safe.
Maxine Frith reports
They are the multimillion pound products that cure serious illnesses and prevent thousands of deaths a year. But now some of the world's bestselling prescription drugs are not simply being taken by the sick but are also increasingly being used as "lifestyle medications".
The easy availability of virtually every kind of drug over the internet has meant that many people are now simply bypassing their doctor and self-prescribing medicines which they hope will improve their looks, job performance or prowess in the bedroom rather than treat a specific disease or condition.
Drugs designed to treat heart disease among the middle-aged are being used as slimming aids by young women; attention-deficit pills for children are taken by adults to concentrate in the boardroom; and even powerful injections for Aids patients are snapped up by people wanting an instant face-lift.
Doctors are becoming increasingly concerned at the ease with which patients can obtain such drugs via websites without any real checks on their medical history or claims to need the medication.
Patients who are refused an anti-depressant such as Prozac from their GP can simply buy supplies online. This is not illegal if the online company has a prescribing doctor on board. Whether that doctor takes a full medical history is hard to check up on.
Young women with eating disorders can, at the click of a button, obtain access to weight-loss products such as Xenical that are only meant for the morbidly obese.
There is an even darker side to the "lifestyle drugs" industry. Many of the drugs sold online are fakes that at best will not have any effect and at worst could kill.
The counterfeit drugs industry is worth an estimated £20bn a year. The Government's Medicines and Healthcare Products Regulatory Agency (MHRA) seizes more than £3m worth of stolen or faked Viagra every year.
In 2003, 24-year-old Liam Brackell killed himself after becoming addicted to a plethora of powerful prescription drugs that he bought off the internet. He had begun by buying Prozac online to counter the effects of his recreational use of ecstasy. By the time of his death, he had tried 23 different drugs. It was later found that what he thought were codeine tablets - a common painkiller - were counterfeits that had been cut with morphine.
Another problem is that pharmaceutical companies are desperate to find the holy grail of the drugs world - a product that can be sold to as many people as possible for as long as possible. So "lifestyle" drugs that don't just treat one condition but have other, beneficial side effects are being aggressively marketed by the industry.
Prozac, ELI LILLY
Chemical name: Fluoxetine hydrochloride.
What it costs: A pack of 30 tablets will set you back about £20 from online pharmacies.
Uses: More than 3.5 million people in Britain take antidepressants, with Prozac among the most widely prescribed of its type. It is one of a class of drugs called SSRIs (selective serotonin reuptake inhibitors), which are highly effective in treating depression as well as having low toxicity levels compared to older antidepressants.
Abuses: Prozac is also one of the most popular drugs sold on the internet. But there are concerns that the websites are creating a dependency on Prozac and allow people to increase their dosage without seeing a doctor or trying "talking therapies" instead of chemical cures. There have also been reports of clubgoers "self-medicating" with Prozac to counter the come down from taking ecstasy. In 2003, 81 deaths were attributed to overdoses of SSRIs and there have been reports of the drugs causing some people to commit suicide.
Chemical name: Orlistat.
What it costs: About £65 for 85 capsules on the internet.
Uses: Marketed as a potential panacea for the obesity epidemic afflicting much of the Western world, Xenical works in a different way from most weight-loss pills, which simply suppress appetite. Instead, Xenical blocks the activity of enzymes called lipases that break down the fat molecules in food. The drug excretes the fat out of the body. It is highly effective but can have unpleasant side effects such as loss of bowel control.
Abuses: Some doctors are concerned that people may be taking Xenical on its own, rather than in conjunction with switching to a healthy diet. It is recommended only for obese people who have tried other weight-loss programmes, but its availability online has raised fears that sufferers of eating disorders may have easy access to it. It is only available on prescription in the UK, although it is on offer at Boots for people who sign up to the high street chemist's own weight-loss programme.
Chemical name: Diazepam. First manufactured by Roche, it is now no longer protected by patent, but produced in generic form by other companies.
What it costs: About £50 for 30 tablets online.
Uses: Dubbed "mother's little helper" when it began to be widely prescribed to women with anxiety or depression in the 1960s, Valium was once one of the world's best-selling drugs. Roche stopped making the drug in 2002 after its patent expired, but it is still produced in unbranded, generic forms by other pharmaceutical companies and is widely available on the internet. The little blue pills are in a class of drugs called benzodiazepines. Concerns about their addictive properties and the emergence of the new class of SSRI antidepressants led to a fall in popularity of Valium in the 1990s.
Abuses: Recently, doctors have begun reporting a rise in the number of young women using the drug to sleep after taking cocaine or amphetamines. They are buying it online or obtaining it through the same dealers selling them illegal drugs. The Priory Hospital in Roehampton estimates that up to one in 10 patients at its addiction centre is now hooked on Valium.
|BLACK BOX WARNING ON RITALIN MEDICINE|
Chemical name: Methylphenidate.
What it costs: About £20 for 60 tablets.
Uses: Ritalin has proved to be a highly successful but controversial treatment for Attention Deficit Hyperactivity Disorder (ADHD) among children. But there are concerns that the drug is being used as a "chemical cosh" and prescribed to too many children. More than 30,000 youngsters are taking the drug in Britain.
Abuses: It has a chemical formula similar to cocaine and because it is an appetite suppressant, young girls and teenagers have been known to take it to keep slim. There have been reports of children selling their supplies to others in the playground, while students and businessmen take it to improve their attention and concentration in exams and the boardroom. Last month, the US Food and Drug Administration ordered that Ritalin and other similar drugs should carry "black box" warnings about an increased risk of heart attacks and sudden death.
Chemical name: Modafinil.
What it costs: About £90 for 30 tablets online.
Uses: Provigil is marketed as a treatment for narcolepsy, a condition that causes excessive sleepiness and can make it impossible for people to stay awake. It has also been useful for multiple sclerosis patients who are often affected by extreme fatigue.
Abuses: Strict regulations on prescribing Provigil in the UK were eased two years ago. Unlike amphetamines that were previously used to treat sleep problems, and caused jittery side effects, Provigil works by targeting the neurones involved in wakefulness. But it is also increasingly being used as a lifestyle drug by people who do not have sleep problems. Suggestions that it could also help boost weight loss and mood have made it even more popular. Clubbers are using it to keep partying through the night, while businessman are buying it to help them through long days in the office, and students are taking it to keep revising. Doctors have warned that the drug can be psychologically addictive and can induce headaches and nausea.