ATLANTA — My wife Lisa doesn’t cherish the fact that this story begins by disclosing her recent acne flare-up. But given the wider public health implications, she’s given me permission to write about the stubborn collection of pimples on her left cheek that didn’t respond to her usual skin care. It is, after all, the problem that led to a prescription drug arriving on our doorstep a couple of weeks ago without a prescription. A drug she’d purchased from one of America’s largest retailers, Amazon.
Lisa wasn’t searching the dark alleys of the Internet for something illicit. While she was scrolling through the acne treatments available on Amazon, where she rocks her Prime account like a boss, the site served her up something she wasn’t looking for and didn’t know she wanted, an acne treatment called Vitara Clinda Gel. Several happy Amazon customers had raved about it in five-star reviews. But once her purchase arrived from a third-party seller in Thailand with “Gift” scrawled across the customs declaration tag, she got suspicious. Then she read the label. “Hey isn’t clindamycin a prescription drug?” she asked me, a physician.
Clindamycin is indeed a prescription-only antibiotic that we don’t use lightly even in the hospital, where it’s known to set off potentially deadly Clostridium difficile diarrhea after killing good gut bacteria, and it sometimes provokes a severe allergic skin reaction called Stevens-Johnson Syndrome. It’s available as a prescription gel for tough acne vulgaris infections, but it’s something I’d leave to the dermatologists and wouldn’t prescribe to someone like my wife for a few pimples. So how’d she get it so easily from Amazon?
I have by no means executed a comprehensive search of wares sold by Amazon directly or through its third-party sellers, but I found other prescription drugs for sale without a prescription, including the antibiotic norfloxacin and the muscle relaxant methocarbamol. Both compounds, like clindamycin, warrant careful oversight to avoid complications or endangering public health, such as by breeding antibiotic resistance. Methocarbamol, which causes a mild high, can be abused and can prove deadly when mixed with alcohol. Selling these drugs without a pharmacy license and without a prescription is flat out illegal.