LAUSR

listed including medications known to have potentially significant interactions such as the azoles. Similarly, dryness was the reported side effect of isotretinoin with no mention of teratogenicity or interactions with other oral acne medications. Thus, although other medications are not as tightly regulated as isotretinoin, their sale without the supervision of a physician can result in great harm to patients given the potential risk of adverse reactions, including drug–drug interactions and black box warnings. This motivated us to investigate commonly prescribed medications by nondermatologists as well. Many of the medications were available for sale from foreign countries. Although the vendor of isotretinoin was from outside the USA, the medication entered through customs without difficulty. Equally concerning is that patient forums (e.g., https://f orum.bodybuilding.com/) featured posts detailing where these medications are available for purchase online. eBay, one of the largest online retailers, has an official policy forbidding the sale of any substance requiring a prescription; however, many clearly named medications were available for sale on their website. It is critical that the medical community be alerted to the availability of medications online without a prescription and that we promote education and policy changes that protect our patients. To report an illegal seller of medications, the FDA provides three main options: (i) to report a life-threatening situation involving an FDA approved product, immediately call 1-866300-4374 or 301-796-8240; (ii) to report a serious reaction or problem with an FDA-approved product, submit the online MedWatch reporting form; (iii) to report a non-life threatening and nonserious reaction, submit an online reporting form. There are numerous limitations to this report. Although isotretinoin was easily purchased and delivered via mail, we were not able to verify its authenticity. Nonetheless, counterfeit medications present significant dangers to the public as they can contain inadequate amounts of active ingredient, wrong active ingredient, or contaminants. Additionally, only a few medications were investigated in this report and were identified based on a limited search query chosen by the authors. Future studies should aim at a more comprehensive approach to prescription medications sold online and at identifying characteristics and motivations of patients who are purchasing online without the supervision of a trained physician.