Hundreds of illegal Craigslist ads list insulin for sale
A recent report in JAMA Internal Medicine revealed that analogue insulins are the most commonly advertised prescription drugs on the online classified ad website Craigslist, with the drugs being offered at a fraction of their retail price.
The unregulated sale and purchase of prescription medication is prohibited by law and Craigslist policy, yet the review by researchers revealed more than 300 ads for insulin products during a 12-day period in June 2019. Insulin prices have nearly doubled between 2012 and 2016, according to 2017 data from the Health Care Cost Institute.
Healio spoke with Jennifer N. Goldstein, MD, MSc, hospitalist with ChristianaCare Hospitalist Partners and research scientist at the ChristianaCare Value Institute in Newark, Delaware, about what may be driving the illegal sale of insulin online, the most popular products listed in ads and the dangers of unregulated diabetes drugs.
What led you and your colleagues to take on this research about the illegal sale of insulin online?
Goldstein: As a hospitalist, I take care of a lot of patients who are in a diabetic crisis because they can’t afford their insulin. I’ve become very interested in this as a clinician. On a patient blog, I read an article about someone who bought insulin on Craigslist. Additionally, on blogs, people were recommending going to Craigslist to buy insulin. My colleagues and I decided to look into this by conducting a mixed-methods, cross-sectional study, analyzing Craigslist ads in the United States for a period of 12 days (June 12 through June 24). We searched for advertisements in the United States for three potentially lifesaving medications: insulin, albuterol and epinephrine (EpiPen).
What did you discover, and did the findings surprise you?
Goldstein: There were hundreds of ads for insulin — 432 advertisements for insulin and albuterol representing 240 cities in 31 states. The most common ads that were found were for the more expensive type of insulin, called analogue insulin, which represented 75.7% of insulin ads. These are the most commonly used insulins, and they have also increased in price dramatically over the last decade. I was surprised to see that these insulins were being sold at a fraction of their retail price. The most common were Lantus, Humalog and Novolog.
We found some ads for albuterol, but overall the prices listed for albuterol, when compared with prices on drugs.com, were higher than the list price, which also struck me as surprising. The price per vial of analogue and human synthetic insulins were $372.30 and $123.19 less expensive, respectively.
Was there any attempt to reach the Craigslist sellers?
Goldstein: We decided not to reach out directly to sellers, but instead conducted a thematic analysis of the texts of the ads. We went through the text and pulled out different themes that were mentioned. We found that many sellers noted they had altruistic tendencies and wanted to help other patients out. Others had financial motivations and noted they were selling insulins to pay for copayments for a different type of insulin or cover basic expenses.
What are some of the dangers with respect to purchasing unregulated insulins?
Goldstein: The main danger is a consumer does not know what they are getting. Some of the ads were advertising insulins that had been used previously, vials that were already opened or vials that had not been refrigerated. All of these things increase the risk for contamination, which can cause direct harm to the people who use them. Other issues are related to insulin itself — it’s a very sensitive medication. It is sensitive to temperature extremes. If too hot or too cold, that can affect the potency of the insulin itself. When purchasing insulin through these channels, there is no guarantee that it is safe and effective to use.
What has been the response to this research?
Goldstein: People are shocked. Personally, I am shocked, too. When I first started exploring this topic, I read about it on a diabetes blog because I am interested in what patients have to go through. I am a big advocate for affordable medications. I’ve done previous research on the use of over-the-counter insulin, but this was like a gut punch. When I first typed the word “insulin” into Craigslist and saw the results, I felt nauseous. So many ads came up, and I just couldn’t believe it. It’s sad. Hopefully, our study and the ensuing media coverage will raise awareness and promote policy change to improve insulin affordability for patients. – by Regina Schaffer
For more information:
Jennifer N. Goldstein, MD, MSc, can be reached at ChristianaCare, 4755 Ogletown Stanton Road, Ammon Education Center, Suite 2E70, Newark, DE 19718; email: firstname.lastname@example.org.
Disclosure: Goldstein reports no relevant financial disclosures.