by Chloe Murtagh, Elisa Wells, Elizabeth G Raymond, Francine Coeytaux, Beverly Winikoff
Contraception 2018;97(4):287-291 DOI: https://doi.org/10.1016/j.contraception.2017.09.016
Objectives – We aimed to document the experience of buying abortion pills from online vendors that do not require a prescription and to evaluate the active ingredient content of the pills received.
Study design – We searched the internet to identify a convenience sample of websites that sold mifepristone and misoprostol to purchasers in the United States and attempted to order these products. We documented price, shipping time and other aspects of ordering. We sent the samples received to a testing laboratory that measured the amount of active ingredient in individual tablets.
Results – We identified 18 websites and ordered 22 products: 20 mifepristone–misoprostol combination products and 2 that contained only misoprostol. We received 18 combination products and the 2 misoprostol products from 16 different sites. No site required a prescription or any relevant medical information. The time between order and receipt of the 20 products ranged from 3 to 21 business days (median 9.5 days). The price for the 18 combination products ranged from $110 to $360, including shipping and fees; the products without mifepristone cost less. Chemical assays found that the 18 tablets labeled 200 mg mifepristone contained between 184.3 mg and 204.1 mg mifepristone, while the 20 tablets labeled 200 mcg misoprostol contained between 34.1 mcg and 201.4 mcg of the active ingredient.
Conclusions – Obtaining abortion medications from online pharmaceutical websites is feasible in the United States. The mifepristone tablets received contained within 8% of the labeled amount of active agent. The misoprostol tablets all contained that compound but usually less than labeled.
Implications – Given our findings, we expect that some people for whom clinic-based abortion is not easily available or acceptable may consider self-sourcing pills from the internet to be a rational option.
From the main text:
> None of the products came with instructions or any written communication.
> None of the websites required a prescription or any medical documents. Two required completion of an online medical history questionnaire; none of the questions asked about gestational age or any of the specific contraindications.
> The interval between payment and package receipt ranged from 3 to 21 business days (median 9.5 business days.
> According to package tracking information, 15 of the products received were shipped from locations within the United States, and 5 were shipped from locations in India. All of the products were labelled as having been manufactured in India. We found evidence that many of the sites were run by the same vendors.
>The median price paid, about $200 with all fees and shipping costs included, is lower than the $504 average cost for a medical abortion in the United States, not including travel or other secondary costs.
>While online ordering may offer benefits in terms of convenience, low cost, and privacy we found some aspects of the ordering process to be suboptimal. Nearly half of the products did not arrive until after the anticipated date. The products received rarely appeared to be the same brand as those ordered, and none came with instructions for use. Some websites disappeared shortly after the order was placed. The security of the information provided to vendors, including financial information, was questionable; indeed, we received fraud alerts and a notification from a vendor suggesting that an active investigation was ongoing. This potential lack of security may be a concern to some buyers given that people in the United States have been prosecuted for using abortion pills they procured online. Nevertheless, to some people seeking abortion, these disconcerting experiences may seem tolerable given the numerous impediments that they may encounter in obtaining care at a clinic.