Maybe you've gone to Craigslist to find a used car or a secondhand couch, but imagine having to turn to the internet to pay for lifesaving drugs.
It's already happening: A new study found that hundreds of ads were placed on Craigslist for insulin and asthma inhalers during a 12-day period in June 2019.
"This study shines a light on how deeply some patients are struggling to afford lifesaving medications. Patients should not have to go to Craigslist to try to find affordable insulin and inhalers," said study senior author Dr. Jennifer Goldstein, a research scientist with The Value Institute at ChristianaCare, in Newark, Del.
People with type 1 diabetes can't survive without a steady supply of insulin, which has to be injected. Those with type 2 diabetes who need insulin face a higher risk of serious diabetes complications if they can't get the insulin they need. But it's gotten increasingly harder to afford. The American Diabetes Association says the average cost of insulin in the United States nearly tripled between 2002 and 2013.
The cost of asthma medications has also risen significantly in a similar time period, according to published reports. People with asthma need "rescue" inhalers like albuterol when they're having symptoms such as wheezing and shortness of breath.
The idea for the study initially came from a news article Goldstein saw detailing how someone purchased medication on Craigslist. When she did a quick internet search, she was surprised to see quite a few listings for drugs.
"It is illegal to sell prescription medications without a license and to purchase medication without a prescription," Goldstein explained.
For the study, the researchers looked at Craigslist ads across the country over a 12-day period. They included all 50 states in their searches.
The investigators found ads for insulin and albuterol inhalers in 240 cities in 31 states.
Insulin was often offered at a very steep discount. For example, a vial of Humalog insulin retails for nearly $300, but was for sale on Craigslist for $37.
Altruism was one reason that people sold insulin online. "I have been blessed with an overabundance of insulin and know what it's like to need it and not have a couple of hundred dollars to pay out of pocket," said one seller.
Not everyone had such altruistic motives. Some were selling older supplies to make money to buy new medications after their doctor switched their prescriptions.
A big concern with insulin is that it needs to be refrigerated. Once it's at room temperature, it has to be used within a month. And you can't tell by looking at the insulin if it's ever been left out of the fridge.
Another issue is whether or not the insulin is sterile. One seller was offering a three-quarters full vial of insulin that had been used on a pet. While the seller claimed to have always used new needles on the vial, there's no way to verify that information.
"This is just not a safe way to get medication," Goldstein said.
Interestingly, asthma inhalers seemed to be more expensive to buy on Craigslist than through a retail outlet. The retail price for an albuterol inhaler was $25, but the average sale price on Craigslist was $44.
Goldstein said the researchers don't know why asthma inhalers were for sale at a higher-than-retail price.
She noted that the researchers couldn't verify the sale of any of these products. They only knew that they were being offered for sale.
Goldstein said it's likely that Craigslist isn't the only online forum where these sales are taking place. The researchers attempted to get in touch with Craigslist via their online contact link, but didn't hear back from them.
Craigslist also did not reply to HealthDay's request for comment.
Dr. Kasia Lipska, an assistant professor in the department of internal medicine at Yale School of Medicine, said, "This adds to the growing body of literature that suggests that patients are desperate. They need a lifesaving drug and are forced to do this or ration their insulin."
Lipska wasn't involved in this study. But she published research in 2018 in the journal JAMA Internal Medicine that found in a group of 200 people with diabetes, more than one in four had rationed their insulin.
Lipska said that buying drugs from strangers on the internet is risky. If patients are having trouble affording their medication, she said they should talk to their doctor. She said it's also important that doctors try to help by broaching the subject. "Patients may not bring this up unless the clinician asks," Lipska said.
"This study's finding -- that people may be getting drugs in unregulated places -- is a symptom of a failing system. It's a symptom of a system that doesn't work for patients. Insulin and other drugs need to be more affordable for patients," Lipska said.
Goldstein's study was published online Feb. 17 in JAMA Internal Medicine.
Visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases to find more resources to help people who can't afford diabetes medicines and supplies.