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  1. Most of us have likely searched for a bargain on an internet forum, like eBay or Craigslist. But, what about costly medications that are necessary for your health? A new study, published this month on JAMA Online, shows just how difficult it is for some patients to afford medications for their chronic illnesses. Researchers found hundreds of ads that had been placed on Craigslist for insulin and asthma inhalers over a 12 day period in June 2019. What Sparked the Idea? Dr. Jennifer Goldstein, the lead study author with The Value Institute of ChristianaCare in Delaware, got the idea after reading a news article about someone buying medications on Craigslist. With her curiosity peaked, Dr. Goldstein performed a quick internet search and was surprised to find multiple listings for unregulated drug sales. Study Details The study looked at Craigslist ads, across all 50 U.S. states, over a 12-day period. Researchers found ads for insulin and albuterol inhalers in 240 cities in 31 states. Insulin was advertised with steep discounts, including one ad priced at $37, a fraction of the nearly $300 Humalog retail price. Insulin Price Hike According to the CDC, more than 100 million adults in the U.S. are diagnosed with diabetes or prediabetes. People with type 1 diabetes do not make insulin in the body and can’t survive without insulin injections. Those with type 2 diabetes do not make enough and face serious complications without the insulin they need. For diabetics, insulin is a life-saving medication that is becoming more difficult to afford. Here is a cost comparison of insulin types, for Q2 2019, according to GoodRx: Regular Insulins Novolin R- $93 per vial Humulin R- $185 per vial NPH Insulins $92 to $183 per vial Rapid Acting Insulins Generic lispro- $180 per vial Humalog- $322 per vial Long Acting Insulins Levemir- $397 per vial Lantus- $340 per vial Some people ration their insulin doses to make medication bills more affordable. This is a dangerous practice since uncontrolled glucose levels can increase the risk of infections, kidney and eye problems, amputations and even death. Asthma Inhalers Researchers found that asthma inhalers were actually more expensive to buy on Craigslist. An albuterol inhaler retailed at $25 and was sold on Craigslist for $44 on average. Researchers were unable to determine why they were sold for a higher price on Craigslist. Could It Be… Rescue inhalers are a lifeline for someone with chronic respiratory problems experiencing wheezing and shortness of breath? The decision to purchase inhalers illegally may be a decision based on issues surrounding access to healthcare services (cost, lack of transportation etc.). Perhaps some people choose this option because they are unable to access healthcare for a legitimate prescription. Motivation to Sell Researchers found that a sense of goodwill was one motivation for sellers to list medications on Craigslist. One seller said, “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”. Others were looking to make enough money to buy new medications after their doctor made changes to their current prescriptions. Just Not Safe Dr. Goldstein warns buying drugs through Craigslist “is just not a safe way to get medications”. Safety concerns include: Insulin that has not been kept in the refrigerator or used within a month after reaching room temperature Whether or not the insulin is sterile Whether or not the medication has been altered or tampered with It is illegal to sell prescription medications without a license It is illegal to purchase medications without a prescription Let Us Hear From You Dr. Goldstein warns that Craigslist is not the only online forum where medications are being sold. Is this a problem or emerging concerns in your area of practice? For More Information Unregulated Sales of Insulin Common on Craigslist Many People with Diabetes Can't Afford 'Good' Insulin. What They Should Know About Switching to the Cheaper Stuff

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