Online shopping has hit brick and mortar retailers hard. From books to clothes to vitamins and even pet supplies, Americans are finding it easier and cheaper to make their purchases online. Ads that market online prescription sales from outside the U.S. offer low prices and quick delivery. But medicines are one item that could prove dangerous to buy over the Internet. When buying medication from a non-FDA regulated pharmacy or pharmaceutical website, you are never sure of the medication’s exact ingredients. Medicine available at an unbelievably low price and without a doctor’s prescription should raise a red flag, a sign that you should not trust the site. Prescription medicine is an enormous and lucrative industry. Counterfeit drugs are also a large and lucrative business. Another danger with medicines purchased from foreign pharmacies is that while they could be the real thing, they could also be expired or past their sell-by date. Or if not expired, they may not carry the full strength. Medicines purchased online could include all sorts of potentially harmful fillers. Metal shavings are just one of the ingredients found in drugs purchased from outside the country. Furthermore, while the site may claim to be a reputable pharmacy in Canada or Mexico, it could be an online scam designed to gain personal information. Identity theft is a real possibility. Finally, online drug sales have mirrored a sharp rise in the rate of prescription drug abuse in America. A university study found that between 2000 and 2007, as more people began to use high-speed Internet, the prevalence of prescription drug addiction also rose. In fact, those same authors reported a 1 percent rise in prescription drug addiction that accompanied every 10 percent increase in the number of high-speed Internet users. The National Center on Addiction and Substance Abuse (CASA) reports that a significant number of online pharmacy sale sites do not require a doctor’s written prescription. Around 85 percent of the sites allow purchase without a prescription and many sites which do require a prescription allow the documentation to be faxed – paperwork that can be easily forged. Interestingly, during these same years, prescription drug abuse has grown to eclipse use of all other illicit drugs combined, with the exception of marijuana. A national prescription database would be helpful in stemming the tide of illicit prescription drug use, but Internet use is notoriously difficult to control. One preventive measure doctors can take is to warn their patients not only about the risks of abusing prescription drugs but also the many inherent dangers of ordering them online. Doctors should also be prepared to refer patients to treatment for prescription drug abuse if necessary.