Accessibility of Ambien through online pharmacies: Cross-sectional study evaluating safety, marketing tactics, and price of a sleep medication

Introduction: Sleep deprivation is a widespread issue, with 1 in 3 US adults reporting not getting enough sleep every day. Ambien, a commonly prescribed medication for sleep disorders, is a schedule IV-controlled substance due to its high potential for misuse, abuse, and dependence. This study evaluated the accessibility of Ambien through online pharmacies. Methods: Using Google and Bing search engines, we conducted an internet search for online pharmacies selling Ambien between May and July 2023. Websites were categorized based on LegitScript classifications and assessed for safety, marketing tactics, and price. The price per pill was compared with traditional pharmacy prices using GoodRx. Results: Of the 36 identified online pharmacies, 91.7% (N=33) were classified as rogue or unverified by LegitScript. Rogue and unverified pharmacies unanimously lacked prescription requirements (100%, N=33), questionnaire requirements (100%, N=33), offers for pharmacist counseling (100%, N=33), and quantity limits (100%, N=33). However, many rogue and unverified pharmacies offered drug administration instructions (58%, N=19), drug related warnings (79%, N=26), and a recommendation to seek physician advice (70%, N=23) on the product page. Marketing tactics included price discounts (82%, N=27), bulk discounts (91%, N=30), coupons (70%, N=23), phone number availability (79%, N=26), customer assistance (61%, N=20), customer testimonials (85%, N=28), registration claims (39%, N=13), privacy assurances (42%, N=14), and acceptance of cryptocurrency (27%, N=9). Rogue and unverified pharmacies offered Ambien at significantly lower prices than traditional pharmacies. Conclusion: The majority of online pharmacies offering Ambien operate illegally and pose significant risks to patient safety. These pharmacies allow unsupervised access to Ambien, increasing the likelihood of misuse and preventable adverse events. It is important for regulatory agencies to shut down illegitimate online pharmacies, search engines to proactively develop algorithms that prioritize legitimate online pharmacies, and healthcare providers to be knowledge of the resources available for patients to identify legitimate websites.