Opioid drugs are sold illegally online, including: thanks to doctors cooperating with gangs – Chief Pharmaceutical Inspector Łukasz Pierzak told PAP. A drug that costs several hundred zlotys for packaging in a pharmacy costs PLN 50-80 per tablet on the black market.
PAP: What is the greatest threat to the pharmaceutical market today?
Łukasz Pietrzak, chief pharmaceutical inspector: Falsified medicines. This is the greatest threat in the entire European Union. In one Europol operation, almost half of the suspicious shipments contained illegal drugs. This is a more profitable business than drug trafficking, which is why gangs that previously dealt in drugs are now switching to pharmaceuticals.
Analyzes conducted by the Chief Pharmaceutical Inspectorate in cooperation with law enforcement agencies and tax administration show that illegal trade and smuggling of drugs to Western European and North American countries have clearly defined directions and product profiles. The most important source of pharmaceutical substances used in illegal trade remains Asian countries, primarily China and India, and in the case of selected biological products, such as botulinum toxin, also South Korea.
The most frequently smuggled products to the European market are counterfeit slimming drugs (GLP-1), illegal Botox and fillers for the aesthetic industry, opioids and psychotropic drugs, potency products and anabolic steroids.
According to data cited by the World Health Organization (WHO – PAP), the profit from counterfeit medicines may reach PLN 250,000-500,000. dollars with an investment of one thousand dollars. This makes drug counterfeiting more profitable than drug trafficking, while the risk of detection is lower.
The scale of the phenomenon is growing, which is why we need specialized services to fight pharmaceutical crime, because it is a completely new type of threat.
PAP: In recent months, there has been a lot of talk about false prescriptions for narcotics. Are we really dealing with a plague of counterfeit prescriptions?
Ł.K.: This is an important clarification – in most cases we are not talking about false prescriptions in the strict sense. Of course, there are situations in which a doctor's certificate is stolen, his digital identity is taken over and prescriptions are issued without his knowledge. Such cases were detected and the certificates were immediately blocked. Unfortunately, in the vast majority of disclosed cases, prescriptions were issued knowingly by doctors operating within organized criminal groups.
PAP: What does the mechanism of such a procedure look like?
Ł.P.: The doctor becomes the de facto supplier of prescriptions.
Prescriptions are filled legally in pharmacies, and then the drugs – most often strong opioids – end up on the black market. There, they are sold online for multiples of the pharmacy price. A medicine whose packaging costs several hundred zlotys in a pharmacy is sometimes sold online for PLN 50-80 per tablet.
PAP: Who buys such drugs on the Internet?
Ł.P.: Sometimes there are people who are seriously addicted, but also people who experiment with psychoactive substances. They are afraid of “gate powder”, so they choose a drug – a product associated with legality, quality control and safety. It's a very false sense of security.
PAP: Why is taking such drugs so dangerous?
Ł.P.: Opioids act on receptors in the central and peripheral nervous system. In large doses, the respiratory center is paralyzed. This is not mechanical suffocation – the person simply stops breathing because the brain forgets about this function. First the breathing becomes shallower, then it stops completely. For a person who has never taken opioids, doses available on the black market can be fatal, especially since these preparations are often modified by illegal sellers.
PAP: However, doctors, quite legally, prescribe such drugs to patients.
Ł.P.: Yes, but in a completely different context. Therapy begins with low doses, usually after other pain treatments have been exhausted. The highest doses are reserved for a narrow group of patients, often for palliative treatment. The doctor knows the patient, his comorbidities and other medications. Self-medication in this area is a huge risk.
PAP: Where is the scale of the problem the greatest?
Ł.P.: It is a nationwide phenomenon. Since March, the e-Health Center has been effectively monitoring subscriptions. We, in cooperation with the Ministry of Health, the Patient Ombudsman and law enforcement agencies, analyze a huge number of prescriptions every year. We use algorithms that allow us to detect unusual patterns – prescriptions issued in series, unrealistic lead times that suggest a lack of physical examinations.
PAP: How do algorithms detect abuse?
Ł.P.: The administration has all the information related to the prescription and fulfillment of prescriptions. Additionally, we have information about the drug's route at every stage of distribution. Skillful analyzes of these data, often also their cross-referencing, give us knowledge about each activity with a given drug. Combining monitoring systems – used by the e-Health Center with data from the Ministry of Health and GIF – creates a complete picture.
The cooperation of these institutions and the exchange of information allow for effective detection of various drug abuses. Such cases are automatically marked and then analyzed by the administration and forwarded to law enforcement agencies.
PAP: Are doctors aware that the system sees them?
Ł.P.: More and more. Every week or every two weeks there is information about further arrests. The myth that no one checks it no longer exists. I would like to add that as of November 7, 2024, regulations have been in force in Poland that impose an absolute obligation to physically examine the patient before issuing a prescription for selected psychotropic substances and narcotic drugs. The list includes: morphine, oxycodone, fentanyl, medical marijuana – dried and extracts. In the case of these substances, a survey or simplified teleconsultation is not enough. The doctor must have direct contact with the patient, and monitoring systems analyze whether such contact could actually have occurred.
PAP: Let's talk about the so-called prescription machines.
Ł.P.: The name stuck, although it originally referred to one entity. I am not a supporter of solutions in which the prescription is the result of a survey without a real consultation. However, let's not throw everything into one bag. Large telemedicine platforms have complied with the law – they do not prescribe opioids without documentation and conduct audio or video calls.
Our practice shows that we are more likely to identify potential abuses in individual medical practices.
PAP: And medical marijuana? Pharmacists are talking about an overflow of prescriptions.
Ł.P.: The data shows the opposite. After the regulation entered into force in autumn 2024, the market shrank by 50-60 percent. Data from the Chief Pharmaceutical Inspectorate, which issues approvals for the import of medical marijuana to Poland, show a clear decline in the market after the entry into force of new regulations regarding the prescription of psychotropic substances.
In 2024, approximately 12 tons of dried medical marijuana arrived in Poland. Meanwhile, from January to September 2025, i.e. after the regulation of November 2024 entered into force, imports amounted to approximately four tons, but there was no market collapse, and currently demand remains stable.
PAP: Why is supervision over substances with narcotic effects important?
Ł.P.: According to the Central Statistical Office data, almost 4,000 people die in Poland as a result of mental disorders caused by psychoactive substances. people per year. Importantly, these are official data, which may be significantly underestimated, and these numbers are increasing.
For comparison: fatalities in road accidents in Poland are approximately 1.8 thousand. people per year, which means that the incorrect use of psychoactive substances – including prescription drugs – causes more than twice as many deaths as road accidents.
The National Health Fund's data are also very worrying, because according to the Fund's reports, every year there are approximately 30,000 cases of hospitalizations caused by side effects and drug poisoning. The cost of these benefits exceeds PLN 92 million.
These data are consistent with WHO estimates that indicate drug misuse as one of the fastest growing public health threats in developed countries.
PAP: Alternatives to slimming drugs, GLP-1 analogues, are also appearing online.
Ł.P.: GLP-1 analogues are among the most sought-after drugs today, and demand still exceeds supply. These preparations are available only on prescription, because their use requires an assessment of the patient's health condition and clear medical indications. These are not drugs for quick weight loss. If used incorrectly, they may lead to, among others: to nutritional deficiencies or side effects. Therefore, drug therapy should be part of a broader treatment plan that includes diet, monitoring of effects and patient safety.
This is a huge problem. Fake preparations sometimes contain insulin, sometimes physiological saline, and may be microbiologically contaminated. Prescription drugs cannot be sold by mail order, and most importantly, the decision to start treatment with them should always be made by the doctor. Any offer to sell prescription drugs remotely is illegal and should prompt immediate caution from patients.
Interviewed by: Mira Suchodolska (PAP).
mir/akar/
