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Deaths attributed to the use of medications purchased online
  1. Jeffrey K Aronson1,
  2. Robin E Ferner2,3,
  3. Georgia C Richards1,4
  1. 1Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
  3. 3Section of Clinical Pharmacology, University College London Hospitals, London, UK
  4. 4Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jeffrey K Aronson, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK; jeffrey.aronson{at}

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Using medicines purchased online without therapeutic advice can lead to outcomes such as treatment failure, antimicrobial drug resistance, adverse drug reactions and deaths. We have reviewed the factors associated with 17 deaths, which UK coroners deemed preventable, in individuals who used medicines purchased online.

This article is part of the Coroners’ Concerns to Prevent Harms series.1 It highlights problems that can arise from using medicines purchased online, exemplified by 16 Prevent Future Death reports relating to 17 individuals.


Coroners in England and Wales have a duty to report deaths that they have investigated when they believe that actions should be taken to prevent similar deaths. They do so in reports to prevent future deaths (PFDs).

This paper is one of a series in which we are charting the epidemiological aspects of such deaths. Here we deal with deaths that coroners have attributed to the use of medicines purchased online and the circumstances in which such deaths occur.


We have described our methods elsewhere.1 Briefly, we used web scraping2 to collect PFDs from the UK’s Courts and Tribunals Judiciary website, which is in the public domain, and created The Preventable Deaths Database and Tracker.3 We screened 3037 PFDs dated from July 2013 to September 2020 to identify cases in which the use of products purchased online were associated with deaths.


We found 17 PFDs, issued between November 2013 and December 2019, relating to 18 deaths associated with online purchase of medicines or non-medicinal chemicals, in 2 cases via the dark web, a part of the internet that allows users to remain anonymous and untraceable. In one case, death was not directly attributable to the substances purchased. Table 1 summarises the other 16 reports involving 17 deaths. Figure 1 shows the dates of the reports.

Figure 1

Timeline of the …

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  • Twitter @JKAronson, @Richards_G_C

  • Contributors GCR created the Preventable Deaths Database; all three authors searched it for relevant cases. JA analysed the data, wrote the first draft and edited it following comments from the other authors. All authors read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JKA has published articles and edited textbooks on adverse drug reactions and interactions, for which he has sometimes received royalties, and has often given medicolegal advice, including appearances as an expert witness in coroners’ courts, for which he has received fees. He is an associate editor of BMJ Evidence-Based Medicine and was a coauthor of the editorial that introduced the Coroners’ Concerns to Prevent Harms Series in the journal. GCR was financially supported by the National Institute for Health Research School for Primary Care Research, the Naji Foundation, and the Rotary Foundation to study for a doctor of philosophy (2017-2020), but no longer has any financial conflicts of interest; she is an associate editor of BMJ Evidence-Based Medicine, was lead author of the editorial that introduced the Coroners’ Concerns to Prevent Harms Series, and is developing ( a programme of research on preventable deaths.

  • Provenance and peer review Not commissioned; externally peer reviewed.