Online shopping for medical products such as contraceptives, contact lenses, sex drugs and slimming pills is a growing public health concern in Singapore, the Health Sciences Authority (HSA) says.
Illegal sellers are finding customers easily over social networking platforms like Facebook and Instagram as well as through blogs, forums and other websites.
Warning of serious health risks, the HSA and doctors told The Sunday Times about buyers who have developed serious complications, including liver failure and blindness, after taking such products.
From 2011 to June this year, the HSA caught 122 people for illegally selling health products online, said its deputy group director of health products regulation, Associate Professor Chan Cheng Leng.
The HSA started keeping online statistics in 2011, after noting the growing presence of sellers on the Internet.
Prof Chan said that at least one person has died after taking slimming pills bought online. The 24-year-old woman died in 2012 of dinitrophenol poisoning after consuming pills bought through an overseas website. The banned substance is used in herbicides. The woman had been warned not to take such pills after being hospitalised a year before her death, but she persisted.
Doctors have seen patients complaining about experiencing heart palpitations, feeling jittery or having mood swings after taking slimming pills bought online. In serious cases, they had liver failure or kidney damage.
Some people developed mental health problems but recovered after they stopped taking the pills, said Dr Lee Ee Lian, a psychiatrist who specialises in treating eating disorders at Promises Healthcare, a private clinic.
She has a patient in her 20s who started hearing voices after taking slimming pills bought online. She began thinking people were out to kill her and it became so bad that she had to be hospitalised. She recovered after she stopped taking the pills.
Another patient, a housewife in her 40s, almost died of liver failure after a few weeks of taking slimming pills she bought online.
"If you are lucky, the pills don't harm you. If you are not so lucky, there are unpleasant side effects. If you are really unlucky, the drugs are really toxic and can kill you," Dr Lee said. "It's anyone's guess what toxic stuff the pills contain."
Most of the slimming pills that the HSA seized, such as Bio-Lissom Fat Reducing Caps, Botanical Slimming and Reduce Weight Fruta Planta, were found to contain a banned substance called Sibutramine which can raise the risk of heart attack and stroke.
Other drugs sold on the Internet, such as contraceptives and sexual enhancement pills, may be fake or harmful.
Gynaecologists said they have patients who became pregnant despite taking birth control pills bought online. The medicine turned out to be fake or ineffective.
Prof Chan said the online peddlers caught were solo operators ranging from students to those with respectable jobs, including a nurse who hawked contraceptives.
"They are trying to make a quick buck online. Some know that such sales are illegal, while others don't know," said Prof Chan.
Last year, a woman in her 30s was caught selling slimming products via Facebook. She was found with 739 sachets of "Slimming Orange Juice Curvy Pearl Beauty" and 113 sachets of "V12 Fruit Slimming".
Although they were promoted as natural health supplements to help in weight loss, they were found to contain the banned substance Sibutramine, which was not stated on the product labels. She was fined $6,000.
A 19-year-old student received the heftiest punishment so far - a fine of $19,000 - for selling contraceptives, unregistered condoms and pregnancy test kits. These items have to be registered and approved by the HSA for sale, while contraceptives need a doctor's prescription.
Almost 3,000 pills and items with a street value of about $5,700 were seized from her home in 2012. All were bought overseas or online.
Those caught selling illegal health products can be fined up to $10,000 and/or be jailed for up to two years.
To report illegal sales of drugs or medical products, call 6866-3485 or e-mail firstname.lastname@example.org
3 REASONS BUYERS GO ONLINE
...TO LOSE WEIGHT REASONS BUYERS GO ONLINE 3
Susan, 30, has been wanting to lose weight for the longest time.
In her teens, she developed an eating disorder after feeling pudgy next to her skinny classmates. So she started starving herself, eating as little as just an apple or a few grapes a day.
She asked doctors for weight-loss drugs, but they turned her down because she was already underweight.
So she went to overseas websites and bought pills despite knowing they could be toxic.
"I bought a lot of slimming pills online as they were not sold in Singapore. I had very bad insomnia, heart palpitations and I felt very anxious and jittery all the time.
"But the drive to lose weight over-rode everything else," she told The Sunday Times.
She began losing weight fast and, at her lightest, the 1.57cm-tall woman weighed only 37kg.
She also alternated between starving and binge-eating, after which she would vomit.
The jobless woman said she stopped taking the pills when she saw how sickly she had become.
"I realised those pills are very bad and I could end up losing my life. And after I stopped, all the nasty side effects disappeared and I'm back to normal," she said.
...TO LOOK LIKE K-POP STARS
A 14-year-old girl ran a thriving online business hawking contact lenses over Facebook to people longing to look like Korean pop stars.
But she was breaking the law because contact lenses are classified as medical devices that only registered practitioners, such as opticians and optometrists, can sell.
The Health Sciences Authority (HSA) found more than 200 pairs of lenses at her home. She had bought them from an overseas supplier. As it was her first offence, she was let off with a warning.
She was the youngest of a rising number of people caught selling contact lenses online illegally. In the first half of this year, 13 people were nabbed, compared to 22 arrested between 2011 and last year. Many of those caught are students.
HSA deputy group director of Health Products Regulation Chan Cheng Leng told The Sunday Times: "The sellers range from teenagers to those in their 30s. They don't see this as a crime, but a business opportunity."
Associate Professor Heng Wee Jin, head of Cornea and Refractive Surgery at the NHG Eye Institute at Tan Tock Seng Hospital, has had patients who used contact lenses bought online and developed problems such as serious infections and even blindness.
One patient's infection was so severe it scarred his cornea and he needed a transplant.
The HSA tested contact lenses it had seized and found that among other problems, some were packed in solution contaminated with harmful bacteria.
The craze for cosmetic lenses started about five years ago, with young people wanting to look like their Korean pop idols.
These lenses include those coloured blue, green, grey, hazel and turquoise, as well as iris-enlarging lenses which can make the iris appear big and doll-like.
Those sold online have names such as Barbie, Candylicious, Celeb Super Nudy, Disney Eye and Lolita, said the HSA.
Young girls buy them online because they are cheaper and delivered to their homes. A pair online costs between $7.50 and $25, compared to between $17 and $30 from a legal source, the HSA said.
One woman who tipped off the HSA about online peddlers turned out to be selling lenses herself. She was out to kill the competition.
The 29-year-old advertised lenses for sale on Facebook at $25 a pair. She was dealt with last year, and her punishment included 150 hours of community service.
Anyone who gets caught selling lenses illegally may be fined up to $50,000 and/or jailed for up to two years.
...TO END PREGNANCIES
Some pregnant maids are turning to the black market for pills that induce a miscarriage, because they want to avoid being found out and sent home.
Taking the Cytotec pills is risky but cheaper than an abortion at private clinics which charge between $800 and $1,000 for a pregnancy termination within the first 12 weeks. It costs about $200 for four pills and those in the know say a woman needs about eight pills to induce a miscarriage.
However, doctors have warned that these women risk serious complications, including infection, massive bleeding, a ruptured womb and incomplete abortions.
And despite taking the pills, doctors said, some women remain pregnant because they bought fake drugs. In the end, those who remain pregnant or have complications turn to doctors for abortions.
The Sunday Times understands that some maids have been selling the abortion pills to earn extra cash. They get their supplies from neighbouring countries or when they go home for holidays.
Manpower laws bar work permit holders, including maids and service sector workers, from getting pregnant or giving birth here unless they are married to a Singaporean or permanent resident with the approval of the Controller of Work Permits.
The HSA has prosecuted four people between 2009 and last year for illegally selling Misoprostol, the active ingredient in Cytotec. They sold the drug online or at shops here.
Drugs containing Misoprostol require a doctor's prescription. Offenders can be fined up to $10,000 and/or jailed for up to two years.
Professor Kuldip Singh, senior consultant at the National University Hospital Women's Centre, said Cytotec is used by doctors to induce abortions. "While there have been no known deaths from the misuse of Cytotec, serious complications can manifest in as short a time as a few hours after consumption if the drug is not properly administered," he said.
Dr Kenneth Wong, of the Obgyn Centre, a private clinic, said he sees about 10 to 20 women a year needing help after taking Cytotec. Some arrive with incomplete abortions and he has to remove the foetus properly.
Another doctor recalled a maid who bled so much after taking Cytotec that she needed a blood transfusion. She had a botched abortion and the doctor had to remove the dead foetus completely.