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Adderall for sale (amphetamine-dextroamphetamine) is a controlled substance with harmful adverse effects if abused or misused. We assessed the availability of Adderall from common search engines, and evaluated the safety and marketing characteristics of online pharmacies selling Adderall.

Design
Cross-sectional study.
Setting and participants
From December 2019 to February 2020, the phrase “buy Adderall online” was queried in four search engines: Google (N = 100), Bing (N = 100), Yahoo (N = 50) and DuckDuckGo (N = 50). Online pharmacies that claimed to sell Adderall and had unique Uniform Resource Locators, were active, free-access, and in English language were included.
Outcome measures
Online pharmacies were categorized as rogue, unclassified, or legitimate on the basis of LegitScript classifications. Safety and marketing characteristics, and costs were collected.
Results
Of the 62 online pharmacies found to sell Adderall, 61 were rogue or unclassified. Across all rogue and unclassified online pharmacies, prescriptions were not required (100%), pharmacist services were not offered (100%), and quantity limits were not placed on the number of Adderall purchases (100%). Rogue and unclassified online pharmacies appealed to cost, offering price discounts (61%), bulk discounts (67%), and coupon codes (70%). Contrary to their claims, cheaper prices were available for all formulations and dosages of Adderall from GoodRx than from these online pharmacies. Rogue and unclassified online pharmacies promoted and enabled the illicit purchase of Adderall, appealing to privacy (74%), offering purchase through cryptocurrency (74%), and claiming registration or accreditation of their sites (33%).
Conclusion
Rogue online pharmacies are pervasive in search engine results, enabling the illicit purchase of Adderall without a prescription. Consumers are at risk of purchasing Adderall, a medication with high abuse potential, from unsafe sources. Law enforcement, regulatory agencies, and search engines should work to further protect consumers from unregistered and illegitimate online pharmacies selling Adderall.
Key Points
Background
• The online pharmacy marketplace is saturated with illegitimate retailers that sell prescription medications without requiring a valid prescription.
• No-prescription access to Adderall, a schedule II medication with a high potential for abuse, poses a threat to public health.
• This article is the first to investigate the safety, marketing, and cost characteristics of online pharmacies selling Adderall.
Findings
• Adderall is readily accessible with no prescription through common search engines — of 62 online pharmacies analyzed, 61 permitted access to Adderall without a prescription.
• For all formulations, doses, and quantities, Adderall was on average more expensive from illegitimate online pharmacies than prices advertised on GoodRx, suggesting additional costs to obtain Adderall without a prescription.
• More efforts to monitor and remove illegitimate online pharmacies are required by law enforcement, regulatory agencies, and search engines.
Background
Buy Adderall for sale (amphetamine/dextroamphetamine [Shire U.S. Inc]) is a central nervous system stimulant medication commonly used to treat attention deficit hyperactivity disorder (ADHD). Although effective in its treatment of ADHD, Adderall carries a high potential for abuse and dependence—its nonmedical use among college students for neurocognitive enhancement has been well documented, with a prevalence estimated from 9% to 23%.1, 2, 3 The overall nonmedical use of prescription stimulants has been estimated at approximately 8% in adults.Inherent to the abuse of amphetamines are risks including weight loss, cardiovascular events, psychological dependence, and morphologic brain changes. Owing to its high potential for abuse, which could lead to severe psychological or physical dependence, Adderall is classified by the U.S. Drug Enforcement Administration (DEA) as a schedule II medication.

Online pharmacies have emerged as a popular destination for the purchase of prescription drugs. Although the overall volume varies on a daily basis, 30,000-35,000 online pharmacy websites were found to be accessible in 2016. Online pharmacies can be defined by whether they operate as legitimate and registered pharmacies or whether they are illegitimate and in violation of U.S. pharmacy laws and practice standards. According to LegitScript, a verification and monitoring service, 96% of the accessible online pharmacies are illegitimate, of which 92% are rogue, meaning that they sell drugs without a valid prescription. Given the high prevalence of rogue online pharmacies, the ease of access to medications with abuse potential is of particular concern.
National organizations have been combating the proliferation of illegitimate online pharmacies. The BeSafeRx campaign of the Food and Drug Administration (FDA) and the Buy Safe Rx campaign of the Alliance for Safe Online Pharmacies (ASOP) empower consumers by raising awareness of the dangers of purchasing medications from illegitimate online pharmacies, as well as providing information on the warning signs that an online pharmacy might be operating illegally. The National Association of Boards of Pharmacy (NABP) lists accredited digital pharmacies on its website. NABP also offers a verification service for legitimate online pharmacies through which they can receive a “.pharmacy” domain, increasing consumers’ visibility of legitimate pharmacies. LegitScript allows consumers to enter a uniform resource locator (URL) to determine a pharmacy’s legitimacy. Moreover, beyond raising public awareness, regulatory and legal actions are ongoing against illegitimate online pharmacies. Operation Pangea, a cooperative effort led by Interpol in conjunction with FDA and the U.S. Department of Justice (DOJ) has led to the removal of thousands of illegitimate online pharmacies.LegitScript has also partnered with the FDA to identify and close illegitimate online pharmacies. Still, illegitimate online pharmacies remain challenging to control because there are innumerable URLs under which they can operate.
Despite these organizational attempts, rogue online pharmacies remain pervasive and many consumers remain unaware of the associated dangers. In choosing rogue online pharmacies, consumers opt out of medication counseling, monitoring, and drug-drug interaction checking that pharmacists and health professionals offer. The use of such resources in health care has been shown to improve patient outcomes. Concerns regarding insufficient safety measures are further exacerbated by the marketing methods that illegitimate online pharmacies use to attract consumers. Although it has been shown that patients using no-prescription online pharmacies are at greater risk of developing treatment-related adverse events, there is a lack of current data on how rogue online pharmacies approach patient safety and what marketing methods they employ, particularly for medications with high abuse potential.
The accessibility of Adderall online is a public health hazard. We investigated the availability of Adderall from online pharmacies through search results of common search engines and documented the websites’ safety and marketing characteristics, as well as the costs of Adderall.
Objectives
Assess the availability of Adderall from common search engines, and evaluate the safety and marketing characteristics of online pharmacies selling Adderall.
Methods
The website selection was conducted from December 2019 to February 2020 using 4 different search engines (Google, Bing, Yahoo, and DuckDuckGo) with the phrase “buy Adderall online.” These 4 search engines were chosen on the basis of user traffic, and for DuckDuckGo specifically, its emphasis on user privacy. Search algorithms on these websites already incorporated synonyms of the search terms. The first 100 results of Google and Bing, and the first 50 of Yahoo and DuckDuckGo were screened, incorporating more results from the more popular search engines. Websites were included if they claimed to sell Adderall, were active websites, were free to access, were in English language, and had a unique URL. Information for websites selling either Adderall immediate release (IR) or Adderall extended release (XR) were collected because these products contain the same active ingredient (amphetamine/dextroamphetamine). Websites that required 1 extra click to reach the website selling the product were also included. Screenshots were taken of the website pages to ensure the internal validity of results.
The legitimacy of the websites was assessed using LegitScript, a verification and monitoring service that has monitored more than 70,000 online pharmacies. Among other criteria, LegitScript classifies pharmacies depending on licensure or registration in affiliated jurisdictions, sale of controlled substances, prior discipline, requirement of valid prescriptions, protection of privacy, patient services offered, transparency, and domain name registration.The websites in this analysis were classified as LegitScript defines them: rogue—“these merchants engage in illegal, unsafe, or misleading activities like selling prescription drugs without a prescription;” legitimate—“these merchants are registered with a LegitScript certification program and have passed LegitScript certification criteria;” or unclassified—no information was available from LegitScript.
The average monthly traffic to website domains defined as unique visits from any country was obtained using www.SimilarWeb.com. This website aggregates information on website traffic from a variety of sources, including open exchange of first-party data and survey of public data sources. The Internet protocol (IP) addresses of websites were checked using which retrieves geographic information on the basis of IP addresses. The registered geographic locations of the IP addresses were compared with the listed website locations.
Safety
Characteristics related to safety were selected on the basis of previous literature and obtained from each included website. The characteristics were collected as binary variables: whether the website displayed or required such characteristics or not, and were examined across rogue, unclassified, and legitimate pharmacies. The characteristics of interest included (1) requirement of a prescription; (2) requirement of a health-related questionnaire; (3) offer to speak with a pharmacist; (4) drug-related warnings and precautions on the product page; (5) drug information on the product page, including class of medication; (6) controls on the amount of Adderall that could be ordered (e.g., restricting patients to a 90-day supply); and (7) country match between website location listed vis-à-vis IP address location.
Marketing
Characteristics related to marketing were selected on the basis of previous literature.
The following marketing characteristics were gathered from each website: (1) claims a “discount” compared with other pharmacies; (2) offers bulk discounts; (3) offers a “promo code” or coupon on checkout; (4) facilitates purchases using cryptocurrency (e.g., Bitcoin); (5) has drug-specific advertisements pertaining to Adderall; (6) displays advertisements for other products on the page advertising the sale of Adderall; (7) has a phone number or WhatsApp contact information listed; (8) includes an offer to speak with an associate; (9) claims pharmacy registration (e.g., Professional Compounding Centers of America [PCCA] or NABP Digital Pharmacy Accreditation); (10) includes customer testimonies; and (11) offers privacy reassurances (e.g., discrete packaging or protection of health- or billing-related information).
Cost
The price and shipping costs of 30 mg Adderall IR and Adderall XR at the most frequently sold quantities of 60, 90, 120, 180, and 240 tablets or capsules were collected. The price per tablet or capsule of Adderall IR and Adderall XR was calculated after accounting for shipping costs. The shipping costs were distributed among the total quantity of pills or capsules in an order. Online pharmacy prices were compared with the prices offered through GoodRx, an online prescription drug coupon site, which is what a U.S. consumer might expect to pay out-of-pocket without insurance at a brick-and-mortar store.
Results
Through searching Google, Bing, Yahoo, and DuckDuckGo with the query “buy Adderall online,” we identified a total of 62 online pharmacies claiming to sell Adderall (Figure 1 ). Of these online pharmacies, LegitScript classified 50 as rogue, whereas 11 were unclassified (i.e., no information about these sites was available through LegitScript), and only 1 site was legitimate. Traffic to these websites, as determined by www.SimilarWeb.com, differed depending on the classification as outlined in Figure 2 . The traffic to rogue and unclassified websites was low, with most receiving fewer than 5000 unique monthly visits. The monthly traffic of the 1 legitimate website was comparatively much larger at 1-2 million unique monthly visits.