Online but unlawful sales of unapproved and misbranded prescription drugs: Internet pharmacy compliance with <scp>Food and Drug Administration</scp> warning letters

Consumers increasingly use online pharmacies. However, illicit pharmacies endanger consumer welfare with unapproved and counterfeit drugs. By linking Food Drug Administration (FDA) warning letter content observations of the 1108 websites cited in those letters, we identify factors associated FDA-requested compliance active/inactive website status. One five failed to comply FDA recommendations. Findings support cost/benefit, social norm, instrumental theories compliance. Compliance declines cost (e.g., when requests changes more drug categories). Organized crime's norms encourage law breaking; thus, less than other Instrumental theory suggests perceived severity certainty penalties influences In support, political will attention focused on opioid crisis, primarily opioid-related violations these letters increased closures. Finally, recommend improved protection efforts address internet pharmaceutical distribution challenges.