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Chengdu buying Heroin

Activities by an organized crime group involving the illegal entry, transit or residence of migrants for a financial or material benefit. The production, transport, storage and sale of goods that are fraudulently mislabeled or fraudulent imitations of registered brands. The illicit transport, handling and sale of excise consumer goods despite a ban or outside a legal market. Excludes oil and counterfeits. The illicit trade and possession of species covered by CITES convention, and other species protected under national law. The poaching, illicit trade in and possession of species covered by CITES and other species protected by national law. Includes IUU fishing. The illicit extraction, smuggling, mingling, bunkering or mining of natural resources and the illicit trade of such commodities. The production, distribution and sale of heroin. Consumption of the drug is considered in determining the reach of the criminal market. The production, distribution and sale of cocaine and its derivatives. Consumption is considered in determining the reach of the market. The illicit cultivation, distribution and sale of cannabis oil, resin, herb or leaves. Consumption is used to determine the market's reach. The production, distribution and sale of synthetic drugs. Organized crime that results in a monetary loss via financial fraud, embezzlement, misuse of funds, tax evasion and abusive tax avoidance. Clearly defined organized crime groups that usually have a known name, defined leadership, territorial control and identifiable membership. Loose networks of criminal associates engaging in criminal activities who fail to meet the defining characteristics of mafia-style groups. Includes foreign nationals and diaspora groups. The State's role in responding to organized crime and its effectiveness. The degree to which states have put oversight mechanisms in place to ensure against state collusion in illicit activities. A country's supranational structures and processes of interaction, policy making and concrete implementation to respond to organized crime. The degree to which states are able to control their physical and cyber territory and infrastructure against organized criminal activities. Assistance provided to victims of various forms of organized crime, including initiatives such as witness protection programs. Refers to the existence of strategies, measures, resource allocation, programmes and processes that are aimed to inhibit organized crime. China is a source, transit, and destination country for human trafficking. Criminal groups, local gangs, and state-embedded actors are all involved in this illegal activity. Women in China are exploited for sexual activities, and foreign nationals are promised jobs but forced into commercial sex. Children of foreign families and those with developmental disabilities are victims of forced labour and forced begging. State actors are accused of subjecting minority groups such as the Uyghur in Xinjiang to forced labour as part of mass detention and labour transfer schemes. Despite law enforcement initiatives, the exploitation of women, children, and minority groups, as well as organ trafficking and the falsification of travel documents, continue to make human trafficking a lucrative business for criminal groups and individuals in China. China is a significant participant in the global market for human smuggling. Chinese nationals are smuggled to and through South East Asia and further to North America, Europe, and other parts of the world. The demand for smuggling services remains high because of economic ambitions and work opportunities in other countries. Sometimes, exploitation and coercion are involved. Smugglers promise employment opportunities beforehand but force their victims into sex work and marriage upon arrival at their destinations. Some smugglers have begun using unidentified boats to smuggle people into China to avoid lengthy quarantine procedures required by authorities. Gang-led extortion and protection racketeering is not widespread in China. Extortion was a main source of income for criminal groups in Hong Kong, but it has been brought under control by strong law enforcement. Currently, this activity mainly involves tradespeople and workers. Despite strict gun laws, most reported cases of arms trafficking involve individuals and criminal gangs operating within China, with primarily domestic actors profiting from this market. Rural areas, mining areas, and urban-rural fringes have been identified as prone to gun crimes. The authorities have encouraged citizens to report illegal arms, and those in possession of such weapons to turn themselves in, but these calls have not been effective in curbing the phenomenon. The growth of e-commerce and social media platforms has facilitated this trade, with Chinese platforms being listed as notorious markets for counterfeiting and piracy. Chinese authorities have taken visible steps to counter the counterfeit goods market, but the issue remains rampant. Investigations into intellectual property rights and the sale and manufacture of counterfeit goods have increased in recent years. Despite improvements in anti-counterfeiting processes and tools adopted by e-commerce platforms, the high volume of counterfeit products sold on these platforms remains a concern for rights holders. The Chinese counterfeit goods industry is linked to Chinese Triads, which generate worldwide turnovers of billions of dollars, with a large part of the money being reinvested in the legal economy. The illicit trade of excise goods is a thriving criminal market in China, with Hong Kong and Macau serving as key transit hubs because of their laxer import regime. Smuggled goods include alcohol, cigarettes, beauty products, luxury goods, and electronic products. Crime syndicates are reportedly involved in these activities, with e-commerce platforms contributing to the illicit trafficking. Transnational tobacco companies have been accused of smuggling their own products or working with smugglers to sell their products on black markets and avoid excises around the world. State-embedded actors, particularly corrupt customs officials, are also reported to facilitate this illicit trade in the country, especially during the COVID border closures. The issue of flora crimes in China mainly revolves around the illegal logging and trafficking of timber, with rosewood being a highly sought-after species. China ranks among the top 10 consumer markets for flora crime in the world. Chinese organized crime networks dominate the illicit trade in rosewood, and Chinese logging companies operating abroad play a significant role in the illegal timber trade. During the pandemic, criminals resorted to air cargo instead of sea cargo to smuggle illegal timber. Corruption in source countries enables illegal logging and trafficking to continue. There is a significant illegal trade in orchids harvested in China and abroad, as well as plants harvested illegally for use in Chinese medicine or decoration. China is widely recognized as the largest destination for illegal wildlife trafficking in the world, with various domestic and foreign criminal actors involved in the illicit supply chain. Illegal wildlife products are seen as investment assets and status symbols and are also used in traditional Asian medicine and remedies, hence the high demand. Hong Kong, which has weak traceability systems for legal wildlife trade, plays a role in the illegal trade and is a major transit hub for re-exporters. Flows into China decreased during the pandemic but are expected to rise rapidly as the country reopens. Chinese actors, including criminal groups and independent offenders, are heavily involved in mining activities in various countries, some of which are illegal. Reports suggest that China is the destination for much of the illegally trafficked minerals from Africa, and there are reports of Chinese illegal mining operations in South America and South East Asia. Oil smuggling is prevalent in China, particularly in the Pearl River Delta and the Yangtze River Delta, where dozens of smuggling rings were dismantled in recent years. Smugglers sometimes transfer diesel from territories such as Vietnam, Hong Kong, and Taiwan. Despite efforts to tackle the problem, will probably persist in the absence of robust anti-corruption safeguards at Chinese companies. Most opioids come from abroad, particularly from the Golden Triangle at the Laos-Thailand-Myanmar border. Additionally, heroin from Afghanistan enters China through Pakistan and the western province of Xinjiang. The penetration of heroin from the Golden Crescent the illicit opium production area at the crossroads of Central, South and Western Asia, covering Afghanistan, Pakistan, and Iran in China has intensified. The COVID pandemic has weakened the fight against drug trafficking in the region, and restrictions imposed on air and land transportation have increased drug trafficking by sea. The pandemic has led to growing unemployment, with more poor and vulnerable people turning to drug use or engaging in drug-related crimes. Although domestic demand for cocaine is low, China acts as an increasingly important transit point for transnational cocaine trafficking originating from South America and destined for Hong Kong, Australia, New Zealand, and other countries in the region. The influx of cocaine into China has intensified in recent years. China has strict laws against the use of cannabis as a drug but allows the cultivation of industrial hemp with low levels of THC. China is primarily a destination country for the illegal cannabis trade, with local demand on the rise. Foreign students and Chinese nationals who have studied or worked abroad are suspected of smuggling cannabis into the country by using international delivery services. Criminals in China are acquiring cannabis cultivation techniques from foreign websites and applying these techniques to grow and sell cannabis in the country. In recent years, cannabis smuggling from North America has increased, and the number of marijuana users has risen. Chinese buyers use foreign communication software or the dark net to place orders, and foreign sellers hide cannabis in international parcels and smuggle them from the south-east coast. Synthetic drugs are the most commonly used drugs in China, accounting for more than half the total drug use in the country. Although China has implemented strict laws and regulations to combat the synthetic drug market, it is still a major source country for the international market. Transnational crime syndicates, independent traffickers, and foreign actors are involved in this illegal trade in response to the high demand for synthetic drugs. However, large-scale production activities have been curbed through special operations carried out by Chinese law enforcement targeting drug manufacturing. In this respect, China has shifted from being a source to a destination country, with increasing incidences of drug trafficking from the Golden Triangle. The abuse of new psychoactive substances and controlled drugs has become a major concern in China. During the COVID pandemic, the circulation of substances such as poison candy and poisonous milk tea increased significantly because of difficulties in obtaining common drugs. Hong Kong has experienced a significant increase in synthetic drug trafficking, especially ketamine. Cyber-dependent crime is a growing problem in China, with an increasing number of reports of personal information infringements and hacking. Experts agree that criminal organizations involved in cybercrime in China have become more organized and sophisticated in recent years. These groups use a range of techniques, including distributed denial-of-service attacks and malware, and they approach their activities like a market-driven business. They are highly structured, with a clear chain of command, and have moved from using ordinary Chinese chat platforms to operating on the dark web. Some countries have accused the Chinese government of sponsoring hacking activities and cybercrime abroad, but Beijing has consistently denied these allegations. Financial crime is widespread in China and is difficult to track because of the lack of transparency in corporate affairs. Cyber-enabled financial fraud such as brushing, false investment schemes, fraudulent loan schemes and impersonation of customer service operators recur most frequently. Cyber-enabled financial crimes are a fact of life in China because of its fast-growing middle-to-high-income population, with most incidents involving gambling. Criminals are now targeting the Chinese diaspora abroad, as the Chinese government has adopted measures to combat such activities domestically. Tax evasion is a major concern, and China has vowed to intensify its fight against it in the coming years. Although embezzlement and misuse of funds do occur in China, they are typically linked to individuals or companies. No prominent cases of organized crime group-related financial crimes have emerged. In mainland China, mafia-style groups tend to be small, and their control is limited to local areas. They are primarily involved in criminal activities related to finance and transportation, and often have some interaction with corrupt state officials. These groups have limited access to weapons and their level of violence is generally low, with extortion being a common practice. In contrast, the Triad groups in Hong Kong have considerably larger memberships and are involved in multiple criminal markets, including illegal gambling, drug trafficking, and sex work. Despite their limited access to weapons, the Hong Kong groups are structured and hierarchical, with distinct codes of conduct and a defined leadership. There has been a crackdown on gang crimes in recent years which resulted in the dissolution of several mafia-style groups in the country. However, these groups continue to be well-financed and enjoy political protection to control certain territories. Criminal networks in China are often transnational, focusing on specific areas within the country, and collaborating with foreign actors. These networks mainly operate in human trafficking, human smuggling, wildlife trafficking, and the drug trade, but there is no evidence to suggest that they are associated with significant levels of violence. They are often hired by local governments to evict residents, to collect taxes and exactions, and to harass protesters. Corruption among state officials remains a significant issue, despite numerous anti-corruption campaigns. This suggests that the state sector is significantly exposed to criminal activities. The Chinese government has taken steps to eradicate corruption, but there are suspicions that the anti-corruption drive is politically motivated rather than signifying a willingness to curb illicit activities. There is no evidence to suggest that the Chinese government influences or is engaged in criminal markets. However, reports on the linkages between individuals of the state apparatus and criminal actors suggest the existence of some form of engagement between state and criminal elements, potentially with the state providing forms of protection. Foreign actors are particularly active in south-west China, which borders countries such as Myanmar and Vietnam. However, transnational organized crime linked to China is often driven by Chinese diasporas abroad, rather than by locals. As a result, foreign actors have no control of criminal activities within China, but they do play a significant role in the illicit drug trade, wildlife trafficking, human trafficking, and counterfeiting. Private sector actors are mostly involved in financial crimes and smuggling activities as well as money laundering. They often launder illegally sourced money through gambling and real estate investments, with money laundering operations occurring on a transnational scale. The government has demonstrated its determination to fight organized crime through various strategies, and has been relatively effective, with a continuing stance against organized crime. The Chinese government exhibits strong authoritarianism with the weakening of institutions and increasing concentration of power. The recent COVID outbreak and extreme confinement policies may have shaken the confidence of some citizens to a certain degree, but trust in the government remains fairly high. Corruption remains a serious issue in China, despite efforts and campaigns carried out over the years to tackle this issue. Some of the most evident forms of corruption have been eliminated but other forms of corruption have emerged, such as collusion among high-level officials to redistribute formerly state-owned assets to themselves and politically-connected firms. Corruption in property rights handling in rural areas is considered endemic, and the lack of transparency and government accountability, particularly among high-ranking members of the Communist Party, leads to major cases of corruption being hidden from the public and relevant government offices for a long time. Human rights and fundamental freedoms are lacking in China, making it impossible for civil society and a free press to serve as anti-corruption watchdogs. However, the CCDI, a body that functions beyond the criminal justice system, is known to use the abusive Shuanggui system while conducting corruption investigations, resulting in serious human rights abuses ranging from solitary confinement and lack of access to lawyers to ill treatment and torture. China has ratified several international conventions and treaties related to organized crime, extradition, and judicial assistance, and has entered into asset return agreements with countries around the world. The country is particularly interested in intelligence sharing for drug trafficking, and authorities have found that countries in South East Asia are willing to share information with them. However, there are concerns about the confidentiality of the information shared with Chinese authorities and the potential for it to be used for political purposes. Some critics have accused China of using its international agreements to legitimize its own domestic policies and suppress dissent, rather than truly cooperating with other countries to combat transnational crime. Organised crime has been criminalized in China and the legal framework specifies punishments for criminal actors in a wide range of illicit markets. Some crime types face extremely stringent punishments, but penalties for people involved in organized crime are seen as relatively light in comparison to the harm caused to society. China recently adopted an anti-organized crime law and has had a cyber-security law in place for several years. The Chinese judicial system does not have a specific unit dedicated to dealing with organized crime, but courts can pass judgments against perpetrators. The lack of judicial independence also results in the judiciary being used as a tool by the Chinese government to repress dissent. The Ministry of Justice manages the prison system in China, but there have been cases of corrupt prison personnel. Forced labour is reportedly prevalent in prisons and other detention facilities, with minorities like the Uyghur being subjected to degrading and inhumane conditions. The country has established a national office to combat organized crime. Local communities generally trust law enforcement agencies, but private actors are sometimes involved in policing local communities. Yunnan and Guangxi provinces are particularly vulnerable to drug production and trafficking because of their location along trafficking routes. However, strong law enforcement and border control have made the country less vulnerable to the threat of organized crime. The Chinese government exercises tight control over the cyber-domain and is believed to have significant offensive cyber power. Even though there are fewer documented cyber-attacks against mainland China than the many reported attacks against foreign countries and institutions attributed to Beijing, China has accused the US of a series of hacks against its institutions and companies in recent years. China has been making efforts to prevent financial crimes such as money laundering for over two decades, with banks being required to track capital sources and verify shareholder and executive backgrounds. However, the current anti-money laundering system has limitations, resulting in incomplete access to data, fragmented analysis and dissemination, and a lack of a holistic view of the problem. Anti-money laundering campaigns typically address cases involving corruption, tax evasion, and organized crime. The authorities have identified risks such as bogus transactions through shell companies, cash trafficking, and transfers through bitcoin and other virtual currencies. Mainland China is at greater risk of money laundering and terrorism financing than Macau and Hong Kong, which are both considered global financial centres. Organized crime groups do not dominate any specific sector, and the country has strong measures in place against this type of criminal behaviour. Some criminal groups do offer financial services, but their reach is limited. In recent years, China has tightened economic regulations on technology companies, prohibited cryptocurrencies, and passed a new personal data privacy law to regulate cyberspace, adding more compliance requirements for companies in the country. However, China has been accused of evading international sanctions by importing oil from countries like Iran and Venezuela and providing North Korea with sanctioned resources. Low or non-existent import tariffs in Hong Kong incentivize the smuggling of goods into Mainland China, creating a black market. There is no permanent mechanism in place for the treatment and care of victims of organized crime in China, and whether victims are helped depends on individual cases. Witness protection measures are in place, but victim treatment is not as well established. However, some social organizations do participate in drug treatment programmes. The government is now shifting towards treating drug users as patients who need care and assistance. But, national attitudes towards this part of the population remain negative. The government has implemented programmes to share information about and enhance knowledge of drugs. China does not have national or regional prevention strategies in place to combat organized crime, but some local authorities and communities have taken the initiative to promote prevention measures. In relation to human trafficking, China has faced criticism for prescribing less severe punishments for people who buy trafficked women and children. Non-state actors play a limited role in combating organized crime, as civil society and media are strictly controlled by the government. The fight against organized crime is primarily carried out by the government, but citizens are encouraged to provide information on organized crime, and non-state organizations are active in fields such as illicit animal trade and drug use prevention. Media outlets in China rely mainly on government sources for their coverage of organized crime. The media landscape is characterized by the control of news and information, as well as online surveillance. Overall, China is considered the biggest jailer of press freedom defenders, and the situation has deteriorated further during the COVID pandemic. The crackdown on independent civil society in recent years further restricted the autonomy of NGOs. The criminal markets score is represented by the pyramid base size and the criminal actors score is represented by the pyramid height, on a scale ranging from 1 to The resilience score is represented by the panel height, which can be identified by the side of the panel. A series of 13 discussion papers, one for each illicit market considered during the development of the Index. We're constantly working to improve the Index. By participating in this survey, you will be providing us with insights and suggestions that will help us make the Index an even better resource. This report was funded in part by a grant from the United States Department of State. The opinions, findings and conclusions stated herein are those of the Global Initiative Against Transnational Organized Crime and do not necessarily reflect those of the United States Department of State. Capital Beijing. Income group Upper middle income. Population 1,,, Geography type Coastal. GINI Index Criminal markets 6. An assessment of the value, prevalence and non-monetary impacts of a specific crime type. Human trafficking 7. Human smuggling 6. Extortion and protection racketeering 5. Arms trafficking 3. Trade in counterfeit goods 9. Illicit trade in excisable goods 6. Flora crimes 8. Fauna crimes 9. Non-renewable resource crimes 5. Heroin trade 6. Cocaine trade 3. Cannabis trade 4. Synthetic drug trade 8. Cyber-dependent crimes 8. Financial crimes 7. Criminal actors 6. An assessment of the impact and influence of a specific criminal actor type on society. Mafia-style groups 6. Criminal networks 7. State-embedded actors 7. Foreign actors 3. Private sector actors 7. Political leadership and governance 6. Government transparency and accountability 4. International cooperation 6. National policies and laws 7. A state's legal action and structures put in place to respond to organized crime. Judicial system and detention 5. Law enforcement 6. Territorial integrity 7. Anti-money laundering 6. Economic regulatory capacity 7. Victim and witness support 4. Prevention 6. Non-state actors 2. Analysis Download full profile english. People China is a source, transit, and destination country for human trafficking. Environment The issue of flora crimes in China mainly revolves around the illegal logging and trafficking of timber, with rosewood being a highly sought-after species. Cyber Crimes Cyber-dependent crime is a growing problem in China, with an increasing number of reports of personal information infringements and hacking. Financial Crimes Financial crime is widespread in China and is difficult to track because of the lack of transparency in corporate affairs. Criminal Actors In mainland China, mafia-style groups tend to be small, and their control is limited to local areas. Leadership and governance The government has demonstrated its determination to fight organized crime through various strategies, and has been relatively effective, with a continuing stance against organized crime. Criminal justice and security The Chinese judicial system does not have a specific unit dedicated to dealing with organized crime, but courts can pass judgments against perpetrators. Economic and financial environment China has been making efforts to prevent financial crimes such as money laundering for over two decades, with banks being required to track capital sources and verify shareholder and executive backgrounds. Civil society and social protection There is no permanent mechanism in place for the treatment and care of victims of organized crime in China, and whether victims are helped depends on individual cases. Read the analysis Listen the podcasts View all events. Next Skip. How to measure organized crime? Read more on globalinitiative. Give us feedback We're constantly working to improve the Index.

2. Manhood, Migration, and Heroin

Chengdu buying Heroin

Official websites use. Share sensitive information only on official, secure websites. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Online pharmacies have gradually penetrated the market, but pose risks to patients' health. The purpose of this study was to conduct a prospective risk analysis of the process of purchasing prescription drugs from online pharmacies in China to guarantee drug quality and patient safety. A multidisciplinary team was assembled comprising a leader, four regulators, four pharmacists, two experts, etc. The process was composed of eight subprocesses: searching for prescription drugs, submitting medication requirements, completing patient information forms, dispensing, delivering, etc. Brainstorming was used to identify and prioritize failure modes, propose corrective actions, and reduce risks. Risk priority numbers were the main criterion and were obtained by multiplying three scores: severity, occurrence and detectability, which were scored by the team The team proposed corrective actions for each selected failure mode. A total of forty-one potential failure modes were identified, and the causes, effects, and corrective actions of the 30 top failure modes were analyzed. After taking corrective measures to control risks, the risks reduced by The results of this study proves that the FMEA is a valuable tool for identifying and prioritizing the risks inherent in online pharmacies. This study shows that there are many potential risks in the process of purchasing prescription drugs from online pharmacies, especially in the drug delivery stage. Enhanced training and the introduction of smart devices may minimize risks. Online pharmacies and Chinese regulators should consider these findings for risk mitigation and the improvement of regulations pertaining to online pharmacies. Keywords: FMEA analysis, prescription drugs, online pharmacy, patient safety, risk reduction. Online pharmacies have gradually penetrated the market given their h access, enhanced privacy, easier price comparisons, home delivery, and direct medication availability 1. According to the latest statistics released by China's Ministry of Commerce, the total sales volume of online pharmacies reached 6. Online pharmacies had The COVID outbreak, not only fostered patients' habit of buying drugs online, but also promoted online medical treatment 3. Thus far, China has built more than 1, Internet hospitals supported by public hospitals 4. Patients can obtain prescriptions through online consultations and transfer these prescriptions to online pharmacies through an internal system. Telehealth is a medical service model similar to Internet hospitals in China, that encompasses a variety of telecommunications technologies and tactics to provide remote health services 5 , 6. Telehealth has been defined in all states in the US, while most countries in the EU have no formal definition of telemedicine services. In Japan, access to telehealth clinical functions was restricted to health consultations, and only during the COVID pandemic did the government allow patients to receive medical care and receive prescriptions via the Internet 5. However, despite the convenience and benefits, the rise of online pharmacies has resulted in increased risks to patients and greater challenges to the government. Catastrophic events caused by medication errors have occurred through online pharmacies in China. For example, the online dispensing of colchicine tablets has resulted in multiple fatalities from overdoses 7. To obtain the logo, pharmacies must meet the GPhC guidelines related to staff requirements, record keeping, pharmacy services and so forth The Canadian International Pharmacy Association CIPA , a trade association of licensed, retail Canadian pharmacies, established certification to verify that Canadian online pharmacies comply with Canadian laws It was not until December that Japan opened online drug sale, and limited it to some OTC drugs, and imposed strict access control on enterprises engaged in online drug sale At present in China, due to the immature online pharmacy market and the lack of appropriate judgment by patients, it is difficult to guarantee the drug safety of online patients. Given this situation, the establishment of a standard for online pharmacies is considered urgent. Accordingly, it is of vital importance to reduce risk proactively. Failure Mode and Effect Analysis FMEA , a valuable prospective analysis that incorporates methods for identifying failure modes, and their causes and effects 22 , was first used in the aerospace industry in the mid s ISMP Canada then applied the FMEA to pharmacy practice, proving that the FMEA was an effective and reliable method to proactively examine complex processes in this field and could be used to highlight the high-risk subprocesses that required targeting to minimize future failures and, consequently, improve patient safety Several studies have proved that the FMEA is useful for the reduction of risks related to pharmacies and medication 26 — 32 , however, no such study has been conducted for online pharmacies. The purpose of this study, therefore, was to conduct a prospective risk analysis of purchasing prescription drugs from online pharmacies in China, not only to identify, quantify, and prioritize potential failure modes, but also to define adequate measures for risk reduction to provide suggestions for the standard of online pharmacy. Given that this study focused on the characteristics of online pharmacies, we assumed that the quality of drugs met the expected standards in the process of transporting the drugs from the manufacturer to the online pharmacies. Thus, we chose to examine the next process by which drugs are transported from online pharmacies to patients. ASHRP suggested that the FMEA team should consist of a subject matter expert s , a leader, a facilitator who understands the FMEA process, and a neutral party whose perspective would be helpful in thinking outside of the box ISMP Canada suggested that the FMEA team should consist of front-line practitioners and management, as they have a clear understanding of the details and challenges of the day-to-day work as well as a perspective on resource management A member multidisciplinary team comprising a leader who had experience guiding an FMEA team and was familiar with drug supply chain regulations in China, played a major role in the process. Subject matter experts included four drug circulation regulators; four online pharmacy pharmacists, two of which had middle-level management experience and two of which had over 20 years' experience in drug supply chain; two professors of drug policy, and one member of the Association of Pharmaceutical Commerce in Chengdu. Also included was a patient representative in the role of a neutral party who was not intimately familiar with the process, but whose perspective would be helpful to thinking outside of the box 23 , Apart from the patient, all team members were familiar with the drug supply chain and the administration of online pharmacies, and thus capable of proposing steps toward systemic risks mitigation and potential corrective actions. During the process, the team members met five times for 2 h per meeting. Based on prior selection method criteria, we chose isotretinoin for our preliminary study Isotretinoin is a prescription medication used to treat severe recalcitrant nodular acne, which is known to cause birth defects, depression, and suicidal thoughts In China, the pharmaceutical forms of isotretinon available include soft capsules and gels. The oral administration of isotretinon is a major systemic treatment for acne 37 , Among the commonly used acne drugs in China, isotretinic acid had the largest market share in At present, China's risk management and adverse reaction information notification of isotretinon is based on assessments of other countries' regulatory regimes, without mentioning more detailed risk control measures Ali Health, Meituan, Jingdong Health are online vendor sites for various products—they are both third-party platforms and have established their own online pharmacies. Dingdang and Jianke are Internet pharmacies, and only provide drugs. The team discussed and revised the process and further determined the subprocesses. Based on the confirmed subprocesses, the team brainstormed the various aspects that could potentially go wrong in each subprocess. Then, the failure modes were discussed and finalized. Next, the team analyzed the causes of the failure modes from the perspectives of manpower, machine, material, method, and environment. The effects discussed mainly referred to the influence on drug quality and patient medication. The prioritization process was achieved by assigning a risk priority number RPN to each failure mode. O could refer, not only to the data from previous adverse events, but also to the personal experience of the team members We used a 5-point scale to score S, O, and D, created by combining two pre-defined scales Table 1 The final results were expressed as the median values for S, O, and D of each failure mode. Ranking scale for failure modes' severity, occurrence and detectability Data analysis was conducted using Microsoft Office Excel The team proposed corrective actions for each selected failure mode. To test the validity of the actions, the S, O, and D scores were reevaluated and the RPNs of failure modes were recomputed. The process of purchasing prescription drugs from online pharmacies consisted of eight major steps and eight subprocesses, as shown in Figure 1. The entire process yielded a total of 41 failure modes and 87 causes. The value of RPNs ranged from 64 to The data referred to in this study includes patients' personal information, drugs, prescriptions, orders, distribution, complaints. The main causes for top failure modes can be summarized as follows: 1 manpower, including lack of pharmacist—patient interaction, pharmacists and delivery personnel mainly lack training, capability, and professional pharmaceutical knowledge, and are negligent in terms of running online pharmacies or platforms; 2 machines to ensure the quality of drugs, such as temperature and humidity monitoring equipment, may not be adequate or may malfunction; 3 causes related to materials include non-standard packaging of drugs, no box or mat isolation, etc. The failure mode effects can be classified as the effect on drug quality and the effect on patient medication process. From the perspective of drug quality, contaminated and expired drugs impact the effectiveness, safety, and stability of the drugs. The effects on the patient medication process refer to the fact that the failure mode may lead to the wrong drug selection and the mismedication of patients Table 2. The team recommended corrective actions to overcome the abovementioned identified failure modes Table 2. Among them, staff training is probably the most important action that could improve the pharmaceutical professional level; it includes training for both pharmacists and delivery personnel. Formulating rules is another important way to fill the loopholes of the existing process, such as specifying the content and format of drug instructions on web pages and implementing uniform provisions for electronic consultation procedures. Introducing advanced intelligent facilities, such as intelligent drug delivery equipment, modern logistics system, and prescription review system, can prevent human errors in the process. Good Supply Practice GSP requirements, such as providing an isolation box or mat and equipping facilities for traceability during drug transportation, should also be met. As shown in Table 2 , after taking corrective measures to control risk, the RPN amount decreased significantly after reevaluation, from 1, to The three failure modes with S value of 5 reduced to 3. This study used FMEA to identify and prioritize the potential risks of purchasing prescription drugs from online pharmacies and to identify ways to successfully decrease these risks. From the combination of this study's findings and experience, and an ongoing monitoring program, we perfected the online pharmacy supervision mechanisms in Chengdu, China. This convenience kept most patients from visiting doctors, except for those with chronic diseases. However, over a long period of time, the toxicity accumulation of some drugs, such as isotretinoin, can harm the health of patients, who need to be checked for liver toxicity after several months. It is easy for patients to ignore such adverse drug reactions when they purchase drugs independently without the supervision of a doctor To prevent such situations, online pharmacies should identify multiple orders with the same address, account, and payment accounts via their computer systems. This requires pharmacists to strictly review prescriptions. However, their excessive workload and insufficient knowledge, as well as unclear prescription photos may pose major obstacles. Online pharmacies need to strengthen the training of pharmacists to improve their ability to identify prescriptions. Such drugs accounted for a large proportion. In the list of non-prescription drugs published by the National Medical Products Administration of China data as of December 18, , double classification drugs account for out of 1, and 1, out of 3, non-prescription chemical drugs and non-prescription TCM, respectively These drugs have a special identity and low popularity, making it difficult for patients to identify or distinguish between them. Online pharmacies should implement classified management of double classification drugs with prominent fonts, obvious labels, and clear statements, distinguishing prescription drugs from non-prescription drugs in indications, dosage forms, specifications, and other aspects. According to the analysis of failure modes, step 5, or drug delivery, had the most failure modes. Drug delivery including storage —markedly different from offline drug purchases—is closely linked to the quality of drugs, which may be one of the reasons why products offered by online pharmacies may not have the same quality as those offered by a retail pharmacy 48 , 50 , One study also evaluated the packaging of the drugs purchased, revealing many problems in the drug samples including loose blister packs, capsules, or tablets in clear plastic bags without labels, the lack of packaging, or packaging that had been tampered with Thus, online pharmacies should introduce modern logistics systems and provide proper packaging, isolation boxes, temperature and light control equipment, and well-trained delivery personnel. NABP found no evidence for how consumers could contact the pharmacy for advice about medicines and the Pharmacy Board of Australia recognized that there were circumstances where these forms of communication were necessary or appropriate for the patient's circumstances Therefore, providing medication consultation services is necessary to avoid medication errors. Our study has two main limitations: First, the FMEA procedure solely depended on brainstorming to identify failures, the effects of failures, causes, and failure mode scoring. Hence, to some extent, the results were subjective and inaccurate. However, our team had covered as many fields as possible to minimize the influence of subjectivity. Second, Shebl et al. Thirdly, the subject of our study is the process by which drugs are transported from online pharmacies to patients, therefore, the conclusion of our study has certain limitations. The results of this study prove that the FMEA is a valuable tool for mapping the process, and identifying and prioritizing the potential risks for prescription drugs from online pharmacies. Causes and effects have also been analyzed to propose corrective actions to re-design the process, which have successfully decreased the RPN value of failure modes. These failure modes may result in drug deterioration, medication errors, etc. Chinese regulators need to consider these findings to establish online pharmacy standards to enhance the regulation of online pharmacies. QH: conceptualization, methodology, investigation, and writing—original draft. HH: writing—original draft. MH: review and editing. JZha: resources and supervision. LG: Software. SS and JZho: visualization and investigation. NZ: conceptualization, funding acquisition, resources, supervision, writing—review, and editing. ZH: conceptualization, funding acquisition, and supervision. All authors contributed to the article and approved the submitted version. National development and research center for licensed pharmacist of China Pharmaceutical University Topic: Research on pharmaceutical care standards provided by licensed pharmacists in social pharmacies and its value evaluation — a case study of Sichuan Province Project number: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Med Lausanne. Find articles by Qinyuan Hu. Find articles by Haiyao Hu. Find articles by Ming Hu. Find articles by Jun Zhang. Find articles by Liangwen Gou. Find articles by Shuping Shi. Find articles by Jingyi Zhou. Find articles by Naitong Zhou. Find articles by Zhen Huang. Received Apr 5; Accepted Jun 27; Collection date Open in a new tab. Top critical failure modes, underlying causes, and corrective actions. Carrying out regular training for Internet doctors to constantly improve their professional level and risk-prevention awareness 4 4 3 48 3 2 2 12 5 5b Medicines were mixed with other deliveries online meal ordering, etc. The content should include business license, drug distribution license, registered pharmacist certificate, agreement signed with a third party platform. Standards include completeness and clarity of the photo 5 3 3 45 3 2 2 12 11 4 Pharmacists fail to check prescriptions in accordance with the Prescription Administrative Regulation 43 -Pharmacists were not careful -Insufficient professional competence of pharmacists -Excessive workload of pharmacists Unreasonable prescriptions, prescription overdose, repeated administration, and other problems affect the health of patients Training pharmacists 5 3 3 45 3 2 2 12 12 7b No complaint window or no way of dealing with complaints -Online pharmacies were shunning complaints -Lack of awareness among online pharmacies or platforms Patients cannot protect their rights Improving the complaint system. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Failure affecting neither the patient nor the process. Failure causing minor effect or perceived as a nuisance to the patient or process, without causing any injury or requiring an increase in the level of health care. Failure causing some performance loss, which can potentially necessitate an increased level of health care provided to the patient, requiring hospitalization or extending the length of hospital stay. Failure causing a high degree of performance loss, having a permanent impact on the patient, resulting in reduced functioning; surgical intervention may be necessary. Failure causing deadly outcome or major, permanent loss of function. Photocopies of paper prescriptions uploaded were reused by patients. The patient's prescription drug dosage exceeds the limit, and overmedication is harmful to health. Identifying multiple orders with the same address, account, and payment account by the computer system. The paper prescription uploaded exceeded the prescription expiration date. The drugs listed in the prescription may not match the health condition of the patients, leading to the wrong medication. The online consultation of doctors was replaced by questionnaires leaving the default responses in place, and patients bypassed this by following the default process without entering any patient-specific information. Patients may not assess their true medical condition, and the collected patient information may be wrong, which could lead to drug allergy and interactions; the use of drugs by pregnant and lactating women could also affect the health of the fetus or baby. Establishing standard electronic consultation procedures. Carrying out regular training for Internet doctors to constantly improve their professional level and risk-prevention awareness. Medicines were mixed with other deliveries online meal ordering, etc. Packaging drugs, which could prevent loose and contaminated drugs; materials should ideally be waterproof and wear resistance, such as foam paper. Delivery people were not pharmaceutical professionals and did not understand the requirements of drug storage and distribution. Some medicines emulsions, etc. Training staff; using foam paper for packaging. Patients' medication problems could not be professionally solved. Introducing policies to stimulate pharmaceutical professionals to register for pharmacists to fill the gap; strictly supervising the suspension of pharmacists. The uploaded prescription photocopy is not the real prescription. Medication errors or overdoses could affect the health of patients. The pharmacies' qualification information was missing or fake. Patients cannot judge whether or not online pharmacies are legal. Standardizing the content and standard of online pharmacy qualification information display. Standards include completeness and clarity of the photo. Pharmacists fail to check prescriptions in accordance with the Prescription Administrative Regulation Unreasonable prescriptions, prescription overdose, repeated administration, and other problems affect the health of patients. No complaint window or no way of dealing with complaints. Improving the complaint system. Setting up a complaint window on the page, arranging someone to deal with complaints, and summarizing the issues regularly. Expired drugs may affect the health of patients. Proactively informing patients of drug expiration dates to ensure that patients are aware. Developing the system for full traceability and equipping it with hardware and software. Failed to provide real and valid contact information of pharmacies and failed to update the information in time when it changed. The patient may be unable to contact the pharmacy. Formulating rules regarding the contact information provided by the pharmacy to ensure that the patient can contact the pharmacy. Medium- and high-alert drugs were sold at online pharmacies. Patients may abuse narcotic, psychotropic, and other specially controlled drugs, causing harm to their own health or using them for illegal purposes; medicines may deteriorate due to improper storage. Controlling the business scope of online pharmacies by prohibiting 1 vaccines; blood samples; narcotic, psychotropic, toxic, and radioactive drugs; and precursor chemicals; 2 long-term drugs that may be excessively used, producing drug dependence or seriously damaging health, such as antibiotics; 3 drugs that will not keep, such as cold-chain drugs. Unsuitable temperature and humidity during transportation. Equipping staff with temperature and light control equipment and training them. Chemical medicine pharmacists provided prescription review and medication guidance services for Traditional Chinese medicine TCM. Failed to accurately identify prescription problems involving TCM prescription drugs. Coordinating Chinese pharmacists and chemical medicine pharmacists, and stipulating that only Chinese medicine pharmacists can provide prescription review and medication guidance services. Prescriptions for children or elderly patients are approved. Children and the elderly could buy drugs by mistake. Patients cannot inform online pharmacies of adverse drug reactions. Patients with adverse drug reactions cannot take timely and effective treatment measures. Establishing patient reporting system to take remedial measures; providing h toll-free telephone service for medication consultation. Delivery personnel suffer from infectious diseases or other diseases that may contaminate drugs. Medicine is contaminated and patients are infected. Carrying out pre-job and regular physical examinations for delivery personnel. The vehicle or device malfunctioned during transportation. Drugs deteriorate or are delayed in terms of use by patients. Stipulating that the vehicle facilities and equipment should be inspected before leaving the vehicle; making emergency plans for facility failure. Photos of drug instructions were unclear and incomplete. Ensuring that information about drug instructions are in the same font, size, and color to meet the requirements of patients for browsing and viewing drug information, including the generic name, commodity name, dosage form, and specification; arranging a review. Drugs were eroded and polluted by moisture or insects in the process of transportation. Equipping delivery personnel with isolation boxes or mats and training them. The transportation distance or time was too long. The quality of drugs may be affected or patients may experience delays. Introducing modern logistics system and training delivery personnel. The drugs directly touched the floor or wall during transportation. Shortage of pharmacists providing pharmaceutical care. Patients' medication problems cannot be professionally solved. Influences prescription authenticity, patient medication and drug quality; there is no way to verify the content of complaints. Developing uniform data recording standards and training staff. Influences prescription authenticity, patient medication, and drug quality; there is no way to verify the content of complaints. Developing uniform data storing standards and training staff. Third party service platforms, online pharmacies, Internet hospitals, and third party logistics service provider shirked responsibility. No one is responsible for the medication problems of patients. Signing an agreement with the platform taking the responsibility first; then, the platform shall pursue responsibilities according to their respective functions.

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