The Rise of Telehealth 'Pill Mills'

—Photo-Illustration by TIME (Source Image: irynakhabliuk via Canva) The elderly patient’s blood pressure had been dropping for weeks, and Chad Wittekind, his primary care provider, couldn’t figure out what was wrong.

He had upped the dosage of one medication and added another, but couldn’t manage to regulate it.

The patient hadn’t reported taking any other new medications or supplements and hadn’t made any major recent lifestyle changes.

So what could be causing the blood pressure irregularity? It took a lot of questions and appointments to find the culprit: a drug he’d gotten through a telehealth website.

Like many other patients Wittekind has seen recently, this one had circumvented his primary care provider to get a drug over the Internet—in this case, an erectile-dysfunction medication.

He’d gone to a website he came across online, filled out a form that a virtual health care provider quickly reviewed, and was sent the medication through the mail, but had been too embarrassed to tell Wittekind about the new addition to his regimen.

You might not think that Wittekind, a Columbus, Ohio-based provider who works in geriatrics, would be seeing many patients turn to the Internet to get drugs for conditions like erectile dysfunction, overweight, menopause , and depression.

But the accessibility of sites like these and the ease of getting meds from them have made them an increasingly popular choice for Americans of all ages and incomes.

Here’s how it works: often after viewing an ad on social media, people click on little-known websites promising a fast and easy way to get medication for a specific condition.

These sites accept credit cards, don’t take insurance, and don’t typically make you have a call with a doctor.

Instead, you fill out a quick form about your medical history and current medications, and a medical provider you’ll never meet (and will probably never talk to) reviews the information within minutes to hours.

If you qualify, they’ll write you a prescription—often a recurring one—and connect you to a pharmacy that ships the drug directly to your home.

Wittekind and other providers see this as a problem.

They’re used to patients coming to them asking for some drug they’ve seen advertised on TV, but the fact that patients can now get these drugs elsewhere, without much screening, is worrying.