The Rapidly Growing Illegal Prescription Market on Social Media: The Expanding "Dark Pharmacy" on SNS — The Cost of Convenience is Trust in Healthcare

When "Receipts (Prescriptions)" Become "Products"—The Invisible Black Market Expands on SNS

On August 16, 2025, Brazilian economic media InfoMoney reported on the semi-open trade of prescriptions, medical certificates, and even the medicines themselves on SNS. The main battleground for these sales is messaging apps and major social networks, where listing, purchasing, payment, and delivery are all completed online. This "dark marketplace," armed with anonymity and automation, easily evades the surveillance of medical institutions and regulatory authorities.InfoMoney

Mechanism: A "Marketplace" Run by Bots and Fake Accounts

The core of illegal sales lies in closed groups and bots. Fake accounts and automated response bots arrange the purchasing process, payment, and delivery (in PDF, image data, or physical form), allowing buyers to instantly obtain the necessary "documents" or drugs. Cases of unauthorized use of doctors' real names and registration numbers are also rampant.InfoMoney

A symbolic case of affected doctors is pediatrician João Batista from São Paulo state. He reported being contacted by the medical association regarding a large number of medical certificates issued under his name for patients he had not examined.InfoMoneyDiário do Centro do Mundo

How Widespread Is It: Over "20 Times" Expansion in 7 Years

Illegal posts have skyrocketed from 686 in 2018 to over 15,000 annually now, a "more than 20-fold" increase. In just January to July 2025, related posts were viewed about 500,000 times, and the number of participants in dedicated groups swelled to 27,000. Not only the numbers but also the "turnover" is rapid. The organization by bots and fake accounts creates a cycle of being discovered, disappearing, and reappearing.InfoMoney

What's Being Sold: "Prescription Menu" of White, Blue, and Yellow, Flexible Medical Certificates

The circulated "documents" are more organized than imagined. There is a "menu" of types, such as white prescriptions for general drugs, blue for psychotropics, and yellow for narcotics and strictly controlled drugs. Manuals for misuse include printing methods, writing "tips," and instructions to avoid major chain pharmacies. Buyers can specify the number of sick leave days and disease codes (CID) on medical certificates, and direct sales of drugs like antidepressants, appetite suppressants, and abortion pills are rampant.InfoMoney

Pathways of Spread: Platform Ads, Videos, List Sales

The exposure venues are diverse. Cases have been confirmed where search ads and SNS ads serve as "pathways," and short videos have semi-tutorialized "acquisition methods." "Sellers" self-promote in comment sections, and "product lists" circulate on X (formerly Twitter). The high visibility attracts new entrants, making monitoring and enforcement difficult.InfoMoney

Regulatory Struggles: CFM's Digital Certification and Judicial Decisions, Anvisa's SNCR

The medical association (CFM) proposed the "Atesta CFM" initiative to verify the authenticity of medical certificates online, but in November 2024, the Federal Court (TRF-1) temporarily halted it. The scope of legal authority and integration design flaws are points of contention, and the dispute is ongoing.InfoMoneyJOTA JornalismoPoder360

Meanwhile, regulatory authority Anvisa announced the expansion of the "SNCR (National Prescription Number Management System)" in 2025. The government will centrally manage the "numbers" of blue and yellow tickets, moving towards a "digital notary" model linked to individual doctors. The plan is to implement automatic authentication at the time of prescription and real-time verification at pharmacies. Phased tests are progressing from spring to summer 2025, with full-scale operation expected within the year.Serviços e Informações do Brasilmed.estrategia.com

Public Health Risks: Loss of "Trust" Due to Self-Treatment and Forgery

The core of the problem lies in the spread of controlled pharmaceuticals without physician supervision. Misadministration, polypharmacy, amplified side effects, addiction, emergency room congestion—and the loss of "trust" in doctors, pharmacists, and the system. Medical organizations warn that illegal medical practices and the "dilution" of prescriptions spread risks to society as a whole.InfoMoney

SNS Reactions: Whistleblowing by Involved Parties, Support for Regulation, and Privacy Concerns

• Whistleblowing is on the rise. Doctors and media accounts are exposing the flood of medical certificates and prescriptions impersonating them. A SNS video by news media g1 highlighted cases of unauthorized documents issued under doctors' names, with the comment section filled with calls for "strengthening identity verification" and "protecting real names and registration numbers."TikTokFacebook

• Support for stronger regulation. Posts evaluating the expansion of SNCR (digitization of blue and yellow tickets) are scattered in medical communities. The view is that "central management of numbers" and "real-time verification" will narrow the scope for forgery.X (formerly Twitter)

• Meanwhile, concerns about surveillance and centralized management. Regarding the suspension of Atesta CFM, there is a persistent narrative pointing out issues of data centralization, integration flaws, and overreach. On SNS, opinions such as "concentration of medical data is dangerous" and "mandatory implementation without interoperability is premature" were shared.JOTA JornalismoPoder360

"Why Now" Has It Expanded: Three Dynamics

1. Automation and Anonymity—Bots and fake accounts automate supply and administration. 2) Explosion of Visibility—Search, video, and SNS become "entry points," visualizing latent demand. 3) Systemic Disconnection—Gaps remain at the junctions of paper, electronic, and regional systems, delaying standardization of authenticity verification. These factors combined have led to a "supply expansion" over 20 times that of 2018.InfoMoney

The Future of Prescriptions: Number-Based, Interoperability, and "Human"

Number-Based (Centralized number management by SNCR) is powerful in removing the "tools" of forgery, but Interoperability (real-time linkage between electronic prescriptions, physician registration, and pharmacy systems) is essential for effectiveness. Ultimately, "humans" will fill the gaps—verification processes by doctors and pharmacists, utilization of audit logs, strengthened ad review by platforms, ease of reporting, education, and literacy.
As illegal "markets" appear convenient, raising the "speed and convenience" of legitimate routes is actually an effective countermeasure.

Conclusion

The prescription black market expanding on SNS erodes the culture of pharmaceutical safety from within. The judiciary, regulation, platforms, and medical fields must strengthen the chain of number management→real-time verification→detection of ads and searches→education as the starting point for the next counterattack.InfoMoneyServiços e Informações do Brasil

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