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Many prescription drugs are freely available for purchase on the Internet without a legitimate prescription from a physician. This study focused on the motivations for using no-prescription online pharmacies NPOPs to purchase prescription drugs rather than using the traditional doctor-patient-pharmacy model. We also studied whether users of NPOP-purchased drugs had poorer health outcomes than those who obtain the same drug through legitimate health care channels. We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. Respondents in both groups were primarily white, female, and in their mid-forties nontraditional users to upper forties traditional users.