>> If the reason you are using an IOP is because the medicine you're ordering can't legally be prescribed in the U.S., well, then you are breaking the law and I guess you shouldn't be surprised when someone comes knocking on your door.
IMO, most medicines ordered from IOP's can be legally prescribed in US or something very similar is available. There are exceptions with nootropics and HIV/AIDS treatments, but the most common reason to order from an IOP is, for example, ambien at my local chain drugstore is $95 for 30.

Several IOP's ship it for $30 for 30. I have a legit Rx for ambien from my fully licensed, local MD. But my health insurance won't cover it - they want me to take a benzo instead. So I might be motivated to acquire ambien from an IOP. JMO!