Pubdate: Mon, 20 Oct 2003 Source: Sun Herald (MS) Copyright: 2003, The Sun Herald Contact: http://www.sunherald.com Details: http://www.mapinc.org/media/432 Author: Mike Cummings SPECIAL REPORT: TEENS & DRUGS ROGUE ONLINE PHARMACIES EASILY PROVIDE PRESCRIPTION NARCOTICS Many sites use 'consulting physicians' Prescription pills are a couple of mouse clicks away. Anyone with an e-mail account endures the steady stream of unsolicited advertisements promising cheaper prescription drugs. It's annoying. It's sinister, too. The Internet offers drug dealers and drug abusers vast opportunities to buy prescription medications without seeing a doctor. Hundreds of Web sites peddle prescription pills, promising customers increased privacy and cheaper prices for controlled substances such as Viagra, Vicodin, Xanax and Lortab. Local law enforcement officials say shopping around for unscrupulous doctors is the most common method of obtaining prescription medications, but the availability of drugs on the Internet is a growing concern that has drawn the attention of Congress. William Hubbard, associate commissioner for policy and planning for the U.S. Food and Drug Administration, testified before a congressional committee in March about the prevalence and dangers of Internet drug sales. "More than many other types of electronic commerce, the unauthorized sale of prescription and unapproved drugs poses a potential threat to the health and safety of consumers," he said. Following a Sun Herald Drug Task Force meeting in which local high school students said prescription drug abuse is common among their peers, a reporter decided to test the online drug market. Purchasing drugs on the Internet is alarmingly easy. All it took was a few minutes, a valid credit card and an Internet connection. The reporter visited dozens of sites before purchasing 30 1 milligram tablets of alprazolam, the generic version of the anti-anxiety drug Xanax. The transaction included a questionnaire that asked for basic medical information and a credit card number. The Web site stated the questionnaire would be reviewed by a physician, who would determine whether to prescribe the pills. Many of the online pharmacies the reporter visited included photographs of smiling people wearing stethoscopes and white lab coats, suggesting a doctor's involvement. Employing "consulting physicians" to review a customer's medical information and prescribe medications without a face-to-face examination exploits loopholes in state and federal laws, many of which aren't equipped to regulate prescribing drugs on the Internet. Leland "Mac" McDivitt, the director of the state Board of Pharmacy, said the process is highly vulnerable to deception. "If somebody is addicted to diet pills and weighs 90 pounds, they're not going to be honest about it. They'll say they weigh 190 pounds," McDivitt said. "There is no way to monitor that. There is absolutely no way to administer honesty online." A handful of states have amended their laws to regulate online prescribing. Mississippi is not among them. The American Medical Association and the U.S. Food and Drug Administration frown upon doctors who prescribe medications over the Internet based on a questionnaire. 'Purposely misleading' information In his testimony to Congress, Hubbard described a case in Arizona in which operators of a network of Internet pharmacies that charged fees for physician consultations were handed a 198-count federal indictment. "The indictment alleges that in the overwhelming majority of applications, no medical reviews, consultations or physical examinations by a physician took place before drugs were shipped to customers," Hubbard said. He said the defendants in the case distributed 48,816 new orders for prescriptions and 41,817 refills, generating sales of more than $28 million. In a statement given to a congressional committee in March, Carmen Catizone, director of the National Association of Boards of Pharmacy, said the Web sites often seek to dupe customers into violating the law. "The information posted on these rogue sites is often purposely misleading and, in some cases, purposely fraudulent so as to lure consumers to these sites and engage them in the illegal purchase and distribution of drugs," he said. Catizone's statement certainly applied to The Sun Herald reporter's online purchase. About two weeks after placing its order, the newspaper received a white envelope containing 30 white tablets taped inside a blue folder. Information included in the package identified the pills as Zopax, a version of alprazolam produced in South Africa. The circular tablets appeared identical to sample pills pictured on the drug company's Web site. Robin Passman, a licensed pharmacist in Gulfport, examined the pills at the newspaper's request. "It's hard to say what we're looking at here," he said. "The question is, 'Do we have a real product?' These could be lactose tablets for all we know," Passman said. "One, did it come from a pharmacy?" Passman said. "If it didn't come from a pharmacy, it could've been made in some guy's back yard... You don't know what conditions it's been stored under. If it was what is says it is, it might not be now." The tablets were expensive, whatever they are. The newspaper bought them for $125, far more than prices listed on legitimate online pharmacies. Sixty 1 milligram tablets of Xanax cost $99.99 on Walgreens.com. The CVS online pharmacy sells 90 1 milligram tablets of alprazolam for $20.89. Legitimate online pharmacies The NABP estimates there are 500 independent Web sites offering to distribute prescription drugs. In his congressional testimony, Catizone called the sites well-financed and well-organized operations. There has been a sharp increase in the number of foreign-based sites offering Americans lower-priced drugs from Canada and other countries. The FDA monitors the Internet and prosecutes the operators of rogue sites, but it is a difficult task as the location and appearance of Web pages are easily changed. There are legitimate online pharmacies that do not prescribe medications over the Internet and offer consumers convenience and privacy. The NABP has a program to certify legitimate Web sites. Randy Johnson, spokesman for the Mississippi Bureau of Narcotics, said it's hard to know how many people in the area are using the Internet to purchase drugs. "I'm sure it's happening," he said. "I couldn't say how much." Capt. Pat Pope, director of the narcotics unit for the Gulfport Police Department, agreed with Johnson. "We haven't had much experience or much evidence that it is a concern here," Pope said. "I'm not naive enough to believe that it's not happening. I'm sure it's being abused some." Both Johnson and Pope said the main source of illegal prescription pills in the area is doctor shopping, where people travel from town to town searching for physicians who will prescribe them medications. "They start out in the morning and hit 10 different clinics in the area," Johnson said. "Within 24 hours, they've received 10 to 12 prescriptions." Be cautious The FDA offers these tips to consumers buying health products online: . Check with the National Association of Boards of Pharmacy to determine if the site is a licensed pharmacy in good standing (visit the Web site at www.napb.net or call 847-698-6227). . Don't buy from sites that offer to prescribe a prescription drug for the first time without a physical exam, sell a prescription drug without a prescription or sell drugs not approved by the FDA. . Use sites that provide convenient access to a licensed pharmacist who can answer your questions. . Avoid sites that do not identify with whom you are dealing and do not provide a U.S. address and phone number to contact if there is a problem. . Beware of sites that advertise a "new cure" for a serious disorder or a quick cure-all for a wide range of ailments. . Be careful of sites that use impressive-sounding technology to disguise a lack of good science or those that claim the government, the medical profession or research scientists have conspired to suppress the product. . Steer clear of sites that include undocumented case histories claiming "amazing" medical results. . Talk to your health-care practitioner before using any medication for the first time. If you suspect a site is illegal, you can report it to the FDA by using the online reporting form on the agency's Web site: www.fda.gov. - - U.S. Food and Drug Administration - --- MAP posted-by: Josh