Pubdate: Thu, 20 Nov 2003 Source: Dallas Morning News (TX) Copyright: 2003 The Dallas Morning News Contact: http://www.dallasnews.com/ Details: http://www.mapinc.org/media/117 Author: JUDITH GRAHAM and MICHAEL HIGGINS PRESCRIPTION DRUG ABUSE RISING IN AMERICA CHICAGO - At colleges across the country, students are taking pills they've sneaked from home, tossing them into bowls and swallowing handfuls with a chug of beer or a sip of a margarita. It's called "pharming," for the pharmaceuticals ingested. In office towers, workers sitting at computers are barraged by spam e-mails offering prescription drugs at low prices, no prescription required. "No physical exam," promised one message widely circulated last week, touting painkillers, stimulants, tranquilizers and anti-depressants. The face of drug addiction is changing in America, from cocaine or heroin addicts snorting or shooting up to teenagers and grandmothers popping pills purchased at the local pharmacy or delivered through the mail in plain packages. Rush Limbaugh turned a spotlight on the epidemic this month when he admitted being hooked on prescription painkillers and told his radio audience he intended to get help. Prescription drug abuse is the fastest-growing type of substance abuse in the United States, a phenomenon fed by aggressive drug marketing, Americans' habit of taking pills for any ailment, physicians' tendency to over-prescribe and the Internet, which is expanding the availability of drugs exponentially. About 6.2 million Americans, including disproportionately high numbers of young people and the elderly, abuse prescription drugs, according to government data released in September. More than 14.5 million people report they've taken such drugs for non-medical purposes during the past year. Meanwhile, 2.4 million people in 2001 started abusing pain relievers - the drugs Limbaugh allegedly asked his housekeeper to buy for him - almost a four-fold increase over the 628,000 reported as abusers in 1990, according to the U.S. Substance Abuse and Mental Health Services Administration. The problem of prescription-drug misuse is so acute that parents may need to start locking their medicine cabinets, just as liquor cabinets were locked decades ago to keep children away from booze, said Joseph Califano, president of the National Center on Addiction and Substance Abuse at Columbia University. For many people, popping pills may appear to be a more sanitized, less stigmatized way to get relief from the stress of daily life. Instead of dealers on mean streets, frequent sources are doctors duped by patients or pharmacies responding to call-ins for fake prescription refills. Califano, a former U.S. Cabinet secretary, cites 2002 figures for legal prescriptions in the U.S: 153 million for narcotics, such as Vicodin, Percocet or OxyContin; 53 million for tranquilizers such as Xanax or Valium; 23.5 million for stimulants such as Adderal or Ritalin; and 5 million for sedatives such as Soma. On top of that is an unknown quantity of counterfeit prescription drugs streaming into the country through the Internet and other sources, often of unknown quality and diverted to the underground market. Officials from the Food and Drug Administration, Secret Service, Justice Department, pharmacy groups and others met last week in Washington to develop strategies for keeping counterfeit pills out of the country. But the rise of the Internet as a source of illegal prescription drugs presents new challenges. At least 2,000 Web sites now sell prescription drugs, the FDA estimates. Traditionally, investigators have looked for geographic "clusters" of drug-related problems - whether admissions to emergency rooms or to jails - to identify physicians who may be overprescribing, buyers who may be doctor-shopping and other drug scams. With the Internet, though, clusters aren't readily detectable. In the past several months, authorities have seen "a new and troubling evolution of this business," from the Internet sale of lifestyle drugs such as Viagra and diet aids to the pervasive marketing of all kinds of prescription drugs, said William Hubbard, assistant commissioner at the FDA. The FDA and the Drug Enforcement Administration last week teamed to form a task force, Operation Gray Lord, that will aggressively pursue outfits that market prescription drugs illegally over the Internet. Doctors who prescribe drugs over the Internet based only on customers' answers to e-mail questionnaires also may be targeted. While some Web-based outfits are legitimate - filling prescriptions written by patients' doctors online for a reduced price - many are rogue pharmacies, offering to be both doctor and drug salesman to anyone with a credit card. They're typically secretive, rarely listing their full corporate names, business addresses or the names of doctors and pharmacists they employ. Many are based in foreign countries. Most require only that the shopper fill out a short online questionnaire and provide no oversight of the often dangerously addictive drugs they so easily distribute. "Basically, you can get as much as you want of anything if you know how to do it," said Dr. Daniel Angres, director of Rush Behavioral Health, a treatment program with several sites in the Chicago area. "It's so frightening. None of us wants to think about it in terms of where it might go." - --- MAP posted-by: Keith Brilhart