Pubdate: Mon, 27 Aug 2007
Source: Tampa Tribune (FL)
Section: Business
Copyright: 2007 The Tribune Co.
Author: Tom Breen, The Associated Press


CHARLESTON, W.VA. - Drug shipments from illegal online pharmacies 
were once so frequent in Appalachia that delivery companies had to 
add trucks to their routes.

Police have cracked down on such deliveries but are confronted by a 
booming global network of so-called rogue pharmacies operating online.

For people addicted to prescription medications such as the 
painkiller hydrocodone - sold mostly as Vicodin - the days of "doctor 
shopping" are over as long as they have Internet access. With the 
help of unscrupulous doctors and pharmacists, hundreds of Web sites 
dispense prescription narcotics to customers in exchange for nothing 
more than a credit card number.

Even as law enforcement agencies and state governments respond, the 
number of rogue pharmacies continues to grow, filling hundreds of 
prescriptions a day, according to a recent study by the National 
Center on Addiction and Substance Abuse at Columbia University.

The Drug Enforcement Administration, which reported the additional 
parcel delivery trucks in southeastern Kentucky, says about 95 
percent of products sold by online pharmacies are controlled 
substances. By comparison, controlled substances amount to roughly 11 
percent of the dosages dispensed by legitimate pharmacies.

The DEA found that 34 rogue pharmacies dispensed more than 98.5 
million dosage units of hydrocodone products in 2006.

Pharmacist Don Perdue has seen customers who run out of prescription 
refills turn to illegal online pharmacies.

"This is a major problem," said Perdue, chairman of the West Virginia 
House of Delegates' Health and Human Resources Committee, which wants 
to see federal law changed to make it easier to shut down illicit pharmacies.

Congress is considering legislation that would clarify federal law on 
Internet pharmacies and increase penalties for selling 
pharmaceuticals to minors. Targeting Needy Doctors, Pharmacies

Testifying before the Senate Judiciary Committee in May, Joseph 
Rannazzisi, deputy assistant director of the DEA's Office of 
Diversion Control, described how rogue pharmacies usually work.

The Web sites approach doctors, often those who are in debt or 
retired and are seeking extra income. The doctors write prescriptions 
after they review online questionnaires filled out by customers. The 
doctors are usually paid between $10 and $25 for each prescription.

The sites approach small pharmacies and persuade them to fill the 
prescription and ship the pharmaceuticals to the customers. The Web 
sites target pharmacies struggling to make ends meet and usually pay 
an additional fee on top of the cost of the medication.

Prescription drugs can legally be ordered online, but rogue 
pharmacies ignore the rules that legitimate pharmacies follow, such 
as requiring a doctor-patient relationship and getting a 
certification from state boards.

The difference between legitimate and rogue pharmacies can be 
confusing. To make the distinction clearer, the National Association 
of Boards of Pharmacy has created a voluntary verification process 
for online pharmacies to establish that they comply with the law and 
ship prescriptions only to patients who have been examined by 
doctors. So far, 13 sites have received verification, including those 
by Walgreen Co. and CVS Caremark Corp.

Rogue Sites May Number In Thousands

In May, the National Center on Addiction and Substance Abuse 
identified 581 Web sites that offer controlled prescription drugs, 
compared with 492 in 2004. Both the center and the DEA say it's 
impossible to know how many such sites there are, with estimates 
ranging from a few hundred to more than 1,400.

"These Web sites come and go very quickly," said Susan Foster, vice 
president of policy research and analysis at the center. "They could 
be up one day and operating under a different URL the next day."

Most of the sites identified by the center were so-called portal 
sites, which don't directly sell drugs. They lead browsers to anchor 
sites, where the drugs are sold. The study identified 187 anchor 
sites. Of those, 157 did not require a prescription.

Experts warn that the sites are dangerous not only because they can 
be used to feed addictions, but also because customers often don't 
know what they're getting. Ninety-one of the anchor sites identified 
by the center were outside the United States, where there are often 
different safety standards for medicine.

"You have no idea what you're getting from these places," DEA 
spokeswoman Rogene Waite said. "It's just a very dangerous business."

Linda Surks of South Brunswick, N.J., knows better than most how 
dangerous rogue pharmacies can be.

She lost her 19-year-old son, Jason, three years ago when he 
overdosed on prescription medication he ordered from a Web pharmacy 
based in Mexico. His family had no idea he had been taking the drugs, 
since he didn't have prescriptions.

"One of the first questions they asked us in the emergency room was 
whether he was on any medications, and we said he wasn't," Surks said.