Federal lawmakers are taking aim at unscrupulous online pharmacies that have used the anonymity of the Internet to sell millions of dollars of addictive drugs to customers without proper prescriptions.
Touting their products in countless spam e-mails, the rogue pharmacies sell prescription painkillers such as Vicodin to consumers based only on a short online questionnaire, with no face-to-face doctor visit required.
State medical and pharmacy board officials call that dangerous and unethical, and congressional hearings on the issue will begin early next year.
“It’s a major compromise of the system,” said Carmen Catizone, executive director of the National Association of Boards of Pharmacy, based in Park Ridge. “Right now it’s safer . . . to move controlled substances over the Internet than it is to sell cocaine or heroin on the street.”
Some people involved in Internet prescribing have paid a price. More than a dozen doctors have lost their licenses, including one in Illinois in October. The U.S. Drug Enforcement Administration has won about a dozen convictions related to online prescribing.
But most of these pharmacies continue to operate freely, despite brazen online offers of “no prescription” codeine or Valium. State medical and pharmacy boards find the deceptive operations hard to locate because they rarely list their full corporate names, business addresses or the names and locations of the doctors they employ.
Some are in foreign countries and can’t be closed without international cooperation. They also change Web addresses and business names frequently, advertising each new incarnation with a new flurry of spam.
Meanwhile, federal efforts to tighten the rules have failed, sunk by concerns over excessive regulation of the Internet or the belief that states–and not the federal government–should make rules regarding the practice of medicine.
Two congressional committees are looking again at the subject. The Senate Committee on Health, Education, Labor and Pensions plans to hold a hearing regarding online pharmacies and the problem of counterfeit or impure drugs.
The House Committee on Government Reform expects to schedule a hearing early next year. U.S. Rep. Tom Davis (R-Va.), the committee chairman, plans to introduce a bill that would require online pharmacies to fully identify themselves. The bill also would create a federal definition of what constitutes a proper prescription and would make it a crime to sell controlled drugs without a valid prescription, said Davis spokesman David Marin.
“Too many sites out there are filling illegitimate prescriptions that could lead to serious illness or death,” Marin said.
That’s not news to many involved in drug regulation and enforcement. The boom in online ordering of prescription drugs began about 1999. Initially, most Web sites focused on “lifestyle drugs” such as Viagra, which can have harmful side effects but are not addictive.
The recent trend toward online sale of controlled substances is more troubling, said William Hubbard, associate commissioner at the U.S. Food and Drug Administration.
“You’ve got to assume that a lot of people are simply trying to avoid the legal system in buying those drugs,” Hubbard said.
The majority of prescription-drug abusers still obtain drugs through traditional methods, such as seeing more than one doctor or presenting fake prescriptions to pharmacies.
But several Chicago-area treatment clinics report that 10 percent to 25 percent of their clients who abuse prescription drugs obtained them over the Internet, up from almost none two years ago.
That’s frustrating for treatment specialists, because computers are so hard to avoid, said Jake Epperly, president of Midwest Rapid Opiate Detoxification Specialists in Chicago.
“It’s like going home and your drug dealer is sitting on your couch,” Epperly said. “It really sets them up for craving and relapse.”
State laws govern how and when a doctor can prescribe drugs. Most states require a physical examination, either as a matter of state law or medical board rule, according to the Federation of State Medical Boards, based in Texas.
Other state laws merely require an established doctor-patient relationship–a standard that the American Medical Association and other groups say precludes prescribing by online questionnaire.
State laws also prohibit doctors from prescribing drugs to a patient who lives in a state where the doctor is not licensed.
Rogue pharmacies often flout both the doctor-patient relationship and state license requirements, said Dr. James Thompson, federation president.
The pharmacy board association has certified 14 pharmacies whose Web sites meet professional standards, including Walgreens.com and CVS.com.
The federation began tracking rogue sites in 2000, using an investigator who visits sites and purposely makes dubious orders.
The federation passes its information on to federal and state authorities. About a dozen doctors have been disciplined, and cases against the others are pending.
In October, the Illinois Department of Professional Regulation revoked the Illinois medical license of Miles Jones, a Missouri doctor licensed in numerous states. Illinois took action after North Dakota officials concluded that Jones had sold the prescription drug Cipro over the Internet without proper prescriptions.
But even if a state medical board finds and suspends a doctor for improper prescriptions, the Web site operator often just hires a replacement, federation officials said. They said some of the doctors who agree to work online are in financial trouble. Others are near retirement age and are apparently willing to risk losing their license.
The work can be lucrative. The online doctor and Web site typically split a “medical consultation fee” that can run from $25 to $75. Doctors can make thousands of dollars a day. There’s also a “prescription handling fee” of about $10 to $25, which is split between the Web site operator and the pharmacy that ships the drugs.
DEA officials hope criminal prosecutions will pack more punch and that a few convictions will deter other violators.
There have been at least 14 arrests and 12 convictions over the past four years for prescribing controlled substances over the Internet, DEA officials said. More than 40 additional investigations are under way.
In 2000 the U.S. General Accounting Office recommended that Congress require all online pharmacies to list their business address on their site.
But that and other reforms foundered.
“I think Congress was really nervous about the possibility of regulating the Internet,” said Hubbard, the FDA official.
“The Internet is kind of sacrosanct. Nobody wants to stymie that new technology.”
