Illegal Online Pharmacies
Perhaps the most potentially dangerous and increasingly used method for the diversion of controlled pharmaceuticals is through the Internet. As the number of Americans with Internet access has increased, so too have opportunities for individuals to acquire controlled substance prescription drugs over the Internet. There are strong societal benefits to allowing individuals with a valid prescription to get their prescriptions over the Internet, as long as the pharmacy that fills these prescriptions is a legitimate one and there is a legitimate doctor-patient relationship. This may be helpful in rural areas or for individuals who are homebound due to illness or other factors. However, the anonymity of the Internet, and the proliferation of websites that facilitate illicit transactions in controlled substance pharmaceutical drugs, have given drug abusers the ability to circumvent both the law and sound medical practice.
There are legitimate pharmacies that provide services over the Internet and that operate well within the bounds of both the law and sound medical practice. The National Association of Boards of Pharmacy has established a registry of pharmacies that operate online and meet certain criteria, including compliance with licensing and inspection requirements of their state and each state to which they dispense pharmaceuticals.
By contrast, other websites used by Internet facilitators will often advertise themselves as pharmacies, but they do not operate in the same manner as brick-and-mortar pharmacies. Many of these websites advertise controlled substances without a prescription, and none include an in-person medical examination from a licensed physician.
Of particular concern is the cursory and abbreviated nature of the medical interaction. Often, if there is any interaction with a medical professional at all, the Internet facilitator will provide only a cursory doctor consultation by computer or telephone for customers. This brief interaction is not meant to elicit meaningful health information, and is generally done by way of a “questionnaire” filled out by the “patient” without any face-to-face meeting between the doctor and the patient. Without this face-to-face interaction, it is not possible for the doctor writing the prescription, who has never met the patient, to verify the information provided by the individual and assess legitimate medical need. This is particularly troubling in the context of youth drug abuse. Unlike when the patient visits the doctor, a minor can easily log onto a website and provide an inaccurate age.
Doctors, who are often paid by the number of prescriptions they sign in these situations, have no incentive to spend time seeking additional patient information. Law enforcement has discovered website-affiliated doctors who sign hundreds or thousands of prescriptions a day. After receiving the prescription from the doctor, the facilitator will then submit the prescription to a cooperating pharmacy. Because there is often no identifying information on these rogue websites, it is very difficult for law enforcement to track any of the individuals behind them.
The Administration is using all available tools to go after the operators of these rogue Internet-facilitator websites. We are conducting investigations and working to intercept controlled substance prescriptions illegally sent into the United States through the mail system. For example, the DEA’s Internet investigation unit at its Special Operations Division continues to coordinate Internet cases, and the DEA has issued a number of immediate suspensions of the DEA registrations of doctors and pharmacies operating illegally via the Internet. The Department of Justice has prosecuted doctors and pharmacies who illegally distribute via the Internet.
The tangible aspects of manufacturing, distributing, prescribing, and dispensing pharmaceutical controlled substances remain squarely under the jurisdiction of the CSA. Any legitimate transaction over the Internet must be in compliance with these existing laws.
Additional clarification of the roles and responsibilities for professionals seeking to use the Internet to meet the needs of clients would not only allow us to more readily identify legitimate online pharmacies and persons operating and promoting them, but it would also assist in gathering information pointing to abuse patterns. Such clarification would also help us investigate drug traffickers hiding behind the façade of an otherwise legitimate practice.
Additionally, there exists no statutory definition of a valid "doctor/patient" relationship. Finally, the penalties associated with the illegal sale of Schedule III-V substances, which are those most commonly sold controlled substances over the Internet, are not as significant as may be warranted.
States can play a significant role in addressing the problem of online facilitators, particularly through PDMPs. As part of the Administration’s work with states regarding PDMPs over the next several years, states will be encouraged to consider addressing, either by statute, regulation, or interstate agreement, a number of scenarios that primarily involve pharmacies dispensing or delivering controlled substance prescription drugs to patients across state lines. To be effective, laws must be updated to reflect the changing ways people live and in which business is conducted.
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Internet Citation: Statement of Joseph T. Rannazzisi, Deputy Administrator, Office of Diversion Control, Drug Enforcement Administration Before the House Government Reform Committee Regarding "Prescription Drug Abuse: What is Being Done to Address This New Drug Epidemic?"
