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Purchasing pills via Web may not be good for your health
By Melissa Schorr, STAFF WRITER

THEY flood your e-mail inbox, relentlessly tormenting you with tempting offers.

"Vicodin. Xanax. Viagra. Buy now!"

The spam e-mails are trying to entice recipients to click onto their Web sites, where online pharmacies are selling medications with no prescription required, no exam necessary -- and no guarantees of your safety.

While most people delete these messages with an irritated mouse click, many end up becoming victims of scam sites. Others try to beat the system and get medications their doctors won't prescribe.

Some online pharmacies are legitimate, offering great advantages of convenience and privacy. But many flout the law, recklessly prescribing drugs, ripping off consumers with weakened drugs or simply pocketing their money and disappearing into cyberspace.

How to tell the difference?

"We tell patients to stay away from any site that offers medications without a prescription, and not to rely on sites that use a cyberspace consult as the only basis for a relationship," says Carmen Catizone, executive director of the National Association of the Boards of Pharmacy.

Legitimate sites like www.walgreens.com or www.cvs.com require users to mail in a prescription. The sites will call the doctor to verify the information. More of a hassle, sure. But safer.

Other sites, often those linked to a spam e-mail, skirt the boundaries of the law. They dispense prescriptions to patients with no more than a health questionnaire in the place of a proper medical exam.

Educating consumers

To educate consumers about this growing problem, the National Association of the Boards of Pharmacy has created the Verified Internet Pharmacy Practice Sites (VIPPS) program, which certifies online pharmacies that have been screened and inspected. Only about 14 have passed muster, including drugstore.com and familymeds.com.

Those that haven't are countless. A quick survey of Web sites such as medstogo.biz, shopmedsnow.biz and medsonlinefast.biz, advertised by spam e-mails just a few weeks ago, already are gone with the wind.

Most of these sites deviously peddle the legal "embarrassment" drugs -- those dealing with weight loss, hair loss, sexual dysfunction, herpes, acne and birth control. By buying online, you don't have to confess your inadequacies to a physician, alert your mother you're going on the Pill, or tell your lover you've contracted herpes.

Sites smoothtalk customers, claiming to have only licensed physicians on board and saying they offer only medications approved by the Food and Drug Administration. "This is a new concept in health care," they tout, "that affords individuals improved access to physician care."

Peek behind the curtain, and the doctor rubber-stamping your Viagra prescription could be a retired veterinarian in Venezuela, as it turned out in one case, Catizone says.

The sites note that "lifestyle" drugs like Viagra really don't require more than a online consultation -- even though the drug has proved fatal among men with heart conditions taking drugs with nitrates.

No matter how good it sounds, these online pharmacies are blatantly flouting the 2001 California Medical Practice Act, which requires a good-faith medical exam to take place in person or by videoconferencing. A doctor you've established a relationship with can change your prescription without an additional in-office exam, but an online survey doesn't count.

"Sometimes patients think, 'I know what's wrong with me.' But these are dangerous drugs which require prescriptions," says Patricia Harris, executive officer of the California State Board of Pharmacy. "You really need to go to the appropriate channels of having a prescription filled properly."

Physicians who work with these sites are putting their medical licenses in jeopardy, she says.

"The law says we can cite any person who causes or allows prescription drugs to be prescribed without a good-faith medical examination," she added.

Learning the hard way

Local pharmacist James Mark Cohen learned this the hard way. Cohen, proprietor of the Medicine Chest Pharmacy in Hayward, contracted to fill prescriptions for a Web site that used a questionnaire to screen patients.

"I sort of knew, but didn't think it would be an issue," he says. "It wasn't well-defined what (the state pharmacy board) was requiring and that they'd be coming down hard."

Despite his reservations, Cohen signed on, anticipating an increase in sales after being financially crushed by competition from drug store chains and mail order services.

But last June he was cited by the California Board of Pharmacy and slapped with a $1.3 million fine. He eventually settled, paying $195,000 personally and $25,000 on behalf of his pharmacy. He was ordered to write an open letter to fellow pharmacists published in the October issue of the board's newsletter, The Script, warning them to learn from his mistake.

"I wouldn't do it again," he says. "I learned the board is serious about enforcing it."

Some sites go a step further and distribute medications that are technically considered controlled substances, like OxyContin or Vicodin. Patients experiencing pain who can't find a sympathetic doctor or who are abusing pain medications have latched onto these sites as a last resort.

"These are people who could not get a prescription legitimately, so they're willing to pay extra," says Catizone.

Many of these Web sites offering controlled substances operate outside the United States and bring in drugs that are totally unregulated by the FDA, experts say.

At online message boards like overseas-pharmacy-forum.com or doctorandpharmacy.com, patients even swap information on which online pharmacies will rush painkillers -- no questions asked -- and how to find "understanding" doctors.

One such online message is from "Ashez," a 34-year-old California writer who was mountain biking with friends in the Sierra when he suffered a major injury.

Forced to leave his job to nurse his wounds, his insurance ran out, and he couldn't afford doctor's visits or pain meds. Soon he was buying painkillers from online pharmacies.

Offering relief from pain but making it worse

But rather than offering relief, many of these sites simply inflict more pain, when deliveries don't arrive or get confiscated at the U.S. border.

"I have been scammed countless times," he laments on the message board to like-minded sufferers. Like many who post on these boards, Ashez prefers to remain anonymous and declined to be interviewed.

The number of Americans abusing prescription drugs such as pain relievers, stimulants and sedatives rose from 4 million to 6.2 million in the last three years, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

With the proliferation of online pharmacies, it may be easier than ever to feed these addictions.

But self-medicating can be extremely dangerous. James Q. Lewis, 47, a former triathlete from Sacramento, began ordering painkillers on the Internet to treat his aches and pains. Last April, his wife Elizabeth Carr discovered him dead in the living room of an overdose of Darvon, the Washington Post reported.

According to the U.S. Drug Enforcement Administration, buying a controlled substance from a foreign Web site and having it shipped to the United States is against the law, unless you are registered as an importer with the DEA. In addition, Web sites that introduce any non-FDA approved medi-

cation into the United States are breaking the law. Even if the same drug is available here, foreign versions usually do not meet FDA standards.

Although consumers are generally not prosecuted, they are putting their health at risk with a drug that is stronger or weaker than it should be.

"Anytime drugs are not FDA-approved, there are concerns to whether they're pure and truly what you're supposed to be taking," says Harris, from the state pharmacy board. "Medications are dangerous and need the oversight of health professionals. I don't think that's something consumers should be messing around with."