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It is far too easy to buy dangerous narcotics online
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Internet access to dangerous drugs is a serious problem for patients and physicians


Date published: 1/30/2005


IN THE MAD and stressful world of family practice, the patients who cause us the most anguish are those on narcotic pain medicines.

These are the patients you worry about. The vast majority are wholesome, responsible, unfortunate pillars of society, but there are a few who give you pause.

Are you over-prescribing? Are you creating a narcotic addict? Are they taking you for a ride and just getting high--or worse, selling their medicines?

Or are you going to be the next patsy to be pounced on and have your license revoked for over-prescribing? "Big Brother," in the form of the Food and Drug Administration, is always watching.

The whole business is highly regulated. You have to have a medical license. Even physician's assistants--who usually can do pretty much anything a doctor can do--cannot prescribe the stronger narcotics. Some doctors won't prescribe narcotic pain medicines at all. (The literature notes that pain is under-treated, but that's another article.)

The world of cyber-drugs
It therefore blew me away when Sally (as we shall call her; it's not her real name, but she is willing to share her story as a warning to others) blithely told me she was feeding her drug habit with an unlimited supply of hydrocodone.

Sally is a nurse who was on hydrocodone for a back problem, and she developed a drug dependency. She told me she simply ordered as much as she wanted online from several of the billions of Web sites that any Tom, Dick or Harry--or child--can access from their home computer.

"I just filled out a questionnaire,"€ Sally told me, and, lo and behold, a couple of days later there was a little FedEx package with her hydrocodone.

She did note that a supposed doctor called her back after she filled out the questionnaire to check a few details on the medical history. But she didn't tell them she was ordering from several Web sites, and thereby taking up to 30 pills a day.

Sally is now in treatment for her dependency. She points out that "it's easy to lie"€ to get your drugs--a problem not unique to buying drugs online, but which confronts us in face-to-face prescribing, as well.

Patients tell you they're in terrible pain and need more medicine. You have no blood test or X-ray to refute that, so you can get suckered into prescribing ever-bigger doses.

Government tests the waters
As reported in The Free Lance-Star last August, the congressional watchdog organization, the Government Accountability Office, took an interest in this problem and did a little shopping for themselves to test the waters.

They ordered 68 samples of 11 different types of drugs from the U.S., Canada and other countries. Sometimes they had to fill out a questionnaire, sometimes they had to consult with a "cyber doctor," sometimes they had to join a "drug club."

But only in 6 percent of cases did the online pharmacy require a prescription from the patient's doctor. Incidentally, the GAO did not always get the drugs it ordered; sometimes it got different drugs.

It is far too easy to get any of a multitude of potentially harmful/addictive drugs online--benzodiazepine and nerve medicines such as Xanax and Valium are at the top of the list in popularity. But you can get all sorts, including the infamous narcotic OxyContin.

Reported in the press and the medical literature are multiple tragedies as a result of this situation. Eighteen-year-old Californian Ryan Haight bought hydrocodone online and died in his bedroom of an overdose. The pharmacy he bought from was created by a young entrepreneur Clay Fuchs, who netted $8 million in the 15 months it operated. The prescription was "legitimized"€ by ex-con doctor Robert Ogle, who had previously been jailed for illegally prescribing addictive medicines, according to The Washington Post.

Or there's the man who didn't heed his doctor's advice and purchased Viagra online, then died of a heart attack while trying it.

It is impossible to estimate how many addictions and dependencies are fed from the Internet. But anyone with a computer knows about the billions of products online offered for their pain, anxiety, erectile dysfunction, whatever.

There are multiple regulations and numerous bodies overseeing the prescribing of restricted drugs. So how can it be that, as Prevention magazine put it in its own investigation, "anyone can get any drug at any time without a prescription"?

The mercurial Internet
Much blame seems to rest on the mercurial nature of the Internet. Pharmacies can set up very credible-looking Web sites, but then disappear overnight with no trace. Furthermore, Web sites outside the borders of the U.S. create jurisdictional problems.

At a Senate hearing last June to review the findings of the GAO-- a hearing at which Ryan Haight's mother testified--the director of a health-care team, Marcia Cross, responded to a question on how many Internet pharmacy Web sites were safe and honest by noting that because the Internet is "changing constantly," it was not possible to say.

So doesn't that make you feel good?

The National Association of Boards of Pharmacies is offering a voluntary program where pharmacies can be listed as Verified Internet Pharmacy Practice Sites. But, as of the time of the hearing, only a measly 14 of those innumerable sites were certified, which doesn't do much to quell one's fears that there are an awful lot of entrepreneurs and charlatans out there.

In a New York Post article, the online drug issue was described as "an epidemic waiting to happen."€ But there is a need/market for the discounted online prices, what with the cost of drugs being so high, and little old ladies going broke trying to afford them.

That's a point the Democratic senator for Arkansas, Mark Pryor, made at the hearing when claiming Congress needs to enact some kind of regulation--but also needs to consider the underlying issue of what is driving consumers to risk their health by purchasing drugs from unfamiliar resources.

I find the discrepancy--between the fanatical regulation of prescribing by well-intentioned doctors versus the easy availability of life-threatening addictive drugs online--to be just a little bit daft.

One eminently sensible solution suggested at the GAO hearing by Sen. Norman Coleman, chairman of the government affairs permanent subcommittee on investigations, was that Internet sites should not be allowed to dispense without a prescription.

But don't expect a bunch of politicians to do anything too fast or too sensible. The issue was put on hold pending the report from the Department of Health and Human Services Task Force on Drug Importation.

And meanwhile, I'll just keep an eye out for patients who seem to be a little more spaced out than they should be from what I have prescribed for them.

DR. PATRICK NEUSTATTER can be reached at

Date published: 1/30/2005

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COUNTING TO TEN - COUNTING TO TEN - COUNTING TO TEN

As I sat and read this article. I shutter at the absolute unchanging excuses given by docs that under prescribe:

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are you going to be the next patsy to be pounced on and have your license revoked for over-prescribing? "Big Brother," in the form of the Food and Drug Administration, is always watching.

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the billions of Web sites that any Tom, Dick or Harry --or child-- can access from their home computer.

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the patients who cause us the most anguish are those on narcotic pain medicines.......unfortunate pillars of society,

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"May I care for others as I would have them care for me."
D. G. D. MD FACS

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"drug club"

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This is appalling, infact the entire article makes my stomach turn. What is it going to take?? With all of the "miracle drugs" causing such needless suffering, we still read articles such as these....

Arielle

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