Is the next battlefield in the US federal government’s War on Drugs your Web browser?
More than 15 million Americans acknowledge they have purchased prescriptions through recognized online drug stores such as cvs.com and drugstore.com that work with a standard prescription authorized and submitted by your personal physician. Yet these pharmacies aren’t the only ones in cyberspace.
The sale of unlicensed prescription drug sales online has surpassed more than $1 billion per year. Since it’s doubtful that all drug sale venues are included in such results, the actual number could be far higher. Some experts suggest that one billion figure only scratches the surface at a time when it’s never been easier to buy drugs not everyone should take.
On any day of the week, hundreds of sites are available that allow you to bypass the normal regulations in place by which to obtain potent and potentially life-threatening medications – from serious weight loss medications to antidepressants and anti-anxiety drugs and beyond to Schedule II and Schedule III restricted narcotic pain relievers – through a process so streamlined that your own doctor won’t even be involved.
Here’s the drill. You go to one of these sites, you pick out your preferred drug(s) and drop it into your shopping cart, you provide some information – sometimes a full questionnaire including the contact information for your doctor to verify your medical condition and sometimes much less (some won’t ask your birth date) – then give your payment details, click, and wait anywhere from 24 hours to 4-6 weeks for your drugs to arrive.
How legal is all of this?
The answer: not very. Federal law, for example, prohibits the importation of narcotics and does not recognize as valid a prescription provided solely on the basis of an online questionnaire. Without a valid prescription, it’s illegal to possess something like OxyContin, Percodan, or Vicodin.
In 2003, the US Food and Drug Administration (FDA) and the Drug Enforcement Agency (DEA) set up a joint task force to deal with this. The FDA provides an online form to report sites you believe are open illegally (http://www.fda.gov/oc/buyonline/buyonlineform.htm). However, concern exists that the FDA only has the manpower to go after just so many shady online vendors and with little recourse to combat the flood of sites that appear to be based in the US but are actually businesses established in Trinidad, Argentina, India, and the Netherlands.
You would not realize this, however, through much of the advertising for such sites, which is becoming far more aggressive and blatant, too. Boasting phrases such as “FDA Approved” and “Discrete and legal”, unsolicited prescription drug ads account for between 25 and 60% of all “spam” sent through Email to dozens of people interviewed. The ads suggest you need a muscle relaxant to enjoy the weekend or Xanax (a commonly abused anti-anxiety agent) to “party hard”. At a time when the volume of antibiotics prescribed to people is becoming a global concern due to the rise of drug-resistant bacteria and disease, some sites invite consumers to buy Amoxicillin and Cipro (the drug used to treat those in the anthrax attack on the US in late 2001) to keep on hand.
Beyond strict legality of possession, there are other issues with unlicensed online drug vendors. Despite claims of deep discounts, consumers often pay more for their prescriptions online through such sites than they would at the neighborhood drug store or through a legal online vendor. Viagra, for example, costs between $8-10 a tablet through normal vendors but the price may increase to $15-25 per pill bought otherwise. Vicodin sells for about 70 cents per pill through many regular drug stores, but costs $3-6 per pill when purchased through a “discrete and private” online pharmacy.
In some of the few documented cases that have been prosecuted in the last few years, it was determined that some sites pay physicians based on the number of prescriptions they approve and write. Under this service model, doctors may receive anywhere from $2-10 or more per ‘script approval, which means they get nothing for patients whom they review and decline, turning proper ethics into a financial disincentive.
As a result, consumers tend to be caught in the middle of a high-stakes game between their own need (real or perceived), sites trying to make money, and a federal enforcement system that seems to be overwhelmed. Unless they shop carefully, only using known valid sites or those displaying the VIPPS certification seal that means the site passes the voluntary certification requirements of the National Associations of Boards of Pharmacy, they may be breaking the law. They also may receive drugs that are made in another country to different specifications, which may be expired, and may not be accompanied by a valid prescription. Such drugs may also not be the best choice for treating their condition. Many thousands of others will receive a fake drug, one little more than starch, water, and food coloring.
However, with prescription drug abuse on the rise, some consumers may be willing to run the risk. According to government studies, more than 1 in 5 young adults between the ages of 18 and 25 routinely abuse prescription pain killers, for example, and the use of narcotics, antidepressants, and anti-anxiety medications has skyrocketed since 2001. Physicians, too, report more and more pressure from the feds to exercise great care in the ordering of medication, which may mean more patients look beyond their doctors for help for chronic pain and serious weight loss.