Internet Trafficking of Controlled Prescription Drugs Remains Extensive

Marlene Busko

July 18, 2008

July 18, 2008 — Prescription opioids, stimulants, and central nervous system (CNS) depressants are widely available online, and 85% of Web sites selling these controlled drugs do not require a prescription, according to the latest report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University, in New York.

Lethal Combinations

"These are not innocent medications," Petros Levounis, MD, director of the Addiction Institute of New York at St. Luke's and Roosevelt Hospitals, who was not involved with the report, commented to Medscape Psychiatry. They are not only quite addictive, but they can also be lethal, especially in combination, he added, noting that several media celebrities have died over the past few years from combinations of controlled substances.

"The problem is huge," he said, referring to Internet sites that do not require prescriptions when they sell these controlled prescription drugs. "There are hardly any controls about [controlled substances], and anybody who has Internet access and can use a search engine can easily find whatever medication he or she wants from the Internet," he added.

On the positive side, many patients surf the net and find out about adverse effects and are more informed than ever before, he added. On the negative side, some patients choose to obtain these drugs from rogue pharmacies (that is, pharmacies that do not obey the law, unlike legitimate online pharmacies that dispense drugs only upon receipt of valid prescriptions).

A psychiatrist might write a prescription for a short course of a benzodiazepine thinking that the patient will have access only to this amount of medication, but the patient — especially a younger, Internet-savvy patient — might opt to obtain more of this drug through the Internet, which can be done very easily, he said.

No Controls to Block Drug Sales to Children

"Anyone of any age can obtain dangerous and addictive prescription drugs with the click of a mouse," said Joseph A. Califano Jr., CASA's founding chair and president and former US Secretary of Health, Education, and Welfare, in a press release.

He added that he applauds federal and state actions to reduce trafficking and efforts by major credit card companies and PayPal to shut down illegal access to these drugs.

Referring to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 to control Internet trafficking of controlled prescription drugs, which was passed by the Senate in April, he said: "We congratulate the Senate, and urge the House to take prompt action and the president to sign the bill into law."

CASA Identifies 365 Web Sites That Advertise or Sell Prescription Drugs

CASA published its first report in 2004 and has updated the analysis every year since then.

This fifth report, "You've Got Drugs V: Prescription Drug Pushers Over the Internet," identified 206 sites advertising drugs (portal sites, which refer people to other sites that actually sell the drugs) and 159 sites selling the drugs (anchor sites). Only 2 of the 365 Web sites were certified by the National Association of Boards of Pharmacy as Verified Internet Pharmacy Practice Sites.

The online pharmacy that fills the prescription and the portal and anchor sites may be located in different parts of the world, the report notes.

Internet Sites Advertising or Selling Controlled Prescription Drugs, 2004–2008, Number (%)

Internet Site Type 2004 2005 2006 2007 2008
Selling 154 (31) 154 (39) 174 (51) 187 (32) 159 (44)
Advertising 338 (69) 242 (61) 168 (49) 394 (68) 206 (56)
Total 492 396 342 581 365

The decline in the number of Web sites advertising or selling controlled prescription drugs from 581 in 2007 to 365 in 2008 may reflect efforts of federal and state agencies and financial institutes, said Mr. Califano. Nevertheless, "this problem is not going away," he added, noting that widespread availability continues.

A maximum of 11% of prescriptions filled by traditional pharmacies are for controlled substances, but in 2006, 95% of prescriptions filled by Internet pharmacies were for controlled substances, and this is 1 way that the Drug Enforcement Agency identifies rogue pharmacies, the report authors note.

Each analysis by CASA was conducted in the first quarter of the year and involved 210 hours of time devoted to searching the Web.

As in previous years, benzodiazepines were the most frequently offered class of controlled prescription drugs (offered by 90% of anchor sites), followed by opioids (57% of sites) and stimulants (27% of sites).

2008 Internet Availability of Controlled Prescription Drugs by Class

Drug Class Most Frequently Offered Drugs Number (%) of Web Sites Selling This Class of Drugs
Benzodiazepines Alprazolam (Xanax), diazepam (Valium) 143 (90%)
Opioids Hydrocodone (Vicodin, Lortab), codeine, oxycodone (Percocet), propoxyphene (Darvocet, Darvon) 91 (57%)
Stimulants Methylphenidate (Ritalin, Concerta), dextroamphetamine (Adderall, Dexedrine) 43 (27%)
Barbiturates Mephobarbital (Mebaral), secobarbital(Seconal) 3 (2%)

Of the sites not requiring prescriptions, 42% explicitly stated no prescription was needed, 45% offered an "online consultation," and 13% made no mention of a prescription. Of the few sites that require prescriptions, half permit them to be faxed, which allows for opportunity for fraud.

The report concludes by making several recommendations, including that Internet search engines block all advertisements for controlled prescription drugs that do not come from licensed, certified online pharmacies and that the United States negotiate treaties with foreign governments to help shut down Internet trafficking of controlled prescription drugs.

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