RX SOUGHT FOR ROGUE PHARMACIES

CHARLESTON, W.VA. - Drug shipments from illegal online pharmacies
were once so frequent in Appalachia that delivery companies had to
add trucks to their routes.

Police have cracked down on such deliveries but are confronted by a
booming global network of so-called rogue pharmacies operating online.

For people addicted to prescription medications such as the
painkiller hydrocodone - sold mostly as Vicodin - the days of "doctor
shopping" are over as long as they have Internet access. With the
help of unscrupulous doctors and pharmacists, hundreds of Web sites
dispense prescription narcotics to customers in exchange for nothing
more than a credit card number.

Even as law enforcement agencies and state governments respond, the
number of rogue pharmacies continues to grow, filling hundreds of
prescriptions a day, according to a recent study by the National
Center on Addiction and Substance Abuse at Columbia University.

The Drug Enforcement Administration, which reported the additional
parcel delivery trucks in southeastern Kentucky, says about 95
percent of products sold by online pharmacies are controlled
substances. By comparison, controlled substances amount to roughly 11
percent of the dosages dispensed by legitimate pharmacies.

The DEA found that 34 rogue pharmacies dispensed more than 98.5
million dosage units of hydrocodone products in 2006.

Pharmacist Don Perdue has seen customers who run out of prescription
refills turn to illegal online pharmacies.

"This is a major problem," said Perdue, chairman of the West Virginia
House of Delegates' Health and Human Resources Committee, which wants
to see federal law changed to make it easier to shut down illicit pharmacies.

Congress is considering legislation that would clarify federal law on
Internet pharmacies and increase penalties for selling
pharmaceuticals to minors. Targeting Needy Doctors, Pharmacies

Testifying before the Senate Judiciary Committee in May, Joseph
Rannazzisi, deputy assistant director of the DEA's Office of
Diversion Control, described how rogue pharmacies usually work.

The Web sites approach doctors, often those who are in debt or
retired and are seeking extra income. The doctors write prescriptions
after they review online questionnaires filled out by customers. The
doctors are usually paid between $10 and $25 for each prescription.

The sites approach small pharmacies and persuade them to fill the
prescription and ship the pharmaceuticals to the customers. The Web
sites target pharmacies struggling to make ends meet and usually pay
an additional fee on top of the cost of the medication.

Prescription drugs can legally be ordered online, but rogue
pharmacies ignore the rules that legitimate pharmacies follow, such
as requiring a doctor-patient relationship and getting a
certification from state boards.

The difference between legitimate and rogue pharmacies can be
confusing. To make the distinction clearer, the National Association
of Boards of Pharmacy has created a voluntary verification process
for online pharmacies to establish that they comply with the law and
ship prescriptions only to patients who have been examined by
doctors. So far, 13 sites have received verification, including those
by Walgreen Co. and CVS Caremark Corp.

Rogue Sites May Number In Thousands

In May, the National Center on Addiction and Substance Abuse
identified 581 Web sites that offer controlled prescription drugs,
compared with 492 in 2004. Both the center and the DEA say it's
impossible to know how many such sites there are, with estimates
ranging from a few hundred to more than 1,400.

"These Web sites come and go very quickly," said Susan Foster, vice
president of policy research and analysis at the center. "They could
be up one day and operating under a different URL the next day."

Most of the sites identified by the center were so-called portal
sites, which don't directly sell drugs. They lead browsers to anchor
sites, where the drugs are sold. The study identified 187 anchor
sites. Of those, 157 did not require a prescription.

Experts warn that the sites are dangerous not only because they can
be used to feed addictions, but also because customers often don't
know what they're getting. Ninety-one of the anchor sites identified
by the center were outside the United States, where there are often
different safety standards for medicine.

"You have no idea what you're getting from these places," DEA
spokeswoman Rogene Waite said. "It's just a very dangerous business."

Linda Surks of South Brunswick, N.J., knows better than most how
dangerous rogue pharmacies can be.

She lost her 19-year-old son, Jason, three years ago when he
overdosed on prescription medication he ordered from a Web pharmacy
based in Mexico. His family had no idea he had been taking the drugs,
since he didn't have prescriptions.

"One of the first questions they asked us in the emergency room was
whether he was on any medications, and we said he wasn't," Surks said.