NEW BILL TARGETS ROGUE DRUGGISTS ON THE INTERNET

President Bush is set to sign legislation that will help the federal
government crack down on hundreds of rogue Internet pharmacies that
peddle controlled substances like the painkiller Vicodin or the
stimulant Ritalin.

The bill reflects growing concern among parents and public-health
experts that certain online pharmacies enable almost anyone to
purchase drugs with a few mouse clicks and without seeing a doctor or
getting a valid prescription. Experts believe the Web sites are
fueling an increase in the abuse of prescription drugs, especially
among teenagers.

The legislation, approved by Congress last month, aims to make it
harder for people to obtain the drugs by prohibiting online
pharmacies from dispensing medications to anyone without a valid
prescription from a doctor who has examined the purchaser in person
at least once. It would have little effect on legal online
pharmacies, such as drugstore.com and the sites of pharmacy chains
Walgreen Co. and CVS Caremark Corp. that already impose such rules on
their customers.

Regulators say the new law is intended in part to strengthen the
federal government's ability to enforce existing statutes and make
clear how they apply to the Internet. "This is really making explicit
what has been implicit," said Sen. Dianne Feinstein, a California
Democrat and the bill's lead sponsor in the Senate. "We've tried to
close this loophole by essentially addressing this problem of
controlled substances being sold without any medical oversight or
prescription."

The bill has limitations, however. For one, it's not aimed at online
pharmacies based outside the country. Also, the bill also doesn't
address non-controlled prescription drugs, such as the
erectile-dysfunction drugs Viagra and Cialis, hair-loss drug
Propecia, painkiller Celebrex and muscle relaxant Soma that are
popular on rogue sites. Finally, the bill does not create new
requirements for Internet search engines, credit-card companies or
package-delivery concerns whose services are used in online pharmacy
transactions.

Abuse of prescription medicines is beginning to rival that of illegal
drugs as a public health worry. From 1992 to 2006, the number of
people who admitted abusing controlled prescription drugs doubled to
15.8 million, according to the National Center on Addiction and
Substance Abuse at Columbia University. That is more than the
combined number of people who reported abusing cocaine,
hallucinogens, inhalants and heroin.

Teenagers are especially vulnerable. In 2006, 2.2 million teens
between ages 12 and 17 admitted abusing a prescription drug in the
past year. While the role of rogue online pharmacies is hard to
quantify, Joseph Califano, president of the center at Columbia, says
they are a "significant" part of the problem, in part because college
students can get online orders sent to their mailboxes without
parents' knowledge. Teenagers also get drugs out of their parents'
medicine cabinets, he says.

The Drug Enforcement Administration says that a relatively small
percentage of people get controlled drugs illegally over the
Internet, but that they frequently get them in large quantities --
100 to 120 pills at a time, compared to just a handful from friends
or pilfered from pill bottles at home. The DEA also believes these
pharmacies are an "upstream" source of the drugs, meaning they sell
them to individuals who then deal them to others. Potential for Abuse

Controlled substances are policed by the DEA because of their
potential to be abused or lead to addiction. Those popular on the
Internet include stimulants such as Adderall and Ritalin, painkillers
such as Vicodin and OxyContin, depressants such as Xanax and Valium,
and the weight-loss drug phentermine.

Pharmacy Web sites commonly offer questionnaires as the primary
hurdle for getting the drugs, and often steer patients toward answers
that provide medical justification of a prescription for whatever
drug they are seeking, says Carmen Catizone, executive director of
the National Association of Boards of Pharmacy, an umbrella group of
state pharmacy boards. Some also employ doctors who review the
questionnaires and approve hundreds of prescriptions per day, he
says, adding that these doctors are commonly paid per prescription approved.

In addition to insisting on a valid prescription from a doctor who
has examined the patient in person at least once (with certain
exceptions for telemedicine), the new legislation requires pharmacies
to specify in their registrations with the DEA if they're selling
controlled substances online, and to place clear language on their
home pages that they comply with certain of the bill's provisions.

They also must list information, including names, addresses and
contact information for the pharmacies and pharmacists associated
with the sites, and doctors affiliated with the sites. Prison
sentences for illegally distributing many controlled substances are increased.

Patrick Egan, a partner at the Philadelphia law firm Fox Rothschild
LLP who has defended Internet pharmacies, noted that it's hard to
regulate operations based in other countries. Moreover, Mr. Egan, who
provided congressional testimony opposing the bill, said in an
interview that there needs to be "meaningful discussion about whether
this particular model for delivery of drugs might have some
usefulness in our society." He cited instances where online
pharmacies help people who can't afford to see a doctor or live in
remote areas.

Several states have beefed up their own laws to crack down on online
pharmacies. For instance, Arkansas now prohibits Internet sales of
prescription drugs without a doctor having physically examined a
patient at least once. However, "It is very difficult for us to do
something to someone out of state," said John Kirtley, assistant
director of the Arkansas State Board of Pharmacy. A federal law "is
going to put more of an onus on them, from a nationwide level, to do
something about it." DEA Crackdown

The DEA has already shut down a number of online pharmacies, and has
also clamped down on practices of major distributors of prescription
drugs. Last week, drug distributor Cardinal Health Inc. said it had
entered a $34 million settlement with the DEA and seven U.S.
attorneys' offices over allegations it had failed to report to the
DEA suspicious orders of hydrocodone, a main ingredient in Vicodin,
it distributed to pharmacies that filled prescriptions originating
from rogue pharmacy Web sites.

Cardinal spokesman Troy Kirkpatrick said the company, which did not
admit wrongdoing, has beefed up a system to catch such transactions
by flagging unusually large orders of controlled substances from
pharmacies and reporting suspicious orders to the DEA and state
boards of pharmacy. The company is training employees to be more
familiar with their customers' buying habits so they can catch
behavior that's out of character, Mr. Kirkpatrick said.

Another major distributor, McKesson Corp., in May entered a $13
million settlement with the federal government over similar
allegations. The company denied wrongdoing.

The National Association of Chain Drug Stores, a trade group whose
members include Walgreen and CVS, supports the bill. Rogue sites
"were sullying the reputation of the entire industry," said Paul
Kelly, vice president of federal government affairs for the group.
Drugstore.com, which also supports the bill, said it would not
require the company to make significant changes to the way its site
operates, beyond adding some disclosures to the home page.

The National Association of Boards of Pharmacy runs a program to
accredit online pharmacies as "Verified Internet Pharmacy
PracticeSites," or VIPPS, and lists them at www.nabp.net. NABP also
lists "not recommended" sites, describing them as those that appear
to be out of compliance with laws or NABP standards.

[Sidebar]

RED FLAGS

* Does not require a bona-fide prescription issued by your personal physician.

* Does not ask the name, address or phone number of your current physician.

* Advises you about the law and why it's permissible to obtain
controlled substances from foreign countries via the Internet.

* Doesn't take insurance and requires all payments to be made with a
credit card, often only certain cards.

* Limited number of drugs for sale.

* Advises you to have the drugs sent to a post office box or other
location to avoid detection.

* Does not allow a customer to continue unless the "right"
information is entered into a questionnaire, such as a height and
weight associated with need for a weight-loss drug.

Source: Drug Enforcement Administration