SPECIAL REPORT: TEENS & DRUGS

ROGUE ONLINE PHARMACIES EASILY PROVIDE PRESCRIPTION NARCOTICS

Many sites use 'consulting physicians'

Prescription pills are a couple of mouse clicks away.

Anyone with an e-mail account endures the steady stream of unsolicited
advertisements promising cheaper prescription drugs.

It's annoying. It's sinister, too.

The Internet offers drug dealers and drug abusers vast opportunities to buy
prescription medications without seeing a doctor.

Hundreds of Web sites peddle prescription pills, promising customers
increased privacy and cheaper prices for controlled substances such as
Viagra, Vicodin, Xanax and Lortab.

Local law enforcement officials say shopping around for unscrupulous doctors
is the most common method of obtaining prescription medications, but the
availability of drugs on the Internet is a growing concern that has drawn
the attention of Congress.

William Hubbard, associate commissioner for policy and planning for the U.S.
Food and Drug Administration, testified before a congressional committee in
March about the prevalence and dangers of Internet drug sales.

"More than many other types of electronic commerce, the unauthorized sale of
prescription and unapproved drugs poses a potential threat to the health and
safety of consumers," he said.

Following a Sun Herald Drug Task Force meeting in which local high school
students said prescription drug abuse is common among their peers, a
reporter decided to test the online drug market.

Purchasing drugs on the Internet is alarmingly easy. All it took was a few
minutes, a valid credit card and an Internet connection.

The reporter visited dozens of sites before purchasing 30 1 milligram
tablets of alprazolam, the generic version of the anti-anxiety drug Xanax.

The transaction included a questionnaire that asked for basic medical
information and a credit card number. The Web site stated the questionnaire
would be reviewed by a physician, who would determine whether to prescribe
the pills.

Many of the online pharmacies the reporter visited included photographs of
smiling people wearing stethoscopes and white lab coats, suggesting a
doctor's involvement.

Employing "consulting physicians" to review a customer's medical information
and prescribe medications without a face-to-face examination exploits
loopholes in state and federal laws, many of which aren't equipped to
regulate prescribing drugs on the Internet.

Leland "Mac" McDivitt, the director of the state Board of Pharmacy, said the
process is highly vulnerable to deception.

"If somebody is addicted to diet pills and weighs 90 pounds, they're not
going to be honest about it. They'll say they weigh 190 pounds," McDivitt
said. "There is no way to monitor that. There is absolutely no way to
administer honesty online."

A handful of states have amended their laws to regulate online prescribing.
Mississippi is not among them.

The American Medical Association and the U.S. Food and Drug Administration
frown upon doctors who prescribe medications over the Internet based on a
questionnaire.

'Purposely misleading' information

In his testimony to Congress, Hubbard described a case in Arizona in which
operators of a network of Internet pharmacies that charged fees for
physician consultations were handed a 198-count federal indictment.

"The indictment alleges that in the overwhelming majority of applications,
no medical reviews, consultations or physical examinations by a physician
took place before drugs were shipped to customers," Hubbard said.

He said the defendants in the case distributed 48,816 new orders for
prescriptions and 41,817 refills, generating sales of more than $28 million.

In a statement given to a congressional committee in March, Carmen Catizone,
director of the National Association of Boards of Pharmacy, said the Web
sites often seek to dupe customers into violating the law.

"The information posted on these rogue sites is often purposely misleading
and, in some cases, purposely fraudulent so as to lure consumers to these
sites and engage them in the illegal purchase and distribution of drugs," he
said.

Catizone's statement certainly applied to The Sun Herald reporter's online
purchase.

About two weeks after placing its order, the newspaper received a white
envelope containing 30 white tablets taped inside a blue folder. Information
included in the package identified the pills as Zopax, a version of
alprazolam produced in South Africa. The circular tablets appeared identical
to sample pills pictured on the drug company's Web site.

Robin Passman, a licensed pharmacist in Gulfport, examined the pills at the
newspaper's request.

"It's hard to say what we're looking at here," he said. "The question is,
'Do we have a real product?' These could be lactose tablets for all we
know," Passman said.

"One, did it come from a pharmacy?" Passman said. "If it didn't come from a
pharmacy, it could've been made in some guy's back yard... You don't know
what conditions it's been stored under. If it was what is says it is, it
might not be now."

The tablets were expensive, whatever they are. The newspaper bought them for
$125, far more than prices listed on legitimate online pharmacies.

Sixty 1 milligram tablets of Xanax cost $99.99 on Walgreens.com. The CVS
online pharmacy sells 90 1 milligram tablets of alprazolam for $20.89.

Legitimate online pharmacies

The NABP estimates there are 500 independent Web sites offering to
distribute prescription drugs. In his congressional testimony, Catizone
called the sites well-financed and well-organized operations.

There has been a sharp increase in the number of foreign-based sites
offering Americans lower-priced drugs from Canada and other countries.

The FDA monitors the Internet and prosecutes the operators of rogue sites,
but it is a difficult task as the location and appearance of Web pages are
easily changed.

There are legitimate online pharmacies that do not prescribe medications
over the Internet and offer consumers convenience and privacy. The NABP has
a program to certify legitimate Web sites.

Randy Johnson, spokesman for the Mississippi Bureau of Narcotics, said it's
hard to know how many people in the area are using the Internet to purchase
drugs. "I'm sure it's happening," he said. "I couldn't say how much."

Capt. Pat Pope, director of the narcotics unit for the Gulfport Police
Department, agreed with Johnson.

"We haven't had much experience or much evidence that it is a concern here,"
Pope said. "I'm not naive enough to believe that it's not happening. I'm
sure it's being abused some."

Both Johnson and Pope said the main source of illegal prescription pills in
the area is doctor shopping, where people travel from town to town searching
for physicians who will prescribe them medications.

"They start out in the morning and hit 10 different clinics in the area,"
Johnson said. "Within 24 hours, they've received 10 to 12 prescriptions."

Be cautious

The FDA offers these tips to consumers buying health products online:

. Check with the National Association of Boards of Pharmacy to determine if
the site is a licensed pharmacy in good standing (visit the Web site at
www.napb.net or call 847-698-6227).

. Don't buy from sites that offer to prescribe a prescription drug for the
first time without a physical exam, sell a prescription drug without a
prescription or sell drugs not approved by the FDA.

. Use sites that provide convenient access to a licensed pharmacist who can
answer your questions.

. Avoid sites that do not identify with whom you are dealing and do not
provide a U.S. address and phone number to contact if there is a problem.

. Beware of sites that advertise a "new cure" for a serious disorder or a
quick cure-all for a wide range of ailments.

. Be careful of sites that use impressive-sounding technology to disguise a
lack of good science or those that claim the government, the medical
profession or research scientists have conspired to suppress the product.

. Steer clear of sites that include undocumented case histories claiming
"amazing" medical results.

. Talk to your health-care practitioner before using any medication for the
first time.

If you suspect a site is illegal, you can report it to the FDA by using the
online reporting form on the agency's Web site: www.fda.gov.

- - U.S. Food and Drug Administration