A Pharmaceutical Candy Store: Internet Offers Unregulated Access to Dangerous Drugs

By Hugh C. McBride

Over the past decade, the rise of the online economy has had a significant impact in a number of industries. To cite just a few examples, the Internet has created new levels of access and convenience when it comes to buying books, finding new music, and auctioning off unwanted items.

It has also made it much easier to abuse certain types of drugs.

No Prescriptions, Big Problems

Substance abuse was a cause for concern long before computer networks (or, for that matter, computers themselves) came into being. But online drug retailers have made it exceedingly simple for individuals to purchase prescription medications with nothing more than a computer and a credit card.

Researchers with Columbia University have documented the ease with which abusers of prescription medications can purchase the drugs they desire online, while a study by The European Alliance for Access to Safe Medicines (EAASM) has raised alarms over the quality (or lack thereof) of drugs that are bought over the Internet.

According to a July 9, 2008 press release by The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 85 percent of websites that sell controlled, addictive drugs such as OxyContin, Ritalin, Xanax, and Vicodin do not require consumers to present prescriptions.

Adding to the risks associated with unsupervised access to prescription medications is that drugs purchased online may be of dubious quality. In its July 1 article on the EAASM study, Britain’s Daily Telegraph newspaper reported that 62 percent of drugs that researchers purchased online – including medicines that were supposed to treat heart and lung diseases, mental health conditions, and other neurological disorders – were “fake or substandard.”

“Consumers are susceptible to fake medicines which could harm their health, and in extreme cases be deadly,” EAASM chairman Jim Thompson told Rebecca Smith, the Telegraph’smedical editor. “The EAASM calls on all stakeholders including search engines, credit card companies, shipping companies, patient groups and regulators, to take action and halt this dangerous trend.”

Dangerous Drugs, Easy Access

“You’ve Got Drugs V: Prescription Drug Pushers on the Internet,” CASA’s fifth annual report on the state of the online drug market, featured the following findings:

  • The U.S. Drug Enforcement Agency estimates that 11 percent of prescriptions filled by traditional brick-and-mortar pharmacies in 2007 were for controlled substances, while 80 percent of online drug purchases in the same year involved controlled medications.
  • Of the few online pharmacies that require prescriptions, half permitted the prescription to be faxed, which makes it easier for buyers to submit fraudulent documentation.
  • Among the sites that did not require prescriptions to purchase controlled medications, 42 percent stated that no prescription was needed, and 45 percent offered online consultations, a highly disreputable means of determining a person’s medical need for a drug.
  • Benzodiazepines (the category of drugs to which Xanax and Valium belong) continue to be the most frequently offered drugs for sale, with 90 percent of sites selling them.
  • Opioids (for example, Vicodin and OxyContin) are available at 57 percent of sites involved in the study, and stimulants such as the popular ADHD drugs Ritalin and Adderall have a 27 percent availability rate.

With online retailers offering such a wide range of dangerous drugs in a barely regulated marketplace that is easily accessible to individuals of almost any age, the CASA report referred to the Internet as “a pharmaceutical candy store.”

Little Hope, Great Concern

There was a glimmer of hope in the CASA report, with researchers finding a significant decrease in the number of sites that advertised or sold prescription drugs. In the first three months of 2008, CASA researchers counted 365 drug-sale sites, 216 fewer than were found during the same period the previous year.

But the decline in illicit sites was not mirrored by an increase in regulated online sources. Only two websites in the 2008 study were found to have been certified by the National Association of Boards of Pharmacy – the same number of verified sites that existed in 2007.

Joseph Califano, the former U.S. Secretary of Health, Education and Welfare who now serves as CASA’s chairman, made it clear that he found little to be optimistic about regarding drug sales via the Internet. “Anyone of any age can obtain dangerous and addictive prescription drugs with the click of a mouse,” Califano said in the release that announced the study’s results. “This problem is not going away.”

With controlled substances that pose considerable risk for addiction and abuse accounting for the vast majority of online drug purchases, health care professionals and other concerned individuals have joined the EAASM and CASA in calling for tighter regulations on the operation of Internet pharmacies.

In an article that appeared in the July 14, 2008 edition of The Daily Iowan, the paper’s editorial board advocated on behalf of increased federal legislation to control the online sale of prescription drugs:

Only about half of all states have a program that is designed to regulate online pharmaceutical sales. That is not enough. The government should impose laws on every state, making the online sale of any drug without proper documentation and necessary prescription illegal. …
The doctor-patient relationship and medical evaluations were established to protect our society from over-medicating, abuse, and self-administration of dangerous drugs and to ensure the authenticity of medications. The open-door policy of the Internet sites is one that the government needs to close for good.

In April 2008, the U.S. Senate passed legislation designed to control the trafficking of controlled prescription drugs over the Internet, and a House subcommittee held a hearing on the measure in June, though no date has yet been announced for a vote that would send the bill to the president.  

For Joseph Califano, whose organization has also called upon private corporations, public bodies, and international organizations to join the fight against illicit online drug markets, any wait is too great. “Further delays cannot be justified,” the CASA president said, “since these rogue Internet sites put a drug dealer in any home or college dorm room with a computer or laptop.”