"It's an incredible challenge," says Elizabeth Willis, chief of drug operations in the Drug Enforcement Administration's Office of Diversion Control.
And the underground market for prescription drugs, already enormous, is growing. The National Clearinghouse for Alcohol and Drug Information estimated in a 2001 report that 4 million Americans ages 12 and older had acknowledged misusing prescription drugs. That accounts for 2% to 4% of the population -- a rate of abuse that has quadrupled since 1980. Prescription drug abuse -- typically of painkillers, sedatives and mood-altering drugs -- accounts for one-third of all illicit drug use in the United States.
For The Record
Los Angeles Times Friday December 05, 2003 Home Edition Main News Part A Page 2 National Desk 1 inches; 31 words Type of Material: Correction
Internet pharmacies -- An article in Monday's Health section incorrectly identified Dr. James N. Thompson, president and chief executive of the Federation of State Medical Boards, as Dr. Robert N. Thompson.
For The Record
Los Angeles Times Monday December 08, 2003 Home Edition Health Part F Page 8 Features Desk 0 inches; 31 words Type of Material: Correction
Internet pharmacies -- A story in the same issue incorrectly identified Dr. James N. Thompson, president and chief executive of the Federation of State Medical Boards, as Dr. Robert N. Thompson.
The FDA, which regulates the safety and effectiveness of pharmaceuticals in the United States, has relatively few weapons to control the online sale of prescription drugs. With limited legal jurisdiction over the practices of pharmacies and doctors in the United States and none outside the U.S., the FDA has worked mostly through groups such as the National Assn. of Boards of Pharmacy and the Federation of State Medical Boards.
FDA lacks muscle
FDA officials have warned consumers on the dangers of pharmacy Web sites without evident documentation, and have offered tips (www.fda.gov/oc/buyonline/default.htm) on how to identify legitimate ones. Beyond that, the FDA can do little more than issue "cyber warning letters" to the operators of online pharmacies, informing them that they may be operating unlawfully. The FDA has sent out nearly 200 such letters.
According to Thomas McGinnis, the FDA's director of pharmacy affairs, about 70% of those who have received warnings ignore them and continue to operate. The remaining 30% respond to the FDA, he said, often claiming that they believed their activities were legal. But they often disappear afterward, said McGinnis, who suspects many return to business under different names.
The FDA, largely working with state officials, has opened 372 Internet drug-related criminal investigations and has helped prosecute 142 people involved in the online drug trade (securing 106 convictions). But most officials who track the trade acknowledge that that is a drop in the bucket.
However, the move by online pharmacies into sales of narcotics and amphetamines has delivered law-enforcement officials a more potent lever. When the drugs involved are controlled substances -- drugs considered to have clear potential for abuse and addiction -- the DEA can conduct investigations and press criminal prosecutions across state lines. And when foreign governments cooperate, the federal agency can pursue U.S. lawbreakers abroad.
The DEA also works to identify the physicians writing prescriptions for illegal pharmacies -- often a challenging task, says the agency's Willis. The agency has the authority to pull the physician's license to prescribe controlled substances. Without such prescription-writing powers, the doctor's ability to practice would be very limited.
In 2000, California became one of the first states to adopt a law barring physicians from prescribing drugs without first conducting a physical examination. Currently, all but 20 states have similar prohibitions in place, although not all have the force of law. For the San Diego eye surgeon, it is a mystery as to why men and women in his profession would behave so recklessly. "They're just people in that gray zone who weren't quite good enough to get a job, or who lost [a job] ... people just desperate to find some line of work," he surmised.
Such doctors, Haight believes, are helping to transform the Internet from a rich resource of information and entertainment into a very different and dangerous place, especially for young people. Whereas some parents have found themselves looking through their children's sock drawers when they feared a problem with drug use, today they may also feel compelled to search the computer. "You've got to be suspicious, got to do some parenting," says Haight. "Unfortunately, I found out the hard way."