Pharmacy[ articles | activities | features | links ] Wednesday, December 3, 2003 Internet prescribing is out of controlNEWS-JOURNAL EDITORIAL Possessing 30 OxyContin pills bought on a street corner in Daytona Beach could land you in jail for years. But why bother? You can get the same pills over the Internet – cheaper, safer and without the inconvenient hassle of a felony prosecution. It seems too strange to be true. But it’s not. The Internet is virtually flooded with ads promising potent drugs with no prescription. Clicking on the ads takes you to Web sites where you first pick out the drugs you want, then fill out an online “consultation form.” Within hours, a doctor who’s never seen you will write a prescription. Within a day, you can have the pills delivered to your house. Some of the Web sites are coy. Others – like the ones that flood e-mail inboxes with unsolicited come-ons – are so blatant that many e-mail junk filters now automatically block any message with the word Viagra in the subject line. The general air of sleaze hanging around the Web-based “pill mills” brings the era of the snake-oil salesman to mind. Unfortunately, the medications are usually real drugs that carry a high potential for abuse. Many of the worst offenders are based in Florida. In an investigation published last weekend, the Star-Ledger of Newark, N.J. attempted to order six different medications from Internet pharmacies. The list included phentramine (a diet pill) Valium and four painkillers, including OxyContin, dubbed “poor man’s heroin” for its high abuse potential. All are considered controlled substances under the Food and Drug Administration’s guidelines, and at least two – OxyContin and hydrocodone – are listed under Schedule II, the most restrictive class of drugs that can be sold legally in the U.S. Within weeks, the paper had received five of the six drugs, and lab tests proved the pills were the real deal. That’s five bottles of pills, out of millions dispensed each year over the Internet. Chances are that most of the shipments aren’t going to curious journalists, but to people whose own physicians won’t prescribe them – or who can’t or won’t see a doctor. This kind of self-prescribing is dangerous, even with drugs that would seem to have a low potential for abuse, like Propecia, which treats male-pattern baldness. But patients may not have the information they need to properly evaluate the risks – and a doctor who’s never seen them has no chance to give them the advice they need. The FDA is doing its best to crack down on the pill mills, but it’s obvious that the federal agency is understaffed and overburdened. The best hope for regulation is through the states. And Florida is doing a shamefully lousy job. Last year, the state Legislature considered a bill that would give the state Board of Pharmacy more leverage to go after the pill mills. The bill died, but it should come back next year. The state should also consider ways to discipline doctors who prescribe for patients they’ve never examined or treated. Florida lawmakers rationalized their inaction, saying doctors would just move to another state that didn’t have tougher laws. That’s why Congress should be looking for ways to strengthen the national regulatory framework, writing laws that set minimum standards for doctors and pharmacies and giving the FDA the resources it needs to fight this growing problem. There are ways to do this without impinging on personal privacy or restricting patients’ ability to obtain discounts through legitimate Web sites. But the shady pill mills – which, in many cases, are nothing more than drug dealers on cyber street corners – must be shut down.
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