Steep rise in abuse of legal drugs

"Certainly the Internet has facilitated the average person obtaining controlled substances when they would not have done so," says Elizabeth Willis, chief of drug operations in the Drug Enforcement Administration's Office of Diversion Control. "Most people wouldn't go into their doctor and falsify medical complaints to their doctors, but over the Internet, they don't realize it's illegal, and they can do it anonymously."

Government investigators can only estimate how many online pharmacies exist, in part because the illegitimate ones appear and disappear quickly. The first ones started appearing in abundance in 1999. An investigation done by the General Accounting Office in 2000 found 190 Internet pharmacies operating at the time. Of those, 79 provided drugs without a proper prescription.

It's estimated there are now hundreds of such cyber-pharmacies operating from the US and overseas. Like almost every kind of commerce on the Internet, they've proven to be very difficult to regulate and, for those operating illegally, to prosecute.

In part, that's because no one agency has direct control. The FDA, which regulates medicines, has sent out letters warning some sites they may be acting illegally. But it doesn't have criminal enforcement capabilities.

The Federal Trade Commission, which regulates fraudulent claims, can investigate what are known as "cyber-script mills" and file civil suits, but again, its hands are tied when it comes to criminal complaints.

Even the Drug Enforcement Administration (DEA) is operating with limited resources and capabilities. Of the 4,000 drug agents operating in the field, less than 10 percent are dedicated to tracking the misuse of prescription drugs, which in the agency is called drug diversion. Most of their efforts are dedicated to tracking down what are called the bricks and mortar - the doctors and pharmacists who appear to be over-prescribing or handing out controlled substances at will.

The Internet investigations are intermixed with those cases, and don't have a single unit or investigator dedicated to them. What's more complicated is that these diversion agents have no arrest authority: They have to call on other departments within the DEA.

In 2002, the inspector general of the Justice Department criticized the DEA for not dedicating enough resources to drug diversion. That concern is echoed by experts in the field.

"Very little is being done on the Internet situation," says Michael Montagne, a professor of social pharmacy at the Massachusetts College of Pharmacy and Health Science. "The DEA tries to monitor it, but they're just capturing a fraction of what's coming in over the board."

The DEA currently has several cases pending against cyber-pharmacies, but can't talk about them. It's also been involved in several successful prosecutions, including one known as the Pill Box Pharmacy case. That was a pharmacy in San Antonio that opened a website and began prescribing controlled substances after a two- to three-minute telephone interview with a doctor.

In the 18 months it operated, it sold 9.3 million doses of the generic versions of Valium and the pain reliever Vicidin.

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