Virtual Pushers Target Real Pharmacies

Shoes, sports gear, clothing, groceries are available at the click of a button, but online shopping can become a dangerous addiction.

Using online pharmacies to fill prescription medications has pharmacists worried about more serious addictions -- and about being drawn into the fray.

An updated study released Wednesday by the National Center on Addiction and Substance Abuse at Columbia University has shown that online pharmacies continue to pose public health risks as they traffic prescription drugs to patients.

Although the report showed that the total number of such pharmacies has decreased in the last year due to tighter regulations, Susan Foster, an author of the report, suggested the companies are trying to shift their methods from direct drug delivery to fillable prescriptions to get more cooperation from local pharmacies. But pharmacists are having none of it.

"These Web sites are all illegal," said Jeff Holycross, a pharmacist from Russells Point, Ohio. "If the physician has not given a physical examination to the patient, there is no physician-patient relationship.

"Therefore, any prescription written in this manner is not a valid prescription."

The center's report found that 365 Web sites currently advertise or sell prescription drugs directly to consumers, down from 581 Web sites last year. Eighty-five percent of these sites sell potent drugs controlled by the Food and Drug Administration, such as OxyContin, Valium, Xanax, Ritalin and Vicodin without a prescription.

But Foster, vice president and director of policy research and analysis at the center, noted that there has been an increase in the number of sites that offer "online consultations" in which customers fill out a survey about their symptoms, and the site then sends them or their local pharmacy a prescription for medication that can be picked up.

"It can be very dangerous," said Hank Abbot, a pharmacist at the Bird's Hill Compounding Pharmacy in Needham, Mass. "This is how the addicts get their medications and unscrupulous people make money."

What's the Diagnosis, Doc?

But it is difficult, if not impossible at times, to tell the difference between a bona fide prescription from your doctor and a paper prescription from an online pharmacy, according to several pharmacists.

Although the online pharmacy may have an actual doctor reviewing requests for prescriptions, there may be too many questionnaires to go through to evaluate each one accurately. Someone may even have been hired simply to put a signature on each prescription as it goes out without any review.

Red flags and their personal sense of ethics help pharmacists catch online prescriptions before the drugs make it into a customer's hands.

"It is not unusual for a pharmacy to fill a prescription for a patient that doesn't come from a local doctor," said Kevin Gahm, a pharmacist working in West Portsmouth, Ohio. "But it is unusual for that patient to continue to see a doctor from very far away and return consistently to a local pharmacy."

Verifying prescriptions with the doctor who wrote it is another way pharmacists avoid giving wrong medications.

And the type of medication prescribed can tip off a pharmacist. According to the center's report, the majority of prescriptions filled at a traditional pharmacy are noncontrolled medications. Only 11 percent are strong medications, such as opioids and barbiturates. By contrast, 95 percent of prescriptions from online pharmacies are for controlled substances.

Take Your Meds

Foster said the number of sites trafficking prescription drugs may have declined due to profiling and regulatory crackdowns on companies selling too many controlled drugs.

Constantly submitting prescriptions for controlled drugs tips off pharmacists as well.

"I'm not averse to filling oxycodone," said Abbot. Though he does not keep a large amount of controlled drugs in stock, if a true need arises, Abbot said he can get the medications within a day. As for the patient, "if they're legitimate, they'll wait," he said.

There are about a dozen legitimate online pharmacies, including Walgreen Co. and CVS Caremark Corp., that provide online prescriptions and medications. These companies have been voluntarily certified by the National Association of Boards of Pharmacy.

But getting certified, which can cost about $8,000 for the initial certification plus yearly fees, can be too expensive for smaller online pharmacies.

Although the CASA report suggested that federal regulations and low-cost accreditation for online pharmacies be mandatory to prevent blatant drug abuse, with or without prescriptions, as of now the companies do not seem to be suffering for lack of official and legal certification.

But Foster said some pharmacies don't always check with doctors or verify the information before filling prescriptions. Indeed, online companies may target financially strained pharmacies and doctors who have retired to cooperate with their business practices and even earn some money.

But these practices are decried by the rest of the pharmacological community.

"Any pharmacist that knowingly fills such prescriptions should not be permitted to practice pharmacy," Holycross said. "It is dangerous for the patient and society."