It is simple and anonymous, and has
helped lead to what experts are calling a national epidemic of abuse of
everything from painkillers to sedatives to stimulants. Between 1995 and
2002, there was a 163 percent increase in the number of emergency-room
visits tied to the abuse of prescription drugs, according to the
Substance Abuse and Mental Health Services Agency.
Steep rise in abuse of legal drugs
An estimated 9 million people use
prescription drugs for non medical purposes. One key factor: the
| Staff writer
of The Christian Science Monitor
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SAMSHA estimates 9 million people now abuse prescription drugs, meaning
they use them for non medical, and often recreational, purposes. Three
million abusers are kids between the ages of 12 and 17 years old. And
the abuse can be deadly: Prescription drugs now play a factor in a
quarter of all overdose deaths reported in the
drug officials say this represents a dramatic surge - one that took them
by surprise. It has presented a whole new set of challenges, such as a
lack of law-enforcement resources to track down shadowy Internet sites
and unethical doctors and pharmacists. Another key issue: finding a way
to balance any law-enforcement measures with the needs of legitimate
online pharmacies that have helped the elderly and others save money and
Federal officials have
decided one way to combat the problem is with education. SAMHSA and the
Food and Drug Administration have launched a national campaign to warn
people that the misuse of prescription drugs is dangerous, as well as
"There's an assumption that
these are legal, so they're OK - that they can use them and walk away
without any consequences," says H. Westley Clark, director of SAMHSA's
Center for Substance Abuse Treatment (CSAT). "They don't seem to realize
that this misuse can lead to serious problems with addiction."
A complex array of factors
has led to the spike in abuse of prescription drugs. There's the overall
increase in the legitimate use of prescription drugs as a society. For
instance, since 1995, the number of Ritalin prescriptions written by
doctors has quadrupled. During that same time, the stimulant became a
favorite recreational drug among teens.
The number of OxyContin
prescriptions written between 1996 and 2000 increased 20-fold. One
theory contends that the increase in HIV and hepatitis C has prompted
some illegal substance abusers to switch to prescription drugs like
OxyContin, which can have an effect similar to heroin.
The rise of the Internet has
been another factor. Since 1999, online pharmacies - legitimate and
otherwise - have mushroomed, giving kids and addicts alike what appears
to be easy access to the drug of their choice.
"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
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
"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."
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
that opened a website and began prescribing controlled substances after
a two- to three-minute telephone interview with a doctor.
the 18 months it operated, it sold 9.3 million doses of the generic
versions of Valium and the pain reliever Vicidin.