Authorities battle Internet pharmacies

A 4-foot-tall, overweight, alcoholic, heroin-addicted airline pilot placed an order on a Web site for steroids, Ritalin and methadone, noting in the online questionnaire that he wanted “to get high to fly.”

Two days later, the package arrived.

Unfortunately for Dr. David Stephenson, who ran the site from his home near Syracuse, the “pilot” was actually a New York state investigator looking to see just how difficult it was to buy controlled substances online without seeing a physician, a crime in that state and several others.

Stephenson was arrested – he later pleaded guilty – and it became shockingly clear that getting highly addictive drugs over the Internet was as easy as ordering a book.

That first arrest in 2005 sparked what is now a nationwide dragnet by Albany County, N.Y., prosecutors into the illicit sale of steroids entering New York. Twenty people from three states – Florida, Texas and New York – have been indicted, and authorities are promising more arrests.

A similar federal prosecution is under way in Rhode Island, and investigators in Florida and Texas are considering their own state charges.

Although some professional athletes have been linked to the scandal – baseball’s Jose Canseco and John Rocker, former heavyweight champion Evander Holyfield and 1996 Olympic wrestling gold medalist Kurt Angle, among them – authorities have made it clear they’re focusing on prosecuting distributors, not users.

Experts say the steroids sting reveals just a portion of the problem with rogue online pharmacies and shady doctors doling out everything from painkillers to sedatives, no physical exam required.

“They’re the new 21st-century drug traffickers,” said Garrison Courtney, a Drug Enforcement Administration spokesman.

It’s a new front in the war on drugs – from the streets to the World Wide Web.

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Studies show prescription drug abuse in the United States is second only to marijuana – surpassing cocaine, crack and heroin, combined.

The number of Americans abusing prescription drugs, mostly painkillers, nearly doubled from 7.8 million in 1992 to 15.1 million in 2003, according to the National Center on Addiction and Substance Abuse at Columbia University.

Experts can’t say with certainty that the increase in prescription drug abuse is directly linked to online availability, but logic dictates a relation.

“All we know is that the Internet is a wide-open channel of illegal distribution of prescription drugs,” said Susan Foster, the center’s vice president. “Just the sheer availability of these drugs has got to have something to do with it.”

Poisoning deaths, mostly from prescription drug overdoses, were second only to car crashes as the cause of unintentional fatalities in the U.S. in 2004, according to the Centers for Disease Control and Prevention. The numbers of such deaths nearly doubled between 1999 and 2004, from 12,186 to 20,950.

Although there are legal online pharmacies that require pre-existing prescriptions and doctor-patient relationships, illicit sites come and go by the hour, making the networks difficult to track.

Some sites have begun using questionnaires for the appearance that doctors are actually evaluating patients before prescribing medications, but even that is illegal in many states.

In New York and Florida, for example, it is illegal for a doctor or a pharmacy to dole out any prescription drugs to a patient without a previous physical exam. Laws in the state of Utah are a bit less clear. There, doctors can prescribe drugs such as Viagra without an exam, but it is illegal to prescribe other controlled substances such as painkillers absent a pre-existing physician relationship.

The steroids case also involves human growth hormone, a rarely prescribed drug restricted under federal law for specified medical uses, such as wasting disease associated with AIDS. It is not approved for bodybuilding or for enhanced athletic ability, as New York authorities allege it was sold for in their case.

Meanwhile, Congress has not kept up with the rapidly changing venue for illicit sales of all prescription drugs.

“These laws were written before the Internet so they didn’t envision the kind of drug trading we’re seeing now,” Foster said.

Much of the law is open to interpretation.

According to the section used by federal authorities in prosecuting such cases, any prescription written by a doctor for a controlled substance “must be issued for a legitimate medical purpose … in the usual course of his professional practice.”

There is no specific wording that calls for any doctor-patient relationship yet federal authorities still rely on juries to use common sense when determining whether drugs were prescribed for legitimate purposes. Note the 4-foot-tall, overweight, alcoholic, heroin-addicted airline pilot.

The only real clarity is that U.S. pharmacies cannot fill prescriptions written by physicians outside the country, and that it is illegal to provide any controlled substance without a prescription.

“Federal laws are still catching up,” said the DEA’s Courtney.

Two years ago, the DEA created its Virtual Enforcement Initiative. The agency has since arrested dozens of suspects and shut down thousands of illicit drug-peddling Web sites. Prosecutions can be sketchy at times with the absence of federal language specifically citing the crimes committed.

Sen. Charles Schumer, D-N.Y., announced earlier this month that he would introduce legislation clarifying federal law when it comes to doctors prescribing controlled substances without first having met their patients.

The physicians who are hired by the online distributors “have become no more than drug dealers,” Schumer said.

Much like authorities trolling the Internet for child predators, it’s a virtual game of hit or miss.

“How do you, with millions upon millions of sites, look at every single one? You just can’t,” Courtney said.