Opiates Without Rx —A Prescription for Trouble

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Codeine is an effective painkiller. It’s also addictive. And you can order it online without a prescription. In fact, one can get a host of powerful drugs over the Internet by supplying only a payment and a shipping address, according to research at Penn’s School of Medicine. 

Dr. Robert F. Forman, an assistant professor of psychology in the psychiatry department, was primary author of the study, published last August in the Journal of the American Medical Association. He began looking into online pharmaceuticals while writing a chapter in a book on addiction counseling. Based on a tip from a colleague, he went online to Google.com and searched for “no prescription codeine.”

“I hit the button and my jaw just dropped,” Forman says. Over half of the first 100 sites generated in the search provided access without a prescription to “all manner of illegal substances, including the most tightly controlled pharmaceutical drugs.”

Of the first 100 listed Web sites, 53 were either linked to portals to online pharmacies or offered to directly supply the drugs. Forman calls the first set of sites ‘facilitators,’ and says they act as “middlemen, directing traffic” to direct access sites, usually for a fee. The second type of site, the “retailers,” directly offers to sell a variety of drugs, including oxycodone, opiates, morphine, and amphetamines, as well as brand name drugs such as Percocet® and Valium®, to be shipped directly to your doorstep. 

Drugs are classified by the Controlled Substances Act into five schedules, and all of the substances mentioned above are Schedule II-IV substances—meaning drugs with an abuse risk and the ability to cause psychological or physical dependency. While Schedule II drugs have accepted medicinal uses in the U.S., practitioners need a special DEA-issued license to distribute them. The Web sites identified by Forman offered to sell these drugs without any prescription or other controls—directly violating the law.

The implications of this widespread availability are alarming, Forman says. Not only do substance abusers have an essentially unmonitored drug source, but he also believes the legitimate appearances of many of the sites can mislead people into inadvertently ordering unsafe and illegal substances. “This could be your aunt,” says Forman, “looking to find a cheaper price. And she says, ‘Oh geez, I can just buy it here!’”

Many of the Web sites do indeed look legitimate, with professional designs, information and FAQ sections, and pictures of smiling doctors in reassuring white lab coats. Only if you’re looking carefully will you notice the various assurances of “stealth shipping” and, Forman’s favorite, “confiscation guarantees.” (If the government confiscates your order, the company will send you another one.)

Anyone with an e-mail account has probably been in-undated with offers for Viagra. “Buying a drug like Viagra without a prescription is also illegal,” says Forman. “It is also amazing that this has recently gotten so out of control.” But drugs like Viagra are not controlled substances for which a prescribing physician must have a special license, as is the case for opiates. “The significance of what we found is that the Internet makes buying these controlled substances without a prescription as easy as buying a book.”

In 1999, President Bill Clinton issued an executive order calling for a special work group to look into unlawful uses of the Internet, including the sale of illegal substances. But in the wake of 9/11, little progress has been made in addressing this problem. And in terms of practical law enforcement, Forman says, “There are no solutions at this point.” 

Part of the problem is that about half of the facilitator sites as well as all of the direct-seller sites, are based outside the U.S. 

For now, “We want to be sure that people in healthcare and public policy are aware of what’s going on,” and to ensure that the general public does, indeed, understand that such purchases are illegal. It can also be dangerous, Forman adds, because “you don’t know whether the substance you receive in the mail is expired, or has been contaminated, or is even what you ordered.

“We’re attempting to document this, to track it over time because it has potentially profound implications both for Internet commerce and for public health.”

Alison Stoltzfus C’05

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