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In online pharmacy news, the major story today is that FedEx was indicted for distributing controlled prescription drugs for Internet pharmacies to people who did not have valid prescriptions. FedEx claims it is not guilty and that its indictment and potential prosecution threaten a key principle of its business ethics and federal law: don’t open the mail. FedEx also says that for years they have asked the DEA for a list of targeted illegal online pharmacies but have not received one and that it cannot be expected to act as a law enforcement agency. The U.S. Department of Justice alleges that FedEx specifically “conspired” with two online pharmacies selling controlled drugs without proper prescriptions.

I’m departing from this media hot topic (better you read it in Bloomberg, USA Today, etc) to give you some backstory on controlled drugs and Internet sales. Our blog’s usual focus is on consumers seeking non-controlled prescription drugs online, and the Verification bans online pharmacies that sell controlled without a valid prescription, and all international online pharmacies that sell controlled drugs into the U.S. However, some Americans try to obtain prescription narcotics and other controlled drugs without a prescription online, which can turn out deadly.

In 2001, an 18 year-old named Ryan Haight died after overdosing on Vicodin, a prescription opiate, which he purchased from a U.S. online pharmacy. To purchase that drug, he just had to answer some health questions online; he did not submit a prescription from his doctor, one obtained through a face-to-face medical exam. Seven years later, Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 making it expressly illegal for online pharmacies to dispense controlled medication to patients based on online questionnaires without the establishment of a prior doctor-patient relationship.

Prescription drug abuse is a serious health crisis in America. When people think of drug overdoses, heroin and other illegal drugs usually come to mind. The sad truth is that of the 41,340 annual deadly drug overdoses, 22,810 were caused by legal, often highly addictive opiate-based, pharmaceuticals. What role does the Internet play?

The news about FedEx today mostly relates to events occurring before 2010. Generally, the DEA believes that the Ryan Haight Act, which passed in 2008, is a successful deterrent to online prescription narcotic drug dealers. In fact, according to the DEA, the Internet is an insignificant channel for illegally dispensed controlled drugs, accounting for far less than 1% of all illegal sales. In 2012 the Internet was used by only 0.2% of drug abusers to obtain a prescription narcotic. This is a decrease from 0.4% in 2010.

A 2012 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies the distribution channels people use for obtaining prescription narcotics for non-medical use (“to get high”): getting them free from family and friends (54%), by obtaining a prescription from one doctor to fill at a local pharmacy (19.7%), buying them from a friend or relative (10.9%), obtained from a friend or relative without asking (4%), drug dealers or other strangers (4.3%), obtaining a prescription from more than one doctor (1.8%), stolen from a doctor’s office, pharmacy, clinic, or hospital (0.8%).

LegitScript, an Internet investigations and monitoring company, argues that the data above underestimates the problem of the Internet because the survey question feeds a biased response. The survey asks how people have obtained prescription narcotics to get high, not for medical purposes. LegitScript’s point has some merit, but not enough to dispute the DEA’s overall low prioritization on the Internet. If a person goes online and, despite the Ryan Haight Act, obtains a controlled drug based on an online questionnaire only, then he or she may believe (but they may not) that it’s for “medical” use and will not identify the Internet as a way they obtained medication illegally or to get high. Here’s how SAMHSA responds:

The concern about the feeder question is legitimate, although this is probably not as severe a problem as the LegitScript report suggests. The current definition of nonmedical use that is provided to NSDUH respondents in the feeder question asks respondents to report use “if the drug was not prescribed for you, or if you took the drug only for the experience or feeling it caused.” This definition is intended to pick up use of drugs prescribed by a doctor but not used in accordance with the doctor’s instructions (for the feeling or experience), which may be a common occurrence with Internet purchases.

It’s illogical to ignore SAMHSA’s data showing that the Internet is an exceedingly minor channel for prescription abuse and it does explain why DEA places such a low priority on the Internet. Still, if people search hard enough they can get controlled drugs online without a prescription and the DEA should and does remain vigilant.

What should concern consumers are initiatives that invoke the prescription drug abuse problem but overreach by seeking to shut down or delegitimize safe international online pharmacies, often as part of lobbying efforts among pharmaceutical companies opposed to personal drug importation. For example, certain federal legislation promotes the creation of White Lists of online pharmacies that are approved by the National Association of Boards of Pharmacy, an entity funded by drug companies, which wrongly refers to safe international online pharmacies as “rogue.”

To highlight the point made above, note the words of Senator Chuck Schumer in discussing a bill introduced in 2006 to combat rogue pharmacy sites selling prescription narcotics: “The bill is geared to domestic Internet pharmacies that sell drugs without a valid prescription, not international pharmacies that sell drugs at a low cost to individuals who have a valid prescription from their U.S. doctors.”

It’s in this spirit that we should get rid of the online prescription narcotic pushers, domestic and foreign, while promoting access to safe medication online!

Circling back to FedEx: if they were knowingly delivering controlled drugs to people without prescriptions then they must face serious consequences for intentionally endangering lives. For now, the company is innocent until proven guilty. In following that story, it’s important to look behind the curtain for all reasons the federal government might be pursuing FedEx. We’ll be looking…

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