Source: New York Times
Date: October 18, 2003

Two Agencies to Fight Online Narcotics Sales


Two federal agencies, the Food and Drug Administration and the Drug Enforcement Administration, have formed a special task force to crack down on the growing tide of illicit sales of narcotics on the Internet.

And for the first time, regulators are hinting that those who order the drugs may face prosecution. "It's illegal to import narcotics," Mark B. McClellan, the F.D.A. commissioner, said in an interview. "We do have steps in place to intercept such products and to take further legal action."

The task force, called Operation Gray Lord, will include officials from the Justice Department, some local law enforcement agencies and perhaps even top law enforcement officers from Canada because much of the trade originates there. Task force members intend to pursue the purveyors of prescription narcotics aggressively, but they acknowledge the difficulty of the task.

Many of the sites are based in countries where the sales are legal, and officials have few hopes that they will be able to intercept every package sent through the mail. Many of the packages bear fake customs certifications, making them especially difficult to track.

"Like anyone else, I'm inundated with spam for hydrocodone, Valium and Ambien," said Elizabeth Willis, chief of the drug operation section of the D.E.A.'s office of diversion control. But determining who is sending the e-mail takes a lot of work, Ms. Willis said. "Some are registered in Europe, but the drugs are sent from Africa," she said.

"This problem will probably grow as people see an opportunity to make money," Ms. Willis added.

The task force may close Internet pharmacies in the United States that have operated in a legal gray area for years by hiring physicians who write prescriptions based solely on the results of an e-mail questionnaire.

"If a prescription is written by a doctor based solely on information from an online questionnaire, it's not valid, so the distribution is illegal," Ms. Willis said.

The government's crackdown comes as Congress debates legislation that would legalize the reimportation of prescription medicine from Canada and Europe as a means of giving Americans access to lower-priced pills. Drug prices in the United States are often two to three times those found in Canada and southern Europe. Several Midwestern governors have recently announced their support for reimportation.

The drug industry is fiercely opposed to reimportation, saying it is dangerous and undercuts its ability to finance research. F.D.A. officials have warned consumers against ordering drugs from Canada and elsewhere, saying many may be counterfeit.

In the case of prescription narcotics, however, both federal agencies say they worry that the drugs sold are actually what they claim to be — powerful opiates that can cause dangerous addictions. F.D.A. officials say that the growth in reimportation has made limiting the trade in narcotics more difficult.

"Different kinds of drug imports carry different risks," Dr. McClellan said. "As they all come in unidentified packaging, it's difficult to separate one from the other."

Those who support reimportation legislation have accused the F.D.A. in recent weeks of playing politics each time the agency announces enforcement actions against reimportation. But Dr. McClellan said that "no one should argue that uncontrolled access to controlled substances is a good idea."

"The political concerns are not the motivation," he said. "The safety and integrity of the drug supply of the United States is."

Abuse of prescription painkillers is soaring. In 2002, 22 percent of those 18 to 25 abused prescription pain pills, up from 7 percent in 1992, according to government surveys. A survey of emergency room visits found that painkiller abuse nearly tripled from 1994 to 2002 and is now as common as marijuana or heroin use. Rush Limbaugh, the conservative radio commentator, acknowledged recently that he had become addicted to prescription painkillers.

"We think the nature of drug abuse in this country is evolving and is moving toward prescription narcotics," said John Taylor, the F.D.A.'s chief enforcement official.

Most sites selling drugs initially tried to copy the procedures used in brick-and-mortar pharmacies by requiring prescriptions for all purchases — a cumbersome process. To speed purchases, some Internet vendors began hiring doctors who would review written questionnaires and then write prescriptions for the patient. The pharmacies' solicitations focused on Viagra and hair- and weight-loss drugs. In recent months, however, many Internet pharmacies have ended even the pretense of requiring a doctor's prescription to complete a sale, and their solicitations include offers for narcotics.

"A few years ago, you couldn't find any sites that would sell narcotics, and we really looked," Mr. Taylor said. "But recently, there's been a proliferation of selling controlled substances, and we think it's highly dangerous."

A recent examination by the F.D.A. of 1,153 packages of imported drugs found that 25 different controlled medications were among the imported pills. Bo Dietl, a private investigator hired by the pharmaceutical industry, recently released a report saying his team found 1,400 Web sites that sell prescription medicines, and more than 350 of them do not require prescriptions. The report has received widespread circulation on Capitol Hill.

The F.D.A. now has 90 different Internet drug investigations under way, according to a high-level agency official. The agency will hold a conference next month with drug enforcement officials from other countries to discuss how to control Internet drug sales.

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