By Brendan Mckenna
The Dallas Morning News
WASHINGTON, D.C. — When the only pills that online pharmacies promised were Viagra and Cialis, the Drug Enforcement Administration didn’t really care — the agency doesn’t have jurisdiction over those “lifestyle drugs.”
But now that some online pharmacies are selling Americans powerful painkillers like Vicodin and other easily abused drugs without a doctor visit, the DEA is taking notice.
Some of its earliest successes in targeting the pharmacies have come in Texas, and the state has earned high marks for its efforts to target prescription abuse.
“For hydrocodone, Xanax and other drugs, the main avenue of diversion is these rogue Internet pharmacies,” said Joseph Rannazzisi, the deputy assistant administrator of the DEA’s office of diversion control. “Rogue Internet pharmacies basically cut through all the checks and balances that have been set up by the medical community between doctors, patients and pharmacies.”
To counter them, the DEA plans to lean on wholesalers to stop the flow of pills in suspicious situations. And the agency will also start suspending the licenses of certain doctors and pharmacies caught facilitating Internet sales, officials say.
The Web sites work by hiring doctors to sign off on prescriptions based on questionnaires from patients they never see, sometimes hundreds per day. Ringleaders often target young doctors with staggering student-loan debt or retirees looking for extra income. Then, the Web site operators pay struggling “mom and pop” pharmacies to distribute the drugs, promising a huge windfall in extra fees, Mr. Rannazzisi said.
Soon many pharmacies find themselves making so much money that they shutter their storefront operations and rely entirely on illicit Internet sales.
But the scheme can bring felony charges for all involved, including charges of conspiracy to distribute controlled substances and conspiracy to commit money laundering. They can carry sentences of up to 25 years in prison.
It’s unclear how many sites are hawking painkillers, because operators tend to shift their business around to many differently named sites, officials say. But the stepped-up enforcement comes as Americans are increasingly turning to hydrocodone, the main ingredient in Vicodin and other powerful painkillers. Prescriptions of such drugs jumped more than 35 percent between 2002 and 2006, according to the DEA.
“What we’re seeing more and more is people that say, ‘Well, I wouldn’t take cocaine. However, sometimes I’ll pop a Vicodin because it’s manufactured by a drug company, so what can it do to me,’ ” Mr. Rannazzisi said. “These drugs are just as dangerous, just as dangerous as every other drug when used improperly.”
And, the agency says, a small number of suspicious Internet pharmacies fill a disproportionate number of those prescriptions. The Internet has increasingly become the procurement method of choice for those looking to get Vicodin, the anti-anxiety drug Xanax and the muscle relaxant Soma, which are often taken together by users seeking to get high.
Early success
One of the DEA’s big early successes in combating Internet pharmacies came in Texas in 2005, in an effort called Operation CYBERx. It involved more than 23 pharmacies and more than 20 doctors, with 18 arrests and more than $18 million in seized assets.
Rakesh Johar Saran, 44, of Arlington, one of the ringleaders, pleaded guilty to one count of conspiracy to commit health care fraud, two counts of mail fraud, one count of conspiracy to distribute controlled substances and other federal offenses. He could face up to 20 years imprisonment, and as part of his plea agreement, he will forfeit assets earned from his illegal activities, including more than $1 million in cash seized at his residence; more than $375,000 in bank accounts, several vehicles and a custom home under construction in Arlington, according to the DEA.
But such cases are more the exception than the rule, said Gaye Dodson, executive director of the Texas State Board of Pharmacy.
“We have had some and we’ve disciplined some,” Ms. Dodson said. “Percentage-wise, I suspect we’re no different than any other state.”
In many ways Texas is ahead of the curve in combating illegal use of prescription drugs, whether online or off, she said.
“We have some stringent laws in Texas that prohibit a pharmacist from filling a prescription that was issued through an Internet questionnaire,” Ms. Dodson said. “And that’s generally the way the not-legitimate ones work.”
Legitimate online pharmacies generally limit themselves to refilling existing prescriptions and never generate a prescription on the spot, she said.
Ms. Dodson said that the pharmacy board has disciplined two Internet pharmacies in the last two years, but that pales in comparison to the investigations of pain clinics and other “brick and mortar” operations. She declined to give exact figures but said there were more than 20 ongoing cases, though some of those may be looking into legitimate operations.
By next year, the pharmacy board and law enforcement agencies will have another tool to go after illegal distribution: a registry of prescriptions of controlled substances.
The state has closely tracked “Schedule II” drugs such as morphine and OxyContin since the early 1980s, said Johnny Hatcher, manager of narcotic regulation programs for the Texas Department of Public Safety.
Next year, the state will extend its monitoring to classes of drugs less prone to abuse by requiring doctors to list an identifying number issued by the DPS on prescriptions along with the patient’s age. This will enable the state to start putting together the numbers that can help doctors, pharmacists or law enforcement agencies identify possible illegal operations, both by finding prescription mills and by identifying patients who are “doctor hopping,” Mr. Hatcher said.
Policing the Web
But because that requirement will extend only to Texas pharmacists, Mr. Hatcher said he isn’t sure how much use it will be in stopping Texans from buying drugs illegally online.
“My God, if you have a son or daughter or somebody they can just get online and you don’t know [anything] if they get a credit card and get drugs in the mail for personal use, addiction or they’re selling it,” he said. “It’s going to get worse.”
At the federal level, the DEA has had mixed results in going after the Internet pharmacies’ ringleaders and the doctors and pharmacists they recruit, and Congress is looking into legislation that may make it easier to get arrests and convictions, Mr. Rannazzisi said.
The DEA also hopes to persuade wholesalers to stop selling tablets to pharmacies that show a suspicious spike in business for controlled drugs in addition to filing reports.
Distributors were “filing reports and not doing anything about it, continuing to sell,” Mr. Rannazzisi said. “Distributors have a responsibility as well.”
The DEA also plans to use its authority over doctors, pharmacists and distributors to suspend the licenses of those involved in illegal online drug sales.
“If you’re a small mom and pop pharmacy or a small doctor, it’s no big deal, it happens all the time,” Mr. Rannazzisi said. “But if you’re a major wholesaler, a Fortune 500 company, that hurts. ... And what we’re seeing now is a tightening up of the wholesale distribution market.”
Copyright 2007 The Dallas Morning News