A generation ago, neighborhood pharmacists knew all the doctors in town and remembered each customer by name -- making it difficult to obtain prescription drugs, especially potentially addictive ones, without a doctor's order.
But Americans became increasingly mobile, switching communities, doctors, insurance companies and drug plans on a regular basis. And the number of prescriptions soared, from 1.87 billion in 1992 to 2.98 billion in 2000, a nearly 60 percent increase in just eight years, according to the Kaiser Family Foundation.
As a result, pharmacists now are finding it difficult, some say impossible, to ensure that every prescription they fill is legitimate.
In late January, Noelle Bush, the daughter of Florida Gov. Jeb Bush and niece of President Bush, was arrested on charges of trying to buy the anti-anxiety drug Xanax without a prescription. Authorities say that she posed as a doctor to call in an order and that a pharmacist, who suspected something was amiss, contacted police.
Pharmacists and the federal Drug Enforcement Administration say there's no way to determine how many Americans obtain prescription medications illegally. Some fake written or verbal prescriptions, some seek multiple prescriptions for the same drug from several doctors, others obtain drugs from the Internet.
The DEA in the last five years has increased the number of "tactical diversion squads," dedicated to curbing the problem, from just two in early 1997 to seven scattered around the country today; it also has investigators working at more than 70 sites nationwide, an agency official said.
Drug officials acknowledge that little can be done about drugs purchased overseas or shipped by overseas Internet sites without a prescription. But, in the United States, the agency is pushing for a system in which doctors would use a digital signature that must be validated before a drug is dispensed. Pharmacists would be able to tell if the prescription was altered after it was entered into the computer. The agency hopes to have regulations for the system finalized in October 2003.
Even with that system, "we won't know how secure it is until someone tries to beat it," said Susan Winckler, group director of policy and advocacy for the American Pharmaceutical Association, the national trade group for pharmacists.
The Bush arrest, pharmacists say, highlights the problem not only of prescription drug abuse, but of a system that relies on them to find it.
