Cheaper drugs with no exams

Internet: The easy availability of prescription medications without a doctor's involvement alarms pharmacy and physician organizations.

March 11, 2004|By Lewis Krauskopf | Lewis Krauskopf,KNIGHT RIDDER/TRIBUNE

HACKENSACK, N.J. - The Web sites and the e-mail spam cluttering inboxes every day are unabashed and often brazen:

"Cheap Xanax, Valium, Viagra."

"No more doctor's visit."

"No prior prescription needed!"

The come-ons may shout, but they do not lie. Any American seeking prescription drugs who has Internet access can nimbly sidestep traditional health-care controls and have medicine delivered by mail - without the benefit, or cost, of a physician's examination.

The lack of controls alarms pharmacy and medical organizations, which warn of risks for consumers, particularly with the online merchants moving into sales of potentially addictive controlled substances such as Vicodin and Xanax.

The Internet is a "great tool," said Carmen Catizone, executive director of the National Association of Boards of Pharmacy. "When you step outside the regulated world of pharmacies, it's very dangerous."

Supplying the "no-prescription-needed" prescription drugs are an estimated 500 to 1,000 "rogue pharmacies," so named by the federal and state authorities that are increasingly investigating the sites - but are often hamstrung by the open nature of the Internet and laws that have yet to catch up to it.

The "rogue" sites are distinct from Web sites certified by national pharmacy boards, such as drugstore.com, or the sites run by chains such as CVS or Walgreens.

They also have nothing to do with Canadian pharmacies that supply drugs less expensively than their U.S. counterparts - but require American customers to mail or fax prescriptions written by doctors.

To check out some of the inducements, The Record newspaper in northern New Jersey went online.

We found an open market. The offerings differ from site to site and include drugs for depression, pain, sexual health, weight loss and muscle relaxation, as well as aids to sleep and quit smoking.

Commonly, the sites feature people dressed like physicians, in white coats and stethoscopes. They promote privacy, speedy delivery and no need for a doctor's appointment.

Using separate sites, The Record placed orders for three drugs that require a doctor's approval: Viagra and generic versions of Prozac and the muscle relaxant Soma. Ordering required a money order and filling out a questionnaire that asked basic medical history and why the drug was needed. No one followed up to verify the information or asked for further proof.

Then, as with many online shopping excursions, a process begun in cyberspace ended with delivery of three white FedEx envelopes. Although many of the sites selling prescription medicines claim to save the consumer money, each of our three drugs cost considerably more than the same pills sold at a local drugstore or through a certified online pharmacy.

Internet pharmacies are a relatively recent phenomenon. Sites promoting Viagra, the baldness medicine Propecia and other "lifestyle" drugs began sprouting about five years ago. After Sept. 11, 2001, online sites hawked antibiotics such as Cipro to capitalize on biological terrorism scares. Now regulators are charting a spike in Web sites offering controlled substances such as painkillers and other addictive medicines.

Tragic case

The potential danger is exposed in the tragedy of Ryan Haight, 18, a high school student who died of an overdose from mixing drugs, including an online order of hydrocodone, a powerful painkiller.

Haight placed the order late one night using the family computer at home in La Mesa, Calif., and a debit card his parents had given him to buy baseball cards online, according to an account in the Los Angeles Times in December.

The prescribing physician did nothing to verify the teen's claims that he was age 22 and had chronic back pain, the Times reported, noting medical board documents.

"If you're just out there on your own, and go to any old site that offers prescription drugs, you've got to really be careful," said Gail Shearer, health-care analyst for Consumers Union.

Bypassing the doctor's office to buy medicines raises additional safety issues, doctor and pharmacy groups say. "We think the public is at great risk by having prescriptions filled without a patient-physician relationship," said James N. Thompson, president and chief executive officer of the Federation of State Medical Boards in Dallas.

For example, it might seem innocuous to prescribe Viagra, one of the rogue sites' hottest drugs, but Thompson says it can be unhealthy doing so without a doctor's examination. Erectile dysfunction can be an early sign of disorders such as diabetes or high blood pressure.

"A patient may assume he is fine by talking Viagra when, in fact, he missed an opportunity to take care of that," Thompson said.

Another safety concern, regulators warn, is the lack of recourse if the drugs cause bad reactions or other problems. None of the labels on the three drugs obtained by The Record had a telephone number for the prescribing doctor, and one lacked a number for the pharmacy.

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