Commentary: Illegal Online Pharmacies: A Potentially Fatal Threat to Consumers

By Marjorie Clifton | July 20, 2012 | Leave a comment | Filed in Community Related & Prescription Drugs


Over 96% of websites claiming to sell prescription medications are out of compliance with U.S. pharmacy laws and practice standards—a statistic that may come as a surprise to the average American consumer.[1] While this statistic may seem irrelevant to Americans who have never considered using the Internet to purchase products such as antibiotics or allergy medications, prescription drugs are among the most sought after e-commerce products — the 13th most purchased product online behind categories such as furniture, baby products and household supplies.

Getting a prescription filled online is not necessarily bad; it can be convenient and sometimes cheaper. However, there are important factors to consider when purchasing pharmaceuticals over the Internet: (a) the sellers of online medications are atypical; (b) medicine from unsafe sources can be toxic; and (c) the criminal networks behind these websites don’t care about your health – only your money. The newly formed Center for Safe Internet Pharmacies (CSIP) is working hard to address all three factors, and underscoring the importance of knowing who you are buying from.

While most consumers think they can spot a “good” versus a “bad” pharmacy website, they are often indistinguishable. Internet-based prescription drug dealers (or “illegitimate online drug sellers”) are very good at mimicking legitimate online pharmacies — even going so far as to display forged, seemingly authentic pharmacy licenses on their websites — which is why intuition alone is not enough. Most importantly, one should know a legitimate online pharmacy will always require a valid prescription. This means a prescription obtained by a practitioner who has examined the patient at some point. Illegitimate online drug sellers may require a prescription, but source the drugs from unverified supply chains, unregulated for safety or authenticity. Alarmingly, some physicians are not trained to make this distinction and unknowingly promote illegitimate online drug sellers to patients.

So who buys medication online? Although the “typical” online medication buyer is over the age of 55, there are growing numbers of young adults buying online without a prescription. 1 in 6 American adults, approximately 36 million people, are estimated to have bought medication online without a valid prescription.[2] This can be a deadly or life-altering prospect. Craig Schmidt, a 30-year-old plastics salesman, purchased Xanax (an anxiety drug) and Ultram (a pain drug) from an online pharmacy without ever seeing or speaking to the doctor that prescribed the medications. The Xanax tablets that Schmidt received contained quadruple the active ingredient that a doctor would prescribe. As a result of this overdose, Schmidt nearly died and has been left permanently impaired with widespread brain damage that inhibits him from driving or even walking without stumbling.[3] Unfortunately, stories like Craig Schmidt’s are not as uncommon as one would hope.

In 2010, the U.S. market alone accounted for an estimated $75 billion in sales for counterfeit drug makers; a lucrative prospect for criminal networks. There has also been a rising trend of malware appearing on illegal pharmacy sites – designed to steal your information and used for credit card or identity theft. GoDaddy.com took action on 47,000 illegal pharmaceutical sites last year alone and 27,000 of them contained malware.

How can this problem be fixed? The prevalence of illegal online drug sellers has made it virtually impossible for the law enforcement community to address the problem alone. So, in late 2010, CSIP was created to provide a first-ever private sector solution, and among the first public-private partnerships, formed to protect consumers from rogue Internet pharmacies. The mission of the organization is four fold: to educate consumers about the threat of illegal pharmacies, to work with law enforcement to eliminate the criminal networks, to share information among companies about illegal sites and to aid in building a “white list” of safe sites.

Currently, CSIP members include 11 corporations who are part of the Internet ecosystem. These companies will be announcing their partnership with U.S. Government agencies to tackle the problem of illegal online drug sellers at the White House on July 23, 2012. The event will kick off CSIP’s public education campaign, which will include a website with: a URL checker where consumers can confirm the legitimacy of online pharmacy websites, search engine advertising and public service announcement videos.

To learn more, visit the Center for Safe Internet Pharmacies’ website at www.safemedsonline.org.

Marjorie Clifton, Executive Director, Center for Safe Internet Pharmacies

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NY Officials Call State’s New Prescription Drug Monitoring System a Model for Country

By Join Together Staff | July 17, 2012 | Leave a comment | Filed in Community Related, Legislation, Prescription Drugs & Prevention

New York’s new prescription drug monitoring system, which will show pharmacists in real time whether patients have been “doctor shopping” for drugs, is a model for the rest of the country, state officials said Monday.

The Internet System for Tracking Over-Prescribing, or I-STOP, was recently approved by both houses of the state legislature, according to the Associated Press. It is awaiting the signature of Governor Andrew Cuomo, and will go into effect next year, Attorney General Eric Schneiderman said.

Under the new system, physicians and pharmacists will be required to monitor a patient’s prescription history before they write or dispense prescriptions for painkillers that contain oxycodone, such as OxyContin, Percocet and Percodan.

Since the new system will operate only in New York, there is no way to ensure that patients are not getting prescriptions filled in other states, Schneiderman said. He is urging other states to adopt the system, and added that the best solution would be a federal drug monitoring database.

“With I-STOP, we are creating a national model for smart, coordinated communication between health care providers and pharmacists to better serve patients, stop prescription drug trafficking, and provide treatment to those who need help,” Schneiderman said in a news release.

Earlier this year, several state medical groups said they opposed the system, including the Medical Society of the State of New York, which represents 30,000 doctors. The group said it was concerned that the system would create a burden on physicians’ practices. The Pharmacists Society of the State of New York also said it opposes I-STOP because of added demands the system would create for pharmacies.

Advocates Seek to Exclude Death Penalty for Defendants With Fetal Alcohol Syndrome

By Join Together Staff | July 16, 2012 | Leave a comment | Filed in Alcohol,Community Related, Legal & Mental Health

A growing number of murder cases nationwide seek to exclude the death penalty for defendants with fetal alcohol syndrome (FAS), The Seattle Times reports.

In one such case, advocates are trying to prevent the death penalty for Mark Anthony Soliz, a convicted murderer on death row in Texas. His mother drank heavily, used drugs and sniffed paint while she was pregnant, the article notes.

Those who favor eliminating the death penalty for people with fetal alcohol syndrome point to the U.S. Supreme Court decision to abolish the death penalty for defendants with mental retardation. “The damage to the executive functioning of the brain is as severe as someone who is intellectually disabled,” said John Niland, Director of the Capital Trial Project with the Texas Defender Service.

Victims’ advocates and prosecutors say such a decision would let killers off easy. “FAS should not be used as an excuse for intentionally and knowingly murdering another person,” victims’ rights advocate Andy Kahan told the newspaper. “Clearly, the defendant has been able to make law-abiding decisions on a daily basis, and they obviously know right from wrong. FAS is yet another hurdle for surviving family members of homicide to overcome to secure justice for the coldblooded murder of their loved ones.”

Another Texas death-row inmate, Yokamon Laneal Hearn, who was also diagnosed with fetal alcohol syndrome, is set for execution Wednesday. He was convicted in the shooting of a stockbroker during a robbery. Amnesty International is urging a letter-writing campaign for clemency to Texas Governor Rick Perry. The article notes the U.S. Supreme Court has already rejected a request to review a fetal alcohol case, which involved Louisiana death-row inmate Brandy Holmes, who was named after her mother’s favorite liquor.

Commentary: Affordable Care Act Does Little to Increase Addiction Care Access

By Dr. Stuart Gitlow | July 13, 2012 | 1 Comment | Filed in Government,Healthcare, Insurance, Legislation & Treatment


The demand for addiction treatment is high. The supply of addiction specialists is comparatively low. Yet unlike traditional economic models where money is the obstacle, in our field, the obstacle is time.

There are two factors involved: the time required to provide reasonable quality of care, and the time required to produce a specialist who has the ability to provide that care. These limitations restrict the number of patients that can be seen per day by all available addiction specialists. While increasing pay for care would result in an increased interest in the field, development of appropriate training and the years of training necessary would result in only slow growth of available treatment.

Because addiction specialists are not currently sitting idly at their desks surfing the Internet, access to treatment is not limited by financial factors but rather by availability factors. There simply isn’t a great enough supply of specialists to meet the demand of patients.

In 20 years of practice, I have worked in an academic setting as a staff physician in an addiction specialty unit, as a medical director of a community mental health center (CMHC) and as a private practice physician specializing in addiction. In each setting, I have turned no patient away. At the private practice, as is the common practice here, we do not take insurance but always work out a fee arrangement that is compatible with a patient’s needs. The CMHC also utilized a sliding scale for patients, and in the academic center, patients who could not pay were seen by a fellow with oversight from faculty. Patients have roughly equal access to at least one part, if not all parts, of the system. But availability of service, not fiscal issues, always proved the greatest constraint. “We’re happy to see you, Miss Smith, but our next opening is in 2015.”

That’s not to say there is no fiscal issue: my CMHC lost money on physician-provided care for nearly 20 years. Expenses were more than my hourly wage, and included collection costs, billing, insurance reviews and audits, with the revenues limited to copays and insurance payments. Things got much worse a few years ago. Collections dropped, audit rates increased and ultimately the CMHC could no longer afford my services. Did I mention that the CMHC I worked for is in Massachusetts? The community no longer has an addiction specialist and was recently featured in the news due to increased problems associated with substance use.

But the fiscal issue does not represent an access constraint because we clinicians can easily practice outside the employed environment. Looking at my case above, I left the CMHC and took most of my existing patients with me into my private practice in an adjoining state. Because I do not take insurance yet charge a reasonable rate, my expenses are quite low and patients do not have a significant financial burden in comparison to the CMHC model. Thus payment again did not end up being a significant limitation to access.

Now let’s come to the headline of the hour: the recent Supreme Court ruling. In many ways, the ruling was a non-event in that it simply supports, largely, what had already passed in Congress. The Affordable Care Act does very little to increase access to addiction care because it does not solve the primary obstacle we’ve discussed. It promises to increase the number of those who have insurance coverage, but as I’ve pointed out, coverage has not represented a significant obstacle in long-term outpatient addiction treatment. And long-term outpatient treatment is the key to avoiding higher levels of care. Outpatient care is where addiction treatment truly takes place since the higher levels of care are limited to the acute manifestations of substance use (e.g. detox, rehabilitation, and medical/psychiatric sequelae) and not the chronic issues related to addictive illness.

The Act promises that substance use disorders will be covered at parity as part of the essential health benefit. But any expectation that this will lead to coverage of long-term outpatient treatment is misguided. Because the primary limiting factors – time – is not being addressed, we will see no significant improvements. Given my experience in Massachusetts, however, we may see a significant alteration in how services are provided, with greater numbers of independent clinicians moving away from an employed model and into private practice and fewer clinicians accepting insurance. Too, there may be higher charges because of the higher taxes in place now due to the very Act that is supposed to increase access. This is a good thing as costs are much lower in private practice due to the reduced administrative burden and overhead. The overall cost of health care will drop.

Remember pendulums swing both ways. Just as the past decade saw a decline in private practice, the Affordable Care Act, should it not be repealed, will likely prove an economic force in the other direction insofar as bio-psycho-social-spiritual treatment of addiction is concerned.

Stuart Gitlow MD MPH MBA is a member of the American Medical Association’s Council on Science & Public Health, and Acting President of the American Society of Addiction Medicine. This Op-Ed represents his personal opinion and does not imply any position or policy taken by either the AMA

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