The number-crunchers tell us the abuse of controlled prescription medications in the United States exceeds that of the total of all illicit drugs, except for marijuana. An article published a year ago in “Annals of Internal Medicine” describes a further mockery of the term “controlled”—the availability of controlled prescription medications on the internet, without a prescription.
Internet sales of prescription medications have been growing exponentially. Unfortunately, illegitimate online pharmacies have grown right along side the legitimate enterprises, and among their offerings are the narcotic drugs, which may partly explain the increase in prescription drug abuse over the last twenty years. Likewise, there has been an increase in emergency department visits for opioid pain-relieving abuse.
So-called “secret-shopper” studies, conducted by various enforcement agencies, including the Drug Enforcement Agency, have confirmed the relative ease of shopping for drugs without a prescription along the Information Super-Highway—an apparently easier way to get your pot without the potholes. Surveys of prescription drug abusers have found that up to 10% of these individuals have obtained their controlled prescription medications via the internet. However, the problem may be bigger than what these flawed surveys conclude:
• Many of these surveys are taken in methadone clinics, and the individuals found therein may be less likely to be surfin’ the net due to socioeconomic realities; in addition, methadone is not frequently found online.
• Drug dealers are now using online pharmacies to obtain controlled medications for sale locally; these individuals will likely not be captured by a team of behavioral scientists conducting a survey.
A different study found that for every 10% increase in high-speed internet use between 2000 and 2007 (an assumed proxy for access to online pharmacies), utilization of treatment centers for opioid, sedative hypnotic, and stimulant abuse increased by approximately 1% each. However, admissions to such treatment centers for the abuse of substances that are not generally available online (e.g., alcohol, heroin, and cocaine) remained stable.
Despite enforcement action, it is estimated that up to 75% of illegitimate online pharmacies exist in an unknown location. And physician ignorance of patient drug abuse certainly will make it difficult in finding these pharmacies. One large study published in the “American Journal of Drug and Alcohol Abuse’ in 1997 found that 45% of patients being treated for substance abuse reported that their family doctor was unaware of the abuse.
Physicians need to wake up. Like it or not, they are on the front lines of the prescription drug abuse phenomenon. There is now no “typical look” of a drug abuser; the safety of shopping from home renders us all potential abusers. I liken it to a few years ago, when VHS took the furtive XXX-rated moviegoer out of his raincoat and his dark sunglasses, pulled him away from the overweight woman working the ticket booth, and replaced him with the local soccer mom cuddling up to the VCR with Orville Redenbacher in one hand, and Ron Jeremy in the other.
We are all susceptible, and need to be educated regarding the dangers of purchasing any kind of medication over the internet, particularly when done without a consultation with a doctor.
Now, what were you saying about that new Ron Jeremy retrospective edition?