Drug Enforcement Administration
Permanent Subcommittee on Investigations
July 22, 2004
Chairman Coleman, Senator Levin, and distinguished Members of the sub-committee, thank you for the opportunity to discuss the problem of illicit or “rogue” online pharmacies, which illegally sell dangerous and addictive controlled substances over the internet. On behalf of the men and women of the Drug Enforcement Administration, thank you for your interest in this significant threat to public health and safety.
The internet has brought drug dealers from the back alleys directly into every American home wired for email and the World Wide Web. Extremely dangerous, addictive, and potentially life-threatening drugs are now sold illegally every day, just one click beyond virtually every email box. These drugs are peddled by multimillion dollar organizations every bit as sophisticated as international cartels.
For the consumer, buying these drugs over the internet sight unseen and without a legitimate prescription is no safer than taking drugs offered to you by a street corner hustler. No rational person would do that, yet narcotics sold over the internet have led to deaths, overdoses, and addiction nationwide. The public must be vigilant to keep them from our homes. Rogue internet pharmacies pose an immediate threat to lives and health across the country, and the Attorney General and I have made it a priority for the Drug Enforcement Administration to aggressively identify and pursue these organizations.
The Problem of Rogue Internet Pharmacies
Purchasing controlled substances online is simple: someone looking for a drug of choice can simply type its name into a search engine, pick from numerous sites offering it, fill out a brief questionnaire, and then click to purchase. Often, persons are not even looking for drugs but are solicited to buy them by unrelenting “spam” emails. In either case, the physician associated with the website, typically in a business relationship with the pharmacy, almost never has a valid doctor-patient relationship under accepted medical practices.
Among other things, there is no physical examination, no discussion with the consumer of the diagnosis and the evidence for it, no discussion of the risks and benefits associated with various treatment options, no verification of the information provided, and no follow up care by the physician. By extension, the pharmacist then dispenses the controlled substance with an invalid prescription and without the needed and required underlying physician-patient relationship. Acting together, the physician and pharmacist dispense controlled substances without a legitimate medical need, resulting in widespread self-medication over the internet.
The risks of self-medication are obvious: addiction to habit-forming substances, dangerous drug interactions, use of counterfeit or tainted products, and potential adverse reactions to medications that are prescribed without a medical purpose. Pharmacists and doctors that participate in dispensing controlled substances without valid prescriptions essentially become internet-based drug lords.
In September of 2000, the General Accounting Office reported the number of on-line pharmacies to be between 200 and 400. Some pharmacy owners have 25 or more specific sites. Total annual sales for some website operators are estimated at as much as $50 million, with profits of $30 million to $40 million. One case currently under indictment seeks forfeiture of $125 million from the website owner.
The real toll of these rogue internet pharmacies is not in these numbers, however, but in victims across the country. Our investigations have discovered 14 deaths or overdoses and 15 persons who have entered rehabilitation or sustained injuries from drugs obtained over the internet. The tragic case of Ryan Haight, whose mother has testified before you, is nationally known. Ryan died at the age of 18 from an overdose of painkillers, including Vicodin, he ordered over the internet without a legitimate prescription. Sadly, these cases are only examples of a rapidly spreading problem and must be dealt aggressively.
Dealing with the Illicit Internet Pharmacy Problem
President Bush has set forth a coordinated strategy to deal with the problem of illegal diversion and abuse of prescription drugs, including “rogue” internet pharmacies, in the National Drug Control Strategy for 2004. The strategy includes enhanced outreach to responsible businesses used to facilitate the online pharmacy trade, enhanced investigation and enforcement, and greater public education.
The DEA currently has 103 active internet investigations that cover 537 websites. This fiscal year, we have shut down 25 internet pharmacy organizations; over $3.3 million has been forfeited and 3.2 million dosage units seized. $136 million is pending forfeiture.
The DEA is increasing staffing and resources dedicated to the problem of diversion over the internet to improve our capacity to identify and stop illicit internet pharmacy operations, and working more closely with agencies and companies inside and outside the government to coordinate and improve our efforts.
Specifically, appropriations for this fiscal year included an increase of 63 positions dedicated to our internet initiative. We expect this enhancement of specialized investigators to have an immediate impact on internet crime. Another key goal is to enhance our ability to find illicit internet pharmacies, both online and in physical world, and find the organizations behind them. One tool to do so is the use of sophisticated technology to track down “rogue” pharmacy websites and find the organizations behind them. Congress provided $6.3 million in funding for this project, which is now becoming operational, and beginning to provide intelligence relating to ongoing investigations.
The DEA is also working to use the internet itself as a tool to counter “rogue” pharmacies. The ease of obtaining some controlled substances over the internet has dangerously misled the public. The DEA is working with major search engines and internet service providers to warn consumers searching for controlled substances that they are in fact dangerous drugs. We have also established a link to the DEA’s internet homepage to allow citizens to report suspicious internet pharmacies, an initiative which has already provided us with leads.
The scope of the problem of “rogue” internet pharmacies is too broad and far flung for DEA or any single agency to tackle alone. We are building partnerships and working with other regulatory agencies to enlist the support of legitimate businesses essential to the online trade. We are working closely with the National Association of Boards of Pharmacy and the Federation of State Medical Boards to build bridges with Internet Service Providers (ISP), credit card companies and shippers.
Officials from the DEA have already held several meetings with both Federal Express (FedEx) and United Parcel Service (UPS) on this issue and have also visited the FedEx Mail Hub in Memphis, Tennessee to evaluate the processing of international parcels. Both FedEx and UPS continue to support DEA investigations with valuable tracking information on origin and destination of shipments. They are acutely aware that their businesses are being exploited and alert us to any unusual patterns. Similarly, consistent with my emphasis on taking away the proceeds of all illicit drug trade, we have met with both Visa and Master Card to explain their role in policing the activities of the vendors using their services. They fully assist us in all aspects of investigations and with financial leads. Both shippers and credit card companies understand how their companies can facilitate online drug dealing and have agreed to shut down sites when their customers have been determined to be conducting illegal activities.
The importance of our partnerships is best illustrated by a recent example. Last week, the DEA worked with Ebay to remove illegal steroids that had been improperly listed for sale on their website. The sellers were offering several types of Schedule III anabolic steroids to the highest bidder, which had managed to avoid detection in online “filters” Ebay had set up in cooperation with the DEA. Once noted, these harmful steroids were taken off their website immediately. We continue to work with them daily on illegal steroids offered by individuals via their website. While Ebay, of course, is not an illicit pharmacy website, our work demonstrates the successes we have had working with the private sector.
The DEA is also committed to working closely with our Federal partners. An interagency taskforce we participate in with Immigration and Customs Enforcement and the Food and Drug Administration recently coordinated an “import blitz” to target imported pharmaceuticals arriving at the 13 U.S. international mail facilities at JFK Airport in New York. Of 325 packages sampled, 132 contained controlled substances, including codeine products, Valium, Xanax, steroids and Hydrocodone, which had illegally arrived from Spain, India, the Netherlands, Belgium, Romania, Slovenia, Mexico, Argentina and Brazil.
As the Subcommittee has noted, a significant aspect of the pharmacy problem is located abroad. The DEA has staffed critical overseas offices with diversion investigators to cooperate with our foreign counterparts on these matters. In addition, the DEA has assumed a leadership role in the international forum on internet diversion. In March of 2000 and again in 2004, the United States introduced resolutions to the Commission on Narcotic Drugs of the United Nations Economic and Social Council emphasizing the importance of the internet as a global diversion problem. These resolutions, which were overwhelmingly adopted, urge signatories to develop well-coordinated and focused policies to terminate Internet sites that fraudulently sell controlled drugs.
Ultimately, it will also be necessary to address the problem of illicit internet pharmacies within the regulatory structure of the Controlled Substances Act. Currently, no special DEA registration is required for online pharmacies, nor are online pharmacies required to report the nature or volume of their business in controlled substances. Such requirements would allow us to identify legitimate online pharmacies and persons operating and promoting them, to gather information pointing to patterns of abuse, and to punish “rogue” online pharmacies.
Moreover, there is no discrete federal offense prohibiting unlawful distribution of controlled substances using the internet. This includes selling from an unregistered pharmacy, selling without a valid prescription, or acting as a “middleman” for those who do. Nor is there a discrete legal or regulatory requirement for an in-person medical evaluation of patients or a prohibition on using the internet to advertise the illegal sale of controlled substances (as there is for other advertisements offering to sell Schedule I controlled substances).
We look forward to continuing to work closely with Congress to ensure that the Controlled Substances Act ultimately will address the problem of “rogue” internet pharmacies as vigorously as we intend to address them through our enforcement efforts.
Mr. Chairman, I want to reiterate that “rogue” internet pharmacies pose a significant threat to lives and health across the country and pursuing these organizations is a top priority for the DEA. At the same time, it is important to emphasize that, as with so many other areas, the internet is impossible to fully control – which is why caution and awareness are the most important ways to protect the public. I would be happy to answer any questions.