Activists fight for regulation of online pharmaceutical sales

For the past several years, a small group of activists has been trying to get the federal government to do more to regulate online pharmaceutical sales. Now the activists are turning their attention to California.

“It’s the Wild West out there,” said Dr. Bryan Liang, executive director of the Institute for Health Law Studies at the University of California at San Diego. “There’s no regulation.”

No one really knows how many prescription drugs are bought online by American consumers each year. But Liang said that according to his research, Americans buy at least $1 billion in drugs online from Canada alone each year.

Many of these drugs are knockoffs, he said, which contain little or none of the active ingredient patients seek. Some may include yellow road paint, boric acid, or even cement used as a binding agent, Liang said. Many come from countries now associated with toxic toys, especially China. Often, buyers could actually buy safe generic versions in the United States for less, he added.

Anyone who gets spam likely knows the two classes of drugs that are sold the most online, Liang noted. First, there are male performance enhancers like Viagra and Cialis. Second are painkillers and sedatives. Prescription drug overdoses now kill more people each year than overdoses of all illegal drugs combined, according to federal figures. Street prices for prescription painkillers have fallen drastically in recent years, Liang said, and Internet sales are the biggest reason why.

Francine Haight became an activist on the issue after her son Ryan died of an overdose in 2001. An A student and a varsity tennis player, the 17-year-old high school senior died after taking Vicodin and Valium he had bought online. He was able to get a prescription and have it filled by using his credit card and claiming he was in his 20s. The online “pharmacist” who filled his prescriptions had done at least two stints in prison, Haight said.

It’s only recently that organizations that fight drug abuse are really catching on to the problem, Haight said. For years, many if not most anti-drug ads targeted marijuana, Haight said. She pointed to a pair of recent ads from the Partnership for a Drug-Free America focusing on prescription drug abuse. One of these ran during this year’s Super Bowl.

“Pot’s not going to kill you,” Haight said. “Alcohol, unless you’re driving, will probably take a long time. Prescription drugs can kill you right away.”

The federal Food and Drug Administration and the Drug Enforcement Agency have been working together to fight illicit online sales since 2003. In 2004, Haight and others were able to convince Sen. Diane Feinstein, D-California, to carry S.2464, a bill that would have placed severe limits on online pharmacies. That bill failed, but Feinstein has brought the effort back as the Ryan Haight Online Pharmacy Consumer Protection Act of 2007. It has been endorsed by Pharmaceutical Research and Manufacturers of America and Major League Baseball Commissioner Bud Selig.

There are several factors making it difficult to pass legislation, Liang said. While pharmaceutical companies want to stop counterfeit versions, they also don’t want to limit venues for selling their products.

Meanwhile, high prescription drug prices in the United States make this a difficult issue for politicians to touch. Many people see online sales, as well as trips to pharmacies in Canada and Mexico, as a key factor for making drugs affordable. The AARP and other groups representing older Americans have been skeptical of placing limits, Liang said.

The World Health Organization has estimated that more than $35 billion in counterfeit drugs are sold every year, and that in some countries counterfeit drugs make up nearly a quarter of the supply. While much of this counterfeiting does not take place online, the Internet has increased the supply of counterfeit and expired drugs still finding their way to patients, according to many who study the subject.

In August, Haight and others came to Sacramento to hold a press conference and meet with legislators. However, there is still no legislation pending. The state Board of Pharmacy is probably too understaffed to take on policing online sales, Liang conceded. With spending cuts coming due to the state’s dire budget situation, it is unlikely to get that staff anytime soon.

“If we could get a start in California, because it’s such a huge state, it would set a precedent for the rest of the country,” Haight said.

The state could make a major difference, Liang said, by forcing any company selling prescription drugs to Californians to meet certain standards and register with the Board of Pharmacy. Violations, he said, need to be backed up by serious criminal penalties.
“If we catch you, we’re talking about 20 to 25 years in state prison,” Liang said. “Not a federal prison with tennis courts. A state prison with shared showers.”

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