Drugs just a click away: online pharmacies can make dangerous drugs easy to get, but also can promote better health care. Should we regulate them?

• Author: Brand, Rachel

Ryan Haight didn't have to lurk in a deserted parking lot or hang around the high school boys' bathroom to buy drugs. The college-bound 17-year-old placed his order on a computer in the family den. He ordered 100 tablets of hydrocodone--a generic for the powerful painkiller Vicodin--from an online pharmacy on Dec. 6, 2000. Two months later, his mother found him dead in his bedroom. In his blood was a mixture of hydrocodone and morphine ordered from www.nationpharmacy.com. The pills were "prescribed" by a doctor in Texas, fulfilled by an Oklahoma pharmacy, and delivered to the Haights' home in La Mesa, Calif.

Ryan Haight's death typifies the most extreme risks that emerge when pharmacy meets the Internet. Anyone with an Internet connection can buy potentially dangerous medicines online. There are hundreds of websites, doctors who never meet their patients, and pharmacies all over the world.

At the other extreme, the Internet allows law enforcement and boards of pharmacy to shine a brighter light on illegal prescribing practices. The power of aggregated data, complied through web databases, helps officials identify and stop patterns of drug abuse and trafficking.

Finally, using the Internet to transmit prescriptions might even save thousands of lives. Doctors make fewer errors, and pharmacists can catch adverse drug interactions with e-prescribing.

One day, online pharmacy transactions will be safe, convenient, inexpensive and private. Until then, legislators are experimenting with ways to limit Internet pharmacies' harm while promoting their greatest good.

IT'S SO EASY

First, the bad news. The Internet has put addictive drugs just mouse-clicks away from anyone.

Instead of seeing a doctor, a buyer goes online and fills out a questionnaire that pops up after he chooses a medication. The questionnaire might be sent to a physician for approval. But it's unlikely to be scrutinized: doctors associated with rogue sites are known to write 200 to 700 prescriptions a day--in itself not illegal. The prescription is fulfilled in another locale, and sent to the buyer as soon as the credit card is approved. "It's a real market for drug traffickers and hard core abusers," said Carmen Catizone, executive director of the largest association of pharmacists in Canada and the United States. "It's easier and cheaper and more profitable to sell these prescription drugs on the Internet than to sell heroin and cocaine on the street."

Running an online pharmacy is not illegal. But a prescription based solely on an online questionnaire is not valid, according to the federal Drug Enforcement Administration. And the distribution of controlled substances or dangerous pharmaceuticals without a valid prescription is illegal.

Yet the borderless nature of online pharmacies makes it easy for rogue operators to stay a step ahead of the law. Poorly funded state pharmacy and medical boards have trouble keeping up.

In an effort to crack down locally, about a third of states have amended their medical practice acts to require a physical examination as part of a legitimate online doctor-patient relationship.

Other states put the responsibility on pharmacists to verify that an Internet prescription was written pursuant to a valid patient-prescriber relationship. Kentucky is among...