State Boards Fight Illegitimate Pharmacy Web Sites

As a result of the growing popularity of Internet pharmacy sites, some states are becoming increasingly proactive in the fight against rogue pharmacy Web sites.

The Washington State Board of Pharmacy and the Kansas State Board of Pharmacy, for example, have been seeking illegitimate sites for three and two years, respectively.

Searching out Illegitimate Pharmacy Sites

Currently, Washington has eight investigators, who track down the proprietors and prescribers affiliated with illegitimate pharmacy sites, and a non-investigator staff member, who actively scans the Internet for suspect online pharmacies. Most investigations in Washington are initiated through consumer complaints and allegations of wrongdoing by online pharmacies, according to Dick Morrison, chief inspector for the Washington State Board of Pharmacy. Investigations in his state are rarely launched by scanning or randomly searching the Internet for illegal sites.

"The most important thing to consider when a complaint is logged," Morrison says, "is which investigative techniques to use for following up on Internet pharmacies that are based in-state versus those located out-of-state."

If a patient goes online to find a pharmacy and places an order that is subsequently filled improperly, he or she will usually call their local authorities, even if they know the pharmacy is located in another state. In such a case, Morrison says, investigators may decide to refer the complaint and all information to the state in which the pharmacy is located. He points out that most boards of pharmacy cannot afford to travel to another state to conduct an investigation. It is logistically easier for the state in which the pharmacy is located to prosecute that pharmacy's license. On the other hand, states may want to prosecute illegally practicing pharmacies themselves, either by disciplining their non-resident license or enjoining them from doing business in that state.

Gathering Evidence

In direct contrast to the state of Washington, Kansas investigators usually find rogue pharmacy sites by scanning the Internet. Kansas State Board of Pharmacy Executive Director Larry Froelich says his office works closely with the Consumer Protection Division of the Kansas Attorney General's Office. Special agents in the Consumer Protection Division search the Internet for those sites that are a prescriber, marketer, and dispenser of drugs, all in one. To date, no customer complaints have led to an online investigation, according to Angelia Crawford, special agent.

"When a Web site fits our criteria for illegitimate practices, an undercover buy is made. It is important to use a computer that is not affiliated with the state," Crawford warns. "Investigators also use a corporate credit card, registered under their own names, for undercover purchasing," she adds. These two points are important because savvy site operators may not practice as they normally would, or may even shut down their sites if they recognize a state investigation.

Crawford recalls two instances of successful undercover buys that included falsified information. In one case, a 16-year-old, under adult supervision, purchased and received drugs from an online pharmacy despite his status as a minor. On another occasion, Crawford, herself, attempted to purchase a drug that should not be sold to females. After she had submitted the order, the pharmacy site notified Crawford that it could not sell the product to a female, but it prompted her to submit information as a male. She did as they suggested, and was able to purchase the drug.

Once a sale has been made and the drugs received, the Kansas special agents begin collecting background information on the provider Web site and its operators. Information sought includes whether the site is registered as a corporation, where the prescribing doctor is located, and if it has a contracted pharmacy.

"Many of the people who run these Web sites are con-artists," Crawford notes. "They set up shell corporations, making it very hard for us to find them."

It is also important to identify the actual prescribers who are behind illegitimate drug prescriptions. "Internet pharmacy practice is not an exclusive practice of pharmacy by pharmacies," Morrison says. "Most wrongdoing is performed by prescribers who have put on the hat of being a pharmacist. Sometimes it is a nurse who can prescribe, a physician's assistant, or even a doctor or osteopath who thinks it is acceptable to authorize prescriptions by an evaluation form."

According to Morrison, the most abused prescriptions are for Viagra and weight control medications. The patient fills out a simple form, which is then evaluated by a "prescriber." In most cases, there is no way to verify the authenticity of the information.

For companies who are operating illegitimately, money is the main attraction and is used to attract licensed prescribers, Morrison notes. Often, prescribers will be reimbursed $50 per filled prescription. Advertisements seeking prescribers to work for these Web sites have appeared in the classified sections of Washington's local newspapers.

One of the most useful tools for tracking down Web site owners, says Morrison, is www.netsolutions.com, which provides information about the listed operator for a particular site. Investigators can learn the company name, address, telephone number, and a contact name. Every operating Internet site must register with its chosen Internet Service Provider, and this data is public information.

With the information culled from netsolutions.com, investigators can conduct background checks on listed persons. However, it is possible that Web site registrants will use pseudonyms, which will make the investigation longer and more difficult.

"In a recent case," Morrison recalls, "a medical doctor was using a pseudonym when prescribing on an illegitimate Web site. In another case, an osteopathic physician was operating under an alias while selling first aid kits that included legend drugs and controlled substances." He adds that individuals prescribing or selling drugs through one site are often associated with others.

Kansas Assistant Attorney General Fran Brunner also points out that some of the sites her office has brought suit against have been found to operate several other sites under different names.

It can be very difficult to track down individuals because they will be listed with just a first initial and a last name (which may be common names such as Jones or Smith), or may even be listed by only a last name. Crawford says that in one case, they received an 800-telephone number for a doctor, but were told not to expect to ever reach him through the number. She describes another instance when someone they sought, and who was also wanted by 13 other states, had five different addresses. But, she notes there are also many prescribers who are very open about what they are doing, because they think it is a legitimate way to practice.

When investigating illegitimate online pharmacies, it is important to remember that things are often not what they seem. Crawford gives the example of a Web address that is registered to a street address in Utah, but is actually registered for incorporation in Nevada. This is a frequent scenario, she says. If a company is registered as having headquarters in a certain state, but is not incorporated by that state, investigators should check with such states as Nevada and New Jersey, where it is easier to become incorporated.

Preparing for Prosecution

"Once information has been gathered on the online pharmacy's background and its operators, investigators should assess the allegations against the operation," Morrison says. "Did the medication arrive, was it dispensed correctly, or was there information or an examination? These circumstances dictate the investigator's next steps."

If the Web site operation is located out-of-state, Washington inspectors will order the medications themselves. This can be expensive, often costing as much as $150 per prescription, according to Morrison. Once the medication is received, the investigators determine whether it was filled by a legitimate online pharmacy that is licensed in the state of Washington.

Once Washington investigators have conducted their investigation in response to a complaint, they refer their findings to the appropriate regulatory board in their state, such as the medical commission, if a medical doctor commits wrongdoing.

Currently, Kansas has lawsuits pending against six online pharmacy site operators and their prescribers. Brunner says the state began investigating online pharmacy sites in August 1998, and filed its first lawsuit in February 1999. She says none of the lawsuits are criminal suits, as site operators are prosecuted under the Kansas Consumer Protection Act. Defendants are charged with deceptive or unconscionable conduct.

Brunner says she has already seen a decrease in the number of illegitimate Internet pharmacies practicing in Kansas. "I think they are finally getting the message that the states will go after them," she says. "These people are not in the business of healing, but rather want to make money, and when the states prosecute them, it is too high a cost."

Morrison agreed and says he expects that rogue sites will begin to decrease soon. "As the trend toward pharmacy and health care on the Internet grows, I think the agencies that regulate will establish very clear practice standards, such as NABP's VIPPS^TM [Verified Internet Pharmacy Practice Sites^TM] program. As these guidelines are established, I believe the vast majority of practitioners will adhere."

 TOP 

Comments? Click here.