The Drug Policy Digest

Wednesday, October 22, 2003
Washington Post Publishes Major Series on Internet Drug Suppliers
Series Examines Regulatory Loopholes and Impaired Physicians Facilitating Online Narcotic Sales

In response to the alleged widespread Internet availability of such drugs as Vicodin, Valium, "Diet Pills," and other controlled substances, The Washington Post and other papers have begun to investigate drug-related overdose deaths and increasing rates of substance abuse.

While online "patients" are typically required to fill out an extensive medical history and report what drugs they are currently taking, it is unusual for the medication requests (actually, orders for specific drugs) to be refused. Online pharmacies claim to have physicians who review each case before approving their orders and may request supplementary documentation of identity or even medical records, but authorities are increasingly convinced that these operations are merely sophisticated drug-dealing operations.

National surveys of high school students indicate that, after marijuana, the abuse of prescription medications (often painkillers, sedatives, and stimulants) are the second most popular form of illicit drug use. Because these drugs are taken by those not named on the prescription or for reasons other than prescribed, this use is regarded as "illicit" under federal surveys. The use of alcoholic beverages by persons under the age of 21 is also illicit but is not reported by these studies.

Details on the rates of prescription drug abuse can be found in such studies as the "Monitoring the Future" survey and the "National Survey on Drug Use & Health (NSDUH)" annual report (previously known as the "National Household Survey on Drug Abuse (NHSDA)."

The Washington Post's first report, "A Vast, Unregulated Shadow Market U.S. Prescription Drug System Under Attack" was published on Sunday, October 19th.

The second article, "How the Internet Became a Pipeline for Deadly Drugs: Internet Trafficking in Narcotics Has Surged" was printed in Monday's edition. And the third segment "Dangerous Doctors Online: Doctors Medicate Strangers on Web" was in Tuesday's edition (October 21st). Part Four "Lax System Allows Criminals To Invade the Supply Chain" is today's piece.

The Washington Post's reporting on this series involved some serious research and legwork, including "... more than 500 interviews and the analysis of 100,000 pages of court filings, regulatory cases, investigative reports and computer records."

Databases at state pharmacy and medical boards permitted The Post to track 50,000 prescriptions for narcotics from various Internet sites. "A breakdown by Zip codes revealed that the preponderance of those drugs flowed to small towns in states with known prescription-abuse problems." Using medical board records, the reporters documented the histories of some of the doctors writing for the online pharmacies, including drug and alcohol abuse, criminal convictions, medical incompetence and financial difficulties.

The Post reporters "reviewed more than 250 lawsuits and criminal cases involving illicit wholesalers, pharmacies, counterfeiters and online drugstores from New York to Los Angeles. To show how tainted medication is introduced into the legitimate distribution chain, reporters also obtained wholesalers' invoices and purchase orders and matched those against records provided by a dozen patients."

In addition, The Post says that "interviews were held with security investigators for drugmakers, state and federal regulators, law enforcement officers, hospital pharmacy buyers, victims of bad medicine, Internet pharmacy operators and felons convicted of drug diversion and Internet fraud. In all, reporters traveled to 12 states, Canada and Mexico. More than 50 Freedom of Information Act requests were also filed."

Thursday, October 16, 2003
Walgreens Accepts Blame in Methadone Error and Forgery Coverup
Pharmacy Dispensed Methadone Instead of Ritalin to 7-Year-Old - Causing Coma and Brain Damage

After having denied the mistake for two years, Walgreen Co. admitted earlier this month that one of its pharmacists mistakenly dispensed methadone tablets rather than Ritalin to a 7-year-old. After taking the medication for 3 days, the concentration of methadone built up in the boy's bloodstream and caused him to lapse into a coma. After six days in the coma, the boy recovered but was apparently left with permanent brain damage. The dispensing error may have been the result of a pharmacist having misread "methadone" for "methylphenidate" (the generic name for Ritalin).

Further adding to the tragedy of this story is the admission by Walgreens that a forged prescription was substituted in the pharmacy records in a clumsy attempt to cover-up the error. Originally, Walgreens' defense claimed that their pharmacy was not missing any methadone and could account for all medication dispensed. However, when the records were produced in court, lawyers quickly became suspicious of the pharmacy's books. They saw that the "inventory log," which appeared to account for all of the methadone pills, had many entries that were crossed out and written over. New Mexico, where the pharmacy is located, is one of 18 states that the DEA says have some form of advanced prescription monitoring program (sometimes called "triplicate" programs) that provide greatly enhanced surveillance of the prescribing and dispensing of highly controlled drugs like methadone and Ritalin. The New Mexico program is not mature yet, and it is designed to prevent illicit "diversion" of controlled drugs by drug abusers and addicts, rather than misreading of a legitimate prescription.

While it is not unheard of for a patient to receive the wrong medication (due to physician error, pharmacy error, or hospital staff error), the lengths to which this pharmacist went to conceal her culpability is shocking, and a clear violation of a number of criminal laws and codes of professional conduct.

The U.S. Food and Drug Administration (FDA) alerted pharmacies last year that six similar incidents had occurred in recent years due to confusing the two drugs. One case resulted in the death of an 8-year-old boy in 1999.

The full story can be read here (*). But be wary of descriptions of methadone as "prescription heroin" (see the Houston Chronicle story) and other misinformation about this medication. Methadone is a valuable painkiller that can be prescribed by any physician who might order Percocet or other strong painkillers for relief of suffering. Like OxyContin, methadone has been unfairly stigmatized in the press due to its use in addiction treatment and its abuse potential -- factors that should not prevent the aggressive use of these medications in patients where they are indicated.

Tuesday, October 07, 2003
Drug Use in Baghdad at "Crisis" Proportions Says BBC Report
Hallucinogenics, Valium, and "Huffing" Said to be Widespread

A report in the World Edition of BBC News says that there is widespread use of hallucinogenic tablets, sedatives, and the "huffing" (inhalation by mouth) of paint thinner or correction fluid (such as White-Out). An atmosphere of "anarchy" is blamed, as is the pre-war release of most of Iraq's prisoners. The consumption of sedative tablets is said to have been popular in the prison system.

Iraqi Youth "Huffing" Paint Thinner

The report says that among the hallucinogens, some 10 to 15 varieties are available. One tablet is known simply as "Lebanon/" A user interviewed said that "When I take it, I see Lebanon, I've never been there. but it's in the tablet." Although marijuana is available, it is said to be very expensive.

Some police officials claim that, two years ago, very cheap hallucinogenic tablets were coming into Iraq as part of a "sabotage" operation from another country. The story gives no details about the chemical composition of the hallucinogens. Read the story here (*).

Friday, October 03, 2003
Arnold and/on Steroids
Can Schwarzenegger's Behavior Be Explained by his History of Steroid Use?

Those watching the California recall race must be fascinated by Arnold Schwarzenegger's emergence as a front-runner. More interesting are the recent allegations of boorish behavior towards women (groping and other "bad behavior") and, largely overlooked, towards men. In short, he seems to be an aggressive man without regard for social norms.

Can his behavior be explained by his (admitted) extensive abuse of anabolic steroids? Read Andrew Sullivan's post on his own experience with "supplemental" testosterone (which he uses under a doctor's supervision for a legitimate illness) and Salon's take on the issue for some valuable perspective. Steve Sailer, who refers to Sullivan as "AndroGel Andrew," also has some insights. AndroGel is the trade name of a transdermal prescription preparation of testosterone.

As to his allegedly pro-Hitler remarks of some 20+ years ago, well I won't judge the man by his father's sins (in this case, actual membership in the Nazi Party), but people under the influence of steroids or other mind-altering drugs have been known to say some very strange things. Just think of Rush Limbaugh for a moment.

Limbaugh, called the "moralizing motormouth" by the New York Daily News, has been implicated in scheme wherein he is said to have used his housekeeper to obtain large quantities of OxyContin and other opiate painkillers for his own use. Before getting too gleeful about this turn of events, see Mark Kleiman's site for some thoughts. Kleiman, who is generally skeptical about such things, says that "having a horrible disease" is nothing to poke fun at. For Mark's view on Limbaugh and the disease of addiction, see his post and follow a few of his links.