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The rising access of frequently abused prescription drugs via the internet has created public anxieties within the healthcare system in the United States. Prescription drug abuse refers to the deliberate use of a drug without a prescription from a doctor; or for a different purpose other than prescribed purpose (National Institute on Drug Abuse, 2011, p.1). It is worth to note that prescription drugs are needed by patients who suffer from pain, anxiety and other medical problems. Abuse of prescription drugs has disastrous impacts on the health and economy of a country. For example, the abuse of prescription drugs imposed an additional cost of about $99 billion to the US healthcare sector in 2001(Kraman, 2004, p.1). Online pharmacies have extremely grown in the past few years. For example, the US online sales of prescription drugs rose from $150 million to $3.1 billion between 1999 and 2003 alone (Jena & Goldman, 2010, p.2). In spite of the fact that most patients spent less on drugs procured from internet pharmacies, serious issues have emerged on the growth of illegal online pharmacies that encourage unlimited access to both controlled drugs and ordinary prescription medicines without doctor’s examination or approval. A number of studies have revealed that the unlimited access to online drugs is partially responsible for the swift rise in the number of patients admitted in the US healthcare institutions due to abuse of prescription drugs (Jena & Goldman, 2010, p.1192).
A significant number of the online pharmacies are illegal. For instance, the National Center on Addiction and Substance Abuse, based at Columbia University, found that only two of the estimated 580 online pharmacies that sold controlled prescription medicine were legally approved by the National Association of Boards of Pharmacy. An estimated 84% of the online pharmacies did not demand a prescription from prospective buyers while 56% of the online pharmacies only demanded a faxed prescription, one that could easily be forged and used repeatedly to procure drugs. In reaction to the escalating accessibility of online prescription drugs, the federal government ratified the Ryan Haight Online Pharmacy Consumer Protection Act in 2008 (Levine, 2011, p.26). The law was enacted in honour of Ryan Haight, a teenager who died after abusing prescription narcotics he procured from internet drugstore. The Act barred all online pharmacies from selling controlled prescription drugs to patients who did not have official approval from physicians (Jena & Goldman, 2010, p.1193).
The fact that the frequently abused prescription drugs are extensively procured via the internet augment the premise that the enormous growth in internet services has had a significant impact on the rise in the prescription drug abuse. For example, the number of patients admitted to healthcare facilities for non-heroine narcotics (e.g. oxycodone) from 2000 to 2007rose by 373%, whereas those admitted for alcohol abuse decreased by 4.8%. These figures imply that the observed patterns in substance abuse behaviour alone do not fully explain the rise in abuse of the narcotic painkiller. However, internet use grew during this period. For example, about 17.8% of US homes had internet facilities in 1997. The figure rose to over 60% by 2007. Almost 50% of these homes were using internet for many reasons, including procuring drugs from internet pharmacies. Thus, the rapid growth of internet may have contributed to the rising incidences of abuse of prescription medicine available from internet drugstores (Jena & Goldman, 2010, p.1194).
The US has recorded a steady rise in the abuse of prescription drugs as an increasing numbers of users (aged as low as 12 years) use them for the first time. For instance, the number of first-time abusers of pain medication rose from about 627,000 in 1990 to over 2.9 million in 2000. In addition, the number of first-time abusers of tranquilizers and stimulants also rose during the same period. Moreover, the number of visits to the emergency departments by drug abusers reveals that the abuse of prescription drug is on a steady rise in the US. For example, between 1994 and 2002, mentions of pain drugs by patients who visited emergency departments rose from 44,516 to about 120,000 during this period. Prescription drug are unique when compared to other frequently abused drugs such as crack cocaine and heroin since they can be procured via legal means. Prescription drugs have thus been popular to prospective drug abusers since they are legally produced and prescribed by doctors, thereby granting users the delusion of safety. Moreover, most of these drugs are easily procured from rogue online pharmacies that sell to any person able to afford them (Kraman, 2004, p.2).
Since 1999, online pharmacies have offered a fitting option for individuals who wish to procure prescription drugs. On the contrary, the internet has been illegally used as a tool to divert prescription medicine. There are now numerous online sites, disguised as lawful pharmacies that sell controlled prescription drugs to individuals without prescriptions. This raises a serious health concern about the vulnerability of the over 28 million youths who use internet on daily basis (Kraman, 2004, p.7). For instance, the FDA reported in 2003 that there were about 400 online pharmacies that sold drugs illegally, with half the number operating outside the US. There are a number of concerns about these rogue online pharmacies. These include: the ability to elude state licensing standards and requirements; unlawful distribution of controlled prescription drugs; and providing a bogus or substandard medication. It is very difficult to track and dismantle these sites because they emerge and disappear fast. Illegal online pharmacies usually operate in several states and outside the US, which complicate efforts by law enforcement agencies as state laws cannot be used in other states to dismantle the whole operation (Kraman, 2004, p.8).
Irrespective of the method employed by online pharmacies to distribute drugs, federal and states laws that govern conventional drugstores apply to online sale too (Crawford, 2003, p.58). All pharmacies must be approved in the state where they operate in order to comply with the law. It is also necessary that out-of-the state pharmacies be approved in their state so as to sell drugs to the state residents. There are several ways for states to reduce cases of abuse of prescription drugs procured via online drugstores. For example, each state must only provide prescription drugs for serious medical conditions (e.g. cancer) while at the same time, prevent the diversion of these drugs to the illicit market (Kraman, 2004, p.8).
The need for an effective internet control mechanism will play a crucial role in reducing incidences of online drug prescription. For example, the recommendations by American Medical Association (AMA) offer guidelines for online prescription by doctors. AMA recommends that physicians examine patients first to determine if a prescription is necessary. The physician must also personally assess the patient’s medical history in order to determine the best treatment method. States must play the lead role in supervising the pharmaceutical sector. For example, a number of state medical boards, such as Texas have implemented laws that require doctors to have a face-to-face contact with patients before they can buy drugs online. In addition, since some state medical boards have not addressed this issue exhaustively, the Congress must enact federal laws that will make it compulsory for all online pharmacies to register with the relevant medical boards before they launch their operations. This measure is crucial as an online pharmacy in a non-regulated state can illicitly recommend drugs to an adolescent in a regulated state, thereby limiting the ability of the law enforcement agency to take legal action (Kraman, 2004, p.15).
Education is also a vital component for any program that aims to control online prescription of drugs. One of the reasons why some people buy controlled medication from internet is to manage pain. Healthcare doctors are thus expected to play vital roles in prescribing appropriate drugs for patients so as to help reduce the number of patients who buy these drugs from internet. Sadly, majority of doctors are not well trained on drug abuse. For example, a study done in 1999 revealed that over 46% of doctors were unable to effectively discuss prescription drug abuse with their patients. The study reported that most of the doctors interviewed were unprepared to make a diagnosis of drug abuse (Kraman, 2004, p.13). There is an urgent need for training programs to educate doctors how to diagnose and treat patients with history of drug abuse. For example, the American Academy of Family Physicians has initiated a training program to educate doctors on how to screen for drug abuse and apt pain management methods (Kraman, 2004, p.14). This is an effort in the right direction because patients will now prefer to get medical attention from qualified physicians rather than procure drugs from online drugstores.
References
Crawford, SY. (2003). Internet pharmacy: Issues of Access, Quality, Cost, And Regulation. Journal Medical System, 27: 57-65.
Jena, AB., & Goldman, DP. (2010). Health Affairs: Growing Internet Use May Help Explain the Rise in Prescription Drug Abuse in the United States. Web.
Kraman, P. (2004). Prescription Drug Diversion. Lexington, KY: The Council of State Governments.
Levine, G. (2011). RX Drug Abuse in the United States: The Contributing Role of Rogue Internet Drug Outlets. Web.
National Institute on Drug Abuse. (2011). Prescription Drug Abuse. Web.
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