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Government says just 0.5% of Prescription Drug Abuse due to Internet. Why that’s wrong

Every year, the federal government releases a report, the National Survey on Drug Use and Health, that estimates the number of drug abusers in the United States, and which drugs are most commonly abused. The report, which is the single most important document used to determine our nation’s priorities in the War on Drugs, was released again this month.

How much of that is due to the Internet? Some well-respected blogs like Internet Pharmacy Law and Internet Drug Law have already noted that the Internet is not thought to be the main driver in Prescription Drug Abuse. Rather, it is friends and family: those who share unneeded or unused medications.

If we get more granular, however, the government’s study doesn’t make sense: it concludes that just 0.5% of prescription drug abuse is due to the Internet. Common sense, as well as hard data, tells us that this can’t be true. (Side note: in every conversation I’ve had with government officials at ONDCP, the FDA, the DEA, and SAMHSA about this, every single person, without exception, agrees that this number is flawed. This blog explains why.)

Beginning in 2005, survey respondents who admitted abusing prescription drugs were asked how they obtained them. Roughly two-thirds of survey respondents indicated that they obtained the prescription drugs from “friends or family.” And Internet pharmacies? A paltry 0.8%, 0.7%, and most recently, 0.5%, respectively over the last three years.

So just 35,000 Americans ““ 0.5% of the seven million prescription drug abusers in the US ““ are sustaining the multi-billion dollar rogue online pharmacy market? Something doesn’t add up. A closer look at the survey explains why it is flawed, misunderstands common online pharmacy business models, and dramatically understates the role of the Internet in modern-day drug abuse.

First, what drugs are considered in the survey? Controlled substances are, as well as some drugs of abuse that are not (yet?) controlled, like Soma, Tramadol and Fioricet. But what about Viagra, Cialis, Levitra, Nexium, and so forth? These drugs are not evaluated, because they are not considered “drugs of abuse.” Therefore, a huge chunk of the online pharmacy is not represented in the study. It’s also important to remember that the study only attempts to measure the harm caused by prescription drug abuse, and doesn’t touch counterfeiting.

Second, what is the common practice these days for many online pharmacies that do not meet LegitScript’s standards? These sites offer “prescriptions” based on an online questionnaire in lieu of being physically examined by a doctor. As we’ve discussed before, the legitimacy of this practice is questionable. When applied to controlled substances and drugs of abuse, there’s no question that in some cases, these online consultation websites have been an enabler of prescription drug abuse. But in only 1 out of 200 cases?

Unlikely. Here’s the problem. Such websites assure customers that they are being given a “valid prescription.” Yet the government’s drug abuse survey directs participants to answer questions about prescription drug abuse only “if the drug was not prescribed for you.” This results in respondents who purchased their drugs online (most of whom were informed by the online pharmacy that they were being given a valid prescription) simply skipping the questions about prescription drug abuse, making the government’s official finding about how much of a role the Internet plays in prescription drug abuse artificially low. In other words, the government’s study doesn’t define what “prescription” means, adding to the confusion.

A real-world look at hard facts shows how the federal government’s own numbers don’t add up. Consider this: the study estimates that 7 million people were “current” (past-month) prescription drug abusers in 2006. If just 0.5% of those (35,000) people sourced their drugs from the Internet, how do we explain the DEA’s congressional testimony that in 2006, “thirty-four known or suspected rogue Internet pharmacies dispensed 98,566,711 dosage units of hydrocodone (generic Vicodin)”? Even making the impossible assumption that all 35,000 people ordered hydrocodone and no other prescription pills, it would mean that each person ordered more than 2,800 pills ⎯ nearly eight pills a day, from only those 34 websites.

And look to the Department of Justice’s convictions just last month related to, a rogue Internet pharmacy based in Florida. Although the criminal actions took place in 2003 – 2004, from that operation alone, DOJ indicated seizures of nearly $12 million in “rogue” prescription drug money from activity over a 14-month period. Do the math: LegitScript has documented over 10,000 “rogue” online pharmacies. Even if we assume that only 1% (about 100) of the 10,000 online pharmacies are similarly profitable, each of the 0.5% of prescription drug abusers getting drugs from the Internet would each have to spend nearly $35,000 a year on prescription drugs. Again: possible, but not likely.

This flaw in the government’s data has been a valuable tool for opponents of the Online Pharmacy Consumer Protection Act a bill that would crack down on “rogue” Internet pharmacies and clarify that prescriptions written solely on the basis of an online questionnaire are not lawful. If government data shows that the Internet is just half of one percent of the problem, argue the bill’s opponents, why pass a new law? As of this writing, the bill is gradually making its way through the US House of Representatives, but its future is uncertain.

Government data is helpful when it’s reliable. Here, the data have people inside the government scratching their heads: how can we be shutting down all of these rogue pharmacy websites, seizing millions of dollars, but our own studies tell us that the Internet plays almost no role in prescription drug abuse? The answer is easy: the study isn’t asking the right questions the right way, and doesn’t take into account that “online consultation” websites tell the customer that they are being given a valid prescription, all the while enabling drug abuse (in some cases). While the Internet may not be the primary source of prescription drug abuse, it’s not reasonable, based on other objective facts, to believe that the government’s study got it right. As such, the government should re-evaluate the questions in its own survey, and make sure that the data upon which drug policy is based incorporates a real-world understanding of how online pharmacies actually do business.