LegitScript.com has released a detailed report assessing the DEA’s implementation of the Ryan Haight Online Pharmacy Consumer Protection Act (RHA). The federal law, which was introduced by Sens. Diane Feinstein (D-CA) and Jeff Sessions (R-AL), took effect in 2009, and was designed to give the DEA new authority to address “rogue” Internet pharmacies selling controlled substances without a valid prescription.
At the core of the new law was a provision stating that Internet pharmacies can’t sell addictive medications to patients if the patient hasn’t ever been physically examined by the doctor. (Allowing customers to simply fill out a form, or an “online consultation”, is now considered akin to selling drugs without a prescription at all.)
As reported by the Buffalo News earlier this year, DEA senior officials appear to have taken the position that the mere passage of (that is, without needing to file any cases under) the Ryan Haight Act all-but-solved the rogue Internet pharmacy problem in the United States:
The Ryan Haight Act has pretty much eliminated the on-line business in the United States, said Supervisory Special Agent Gary Boggs with the DEA.
The act doesn’t stop rogue pharmacies working overseas, Boggs said, but he noted that it’s already illegal in the United States to buy those drugs from foreign countries. The DEA hasn’t found a large number of foreign sites selling controlled substances, but those that do offer them, often are scams, Boggs said. “Most are scams, or you get something different than what you order,” he said. “They offer to sell you this or that, and you might get Viagra, or you might not get anything.”
Similarly, the Chief of the Pharmaceutical Investigations Section, Robert Hill, stated at a counterfeit drug forum late in 2010 that “the Internet isn’t as big of a problem” (as the audience might think it is); when specifically asked, he conceded that there had been no prosecutions under the new law as of late 2010, and indicated his belief that there’s virtually no problem on the Internet pertaining to controlled substances.
Well. LegitScript begs to differ.
In our report, in contrast to the DEA’s assessment that there simply aren’t many rogue Internet pharmacies offering controlled substances out there any longer, we document 1,000 sample rogue Internet pharmacy websites — a fraction of those that exist — marketing controlled substances without a valid prescription in direct violation of the Ryan Haight Act.
Importantly, most of these illicit pharmacy websites (by our assessment, 55% to 75%) are using US-based servers or Domain Name Registrars.
In our press release, LegitScript was joined by Francine Haight, mother of Ryan Haight (the 18-year old who died from an overdose after purchasing prescription drugs on the Internet, and after whom the federal Internet pharmacy law was named). Ms. Haight said:
I have always had the support of DEA over the years. They fought so hard to get Ryan’s bill passed, so that they would have the tools to shut down these Internet Pharmacies. But, I agree wholeheartedly, they must fight even harder to shut down the Internet drug dealers that are killing our kids and destroying families across the country.
Our report follows a May 2011 study by Massachusetts General Hospital that showed prescription drug abuse increasing fastest in regions with the greatest expansion in high-speed Internet access. That study argued that increased access to rogue Internet pharmacies was to blame.
In our report, we point out several problems with the DEA’s mindset. Among other points, we argue that:
- The DEA is operating on a “pre-Internet” model, only looking to whether there is a “DEA Registrant” (US-based physician or pharmacy) involved in the distribution chain, failing to consider whether there is a US server or Domain Name Registrar that could easily shut down the illegal website.
- The government study (the National Survey on Drug Use and Health) that the DEA relies on to argue that only 0.4% of prescription drug abuse is due to Internet pharmacies relies upon a flawed methodology that fails to account for the “real-world” way that rogue Internet pharmacies operate, and as a result, excludes rogue Internet pharmacy customers from its survey base. (More on that here.)
- Using advanced cyber-crime techniques, rogue Internet pharmacies have found a way to achieve a tricky balance: remain visible enough so that customers can find them, but mask their operations from third parties such as the DEA, intellectual property rights holders, payment service providers like VISA, and Domain Name Registrars. In particular, some rogue Internet pharmacies initially appear to only be offering non-controlled substance prescription drugs, when in fact they are heavily marketing controlled substances.
The DEA plays a critical role in addressing substance abuse, particularly among youth and young adults. The Ryan Haight Act was a tool given exclusively to the DEA; if they don’t use it, who will? Our report concludes with specific recommendations for the agency. Among those recommendations:
- First, the DEA should conduct a thorough threat assessment — a re-assessment — of the nature and extent of the rogue Internet pharmacy problem.
- Second, the DEA simply must reorient its understanding regarding what it means for an Internet pharmacy to be “US-based.” The fundamental question isn’t just whether there is a US-based doctor or pharmacy involved, but also whether the Internet drug dealing is being facilitated by US-based Internet infrastructure.
- Third, the DEA should work with its partner agencies, including the Department of Health and Human Services and Office of National Drug Control Policy, to recalibrate the methodology used to assess the extent to which Internet pharmacies contribute to prescription drug abuse. There are many contributors to the problem, and Internet pharmacies may or may not be the most significant one, but the current methodology is fatally flawed.
As we conclude in our report, the so-called “War on Drugs” –– including that portion which is focused on prescription drug abuse, still the second-largest drug abuse problem in the US –– is not a “war” in the sense that itʼs possible to win it, sign an armistice and go home. But neither can we afford to lose it. The good news is, the Ryan Haight Act does give the DEA the tools it needs to dramatically reduce the number of rogue Internet pharmacies selling controlled substances. Yet those tools sit, gathering dust. The fate of Ryan Haight, and others like him, demand that the DEA take a fresh look at the problem, pick up those tools, and use them.