Web sale of drugs targeted Mainers in jeopardy, state authorities say

AUGUSTA – With more than half of Mainers telling pollsters they have access to the Internet, there is growing concern over Web-based “drug stores” that offer access to prescription drugs over the Net with little or no say from a doctor.

“We’re not talking about people filling their prescriptions over the Internet to try and get a lower price,” said Maine Attorney General Steven Rowe. “The concern is sites that sell prescription drugs with no real consultation with a physician.”

Without proper medical supervision, Mainers could be buying the wrong drug for their illness or one that will interact negatively with other medications they are taking – possibly with fatal results.

Type in “prescription drugs” or “cheap drugs” on a computer search engine, and the number of hits is in the tens of thousands. Narrow the search to sites that actually sell drugs, and there are still thousands of choices. And not all are legitimate sites seeking to sell drugs at a discount.

“We took the lead in prosecuting several of these Internet pharmacies,” said Kansas Attorney General Carla Stovall, president of the National Association of Attorneys General. “But as soon as you shut one down, they pop up with another name and another Web site. It is a very serious problem for every state.”

But no state agency has yet received a consumer complaint about an Internet drug sale. Both the state Pharmacy Board and the Board of Licensure in Medicine say they have not received any complaints. Nor has Rowe’s office. But Stovall said the problem has probably occurred in Maine.

“It’s been my experience that these Internet pharmacies have been illegally sending drugs into every state,” she said. “I don’t think any state is safe from this.”

On that, Maine officials agree.

“But I would not say it is not going on,” said Randall Manning, executive director of the medical board. “We have seen the reports it is going on in other states, and we are concerned.”

Manning said the various state doctor-licensing boards closely cooperate to investigate charges of inappropriate or illegal conduct by physicians. He said if a doctor from out of state were prescribing drugs for a patient in Maine, he would ask the licensing board in that state to investigate and take appropriate action.

“And if it were a criminal matter, we would refer it to the Attorney General’s Office for possible prosecution,” Manning said.

Rowe said a doctor practicing in another state who was prescribing drugs to a Mainer, without establishing a doctor-patient relationship, could be charged with practicing medicine without a license. He said he would consider bringing such charges because of the potentially serious consequences to a Maine consumer who received a prescription from a doctor who had never met – let alone examined- the consumer.

“This office will act to protect Maine citizens,” he said. “We are looking at a potentially life-threatening situation if people get prescription drugs without proper oversight by a doctor.”

That is the major concern of Maine health officials. Dr. Dora Mills, director of the Bureau of Health, said it is an issue of growing concern to public health officials across the country.

“I am very concerned this may be happening in Maine,” she said. “There is a real public health concern if doctors are just writing a prescription over the Internet. There is the potential for drug interactions, for example, and that could be very serious.”

And advocacy groups such as Consumers for Affordable Health Care share the concern. The group has worked with people with low incomes and senior citizens to help them get lower-cost drugs in Canada, but only after proper consultation with a doctor. Joe Ditre, executive director of the group, shares Mill’s concern over possible drug interactions.

“The person might forget what drugs they are taking when they fill out that little pop-up screen and all of a sudden they could find themselves having a heart attack, or worse,” he said.

The Internet drug sellers often use an online questionnaire that is then allegedly reviewed by a doctor. Some of the questionnaires seem as thorough as those used in a doctor’s office, but some are not. In some instances, like a highly publicized case from Texas, a doctor follows up with a brief phone consultation before writing the prescription.

“We don’t think that constitutes a proper physician-patient relationship,” Manning said.

Texas officials agree. They took action to suspend the doctor’s license as well as that of the San Antonio pharmacy that was filling the Internet drug orders.

But the nation’s attorneys general admit they are in a difficult battle. A year ago they passed a resolution urging Congress to adopt legislation bolstering the states’ ability to deal with the problem. Differing versions are under consideration in the U.S. House and Senate.

Meanwhile, Stovall warns that the Internet drug companies are taking advantage of the mobility of the Web. Many have moved their base of operations to foreign countries.

“Congress needs to act on providing the Justice Department with the tools to go after these off-shore companies,” she said. “The states already have their hands full at home.”