The Internet has become one of the fastest methods used today to divert huge quantities
of controlled pharmaceuticals. Certainly there are benefits to allowing individuals with a valid
prescription to get their prescriptions over the Internet, ranging from simple convenience to
providing individuals in remote areas or with limited mobility with access to needed medications
they may not otherwise obtain. As with many other products, the Internet affords businesses
access to a customer base not possible for a traditional “brick and mortar” location. The
convenience appeals to consumers as well. Legitimate pharmacies operate everyday providing
services over the Internet and operate well within the bounds of both the law and sound medical
practice. In support of these legitimate efforts, the National Association of Boards of Pharmacy
(NABP) has established a registry of pharmacies that operate online and meet certain criteria,
including compliance with licensing and inspection requirements of their state and each state to
which they dispense pharmaceuticals.

Unfortunately, other so-called ‘pharmacy’ sites on the Internet today illegally sell
controlled substance pharmaceuticals. These rogue Internet sites are not there to benefit the
public, but to generate millions in illegal sales. To the uninformed individual these sites may
seem convenient, cost-effective and safe, but to the investigator and the drug-seeking individual
there are indicators on the rogue sites which should serve as a warning that the site is operating
beyond the bounds of what’s safe and legal.

A consumer will notice a level of authorization and accountability with legitimate sites
that is very rare to find with a “rogue” site. Before you even access its main page, an illicit site
will draw you in by advertising powerful prescription medicines. The drugs and their cost (often
designed to convey the sense that the consumer is saving money, when in actuality, they’re
frequently spending far more via “rogue” sites) are the first pieces of information these sites
typically publish in order to get the customer’s attention. More often than not, a “rogue” site will
also validate and process prescriptions based on the completion of a cursory questionnaire. This process is designed to elicit what drug the customer wants and what the method of payment will
be, rather than diagnosing a health problem and establishing a sound course of medical
treatment.

In contrast, a legitimate site will never authorize a prescription based merely on this criterion.
There will be an expectation in working with a legitimate on-line pharmacy that a customer will
have a prescription from a doctor before visiting the site—just as a customer would when
visiting a brick and mortar drug store. While DEA does not certify websites or the legitimacy of
Internet pharmaceutical sales, if an Internet pharmacy follows all rules applicable to their brick
and mortar counterparts (including, but not limited to, ensuring a patient’s right to privacy,
authenticating and securing prescription orders, and adhering to a recognized quality assurance
policy), then the Internet pharmacy is acting in compliance with existing law.

Rogue sites, on the other hand, may provide bogus pictures of individuals wearing white
lab coats designed to imply a level of trustworthiness, but these sites have structured themselves
to avoid accountability for the products they sell. DEA believes a majority of the rogue sites
operating today are based in the United States and work in concert with unscrupulous doctors
and pharmacies. The fact that all of these individuals are complicit in this operation defeats the
important checks and balances that have been established in the legitimate process of supplying
controlled substance prescriptions to patients in need. While DEA has had some law
enforcement successes against these organizations, the criminals promoting this activity are
becoming more sophisticated. Their business model takes advantage of the anonymity of the
Internet, the ease with which new web sites can be created, and the trust of the American people
in the safety and efficacy of pharmaceutical products.

While this business model has evolved significantly over time (and we expect it to keep
doing so), there are three primary players that facilitate these web sites: the doctor, the pharmacy,
and the Internet facilitator. These three players collaborate in an almost seamless fashion.

Illegal pharmaceutical sales are promoted by Internet facilitators who have no medical
training and are not DEA registrants. These facilitators start by targeting doctors who may be
carrying a significant debt, such as a young doctor fresh out of medical school, or those who
have retired and are looking for some extra income. The facilitator convinces these doctors that
it’s OK to approve the prescriptions because they will be provided with some ‘medical history’
(submitted by the “patient” through a web site). Increasingly common is for the facilitator to
provide an opportunity for the doctor to have a telephone conversation with the “patient” or for
the “patient” to fax or email ‘medical’ information to the doctor. The doctor then approves a
prescription for a schedule III or schedule IV substance with the mistaken belief or
“justification” that these substances are not as “dangerous” as those in schedule II. (Note: The
criminal penalties for violations involving schedule II substances can be significantly higher than
for those involving a schedule III or IV substance.) This poorly constructed veil of medical
evaluation is designed to provide added justification for the requested medicine. And for every
prescription the doctor authorizes, the Internet facilitator will pay the doctor ten to twenty-five
dollars. Law enforcement has discovered website-affiliated doctors who authorize hundreds of
prescriptions a day.

The Internet facilitators will also recruit pharmacies into their scheme. They often target
small, independent pharmacies struggling to make ends meet. The Internet facilitator will tell the
pharmacist that all they have to do is fill and ship these prescriptions to customers. The
prescriptions have all been approved by a doctor, and they are only for schedule III or schedule
IV substances. In addition to paying the pharmacy for the cost of the medicine, the Internet
facilitator will also pay the pharmacy an agreed upon amount that may reach into the millions of
dollars. DEA has seen pharmacies close their doors completely to walk-in customers and
convert their entire business to filling these orders.

The Internet facilitator generates the web sites that draw customers into this scheme.
Web sites used by Internet facilitators often mislead the public by advertising themselves as
pharmacies, but they do not operate in the same manner as brick-and-mortar pharmacies. These
rogue sites offer only a few pharmaceutical products for sale, and are typically limited to only
controlled substance and life-style drugs. Advertising typically emphasizes the ability to acquire
controlled substances without a prescription or an appropriate examination, and none include a
face-to-face medical examination from a licensed physician. They provide the customer with a
wide-variety of quick and easy payment methods, ranging from cash-on-delivery to credit ‘gift’
cards. Various steps of the ordering process will link and shift the buyer to different web sites,
making it difficult to connect payments, products, and web providers together. Rarely is there
any identifying information on the web site about where the Internet pharmacy is located or who
owns or operates the web site.

Frequently, and as mentioned in previous paragraphs, these web sites offer, at best,
abbreviated medical interaction. This brief interlude is not meant to elicit meaningful health
information; and is generally done by way of a questionnaire filled out by the customer without
meaningful interaction between the doctor and the “patient”. All too often the questionnaire is a
ruse constructed in a manner solely for the purpose of identifying exactly just what type of
controlled substance the customer is looking to purchase. In some cases, we have seen web site
questionnaires that will not allow the customer to continue unless the ‘right’ information is
entered to “justify” the drugs being requested. For example, if someone wanted a weight-loss
drug, but filled out the questionnaire saying they were five feet tall and weighed ninety pounds,
the questionnaire would not allow the customer to advance until the provided height and weight
were more conducive to someone needing a weight-loss drug.