December 17, 2003

(The New York Times News Service) -- The white FedEx envelope arrived in broad daylight only 48 hours after the order was submitted on the Internet.

Inside was a plastic pill bottle, just like the ones you get when your druggist fills your prescription at the neighborhood pharmacy. The label read: Xanax, 1 milligram, (30 pills).

It was a month's supply of a drug used to treat anxiety -- a highly addictive substance that should be taken only under a doctor's care.

How this powerful medication and other potent drugs came to be delivered illegally to a Texas home is a cause of concern to health authorities in several states. Some may investigate.

No doctor saw the "patient." They didn't talk on the phone. Instead, the patient filled out a token online questionnaire to request the drug.

The patient could have been a child, and no one would have known.

It wasn't; it was the "Fort Worth Star-Telegram."

The questionnaire was supposedly reviewed by a doctor named Nancy Melendez. But no one by that name is licensed in Florida, where Speed Scripts of Miami filled the order. Florida authorities aren't even sure she exists.

But if authorities find the doctor who wrote the prescription, it could result in the loss of her or his license. The pharmacy could also face punishment. Florida -- like most states and licensing boards -- considers it substandard medical practice to write prescriptions without a face-to-face consultation. And pharmacies that fill such orders may face disciplinary action as well.

They aren't the only ones who can be held accountable.

Every day, thousands of Americans are breaking the law by ordering potentially harmful and addictive prescription drugs from what the federal government considers renegade Web sites engaged in the newest form of drug trafficking.

These are not certified pharmacy sites such as CVS, Eckerd and drugstore.com, which are licensed and strictly regulated.

The renegade sites write, fill and sell prescriptions for hundreds of medications such as Viagra, Xanax, Prozac, Percocet, Zoloft, Vicodin, Didrex, Cipro, Ambien and Valium.

There are no back alleys to slink down to score these drugs; they aren't smuggled to consumers under the cover of darkness.

Many Americans with Internet accounts and e-mail addresses receive dozens of unsolicited e-mails hawking the drugs every day.

"Free online consultation. 100 percent safe and confidential. No waiting or embarrassment. Discreet packaging. We write, fill, ship," says Pharmacy Discounts.

"No prescription required. No lengthy forms to fill out," boasts Offshore Pharmacy.

As easily as these online drug pushers find you, it is almost impossible to track them down or to find the prescribing doctor and the pharmacy that filled the order. Web site operations are cloaked in secrecy, often shutting down one day and re-emerging the next under a different name.

During the course of several weeks, the "Star-Telegram" made four online purchases of prescription drugs: Xanax; the weight loss medication and stimulant Didrex; the narcotic pain killer Ultracet; and the antidepressant Prozac.

Four Web sites were used. Each required completing a short questionnaire. The drugs all arrived within 48 hours of being ordered.

This doesn't surprise Susan Winckler, vice president for policy and communications for the American Pharmacists Association, but it dismays her.

"Why are health care professionals, with obligations to protect patients' health, not showing more discretion?" asked Winckler, who is a lawyer and pharmacist.

It was a rhetorical question.

It's about the money.

Doctors who write online prescriptions can earn thousands of dollars a month. For each one they sign, they may earn $20 or more.

Pharmacies that ask few questions and fill the orders can also profit.

But it's the Web sites that are really cashing in on what authorities believe is a multimillion-dollar-a-year business fueled by the fact that most patients will regularly order refills.

"If I had a choice of selling heroin or crack, I'd go online and sell illegal prescription drugs on the Internet," said Carmen Catizone, executive director of the National Association of Boards of Pharmacy.