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Taking on online prescription drug diversion

Rush Limbaugh. Eminem. Brett Favre. Liz Taylor. The names of celebrities admitting and receiving treatment for addiction to prescription medications grows longer each day.

However, prescription drug addiction, once exclusive to the rich and famous, has spilled down to the masses and its list of addicted individuals is far longer.

"This is a problem that has existed for many years but started to significantly increase over the past five years," says Nora Volkow, director of the National Institute of Drug Abuse (NIDA). "Unfortunately, it has not abated, even though the abuse of other substances has gone down."

Rising to meet the demands of the growing number of addicts are rogue online pharmacies, where individuals can buy anything and everything from prescription pain medications and analgesics to stimulants - without a prescription.

Unfortunately, the number of arrests from these illegal sales has not kept pace with the sales themselves, a factor John Burke, president of the National Association of Drug Diversion Investigators (NADDI), attributes to a lack of awareness among law enforcement officers.

"Drug units will execute search warrants and bypass prescription drugs; they are looking for cocaine, marijuana and meth," he explains. "But major cases can grow out of the prescription drugs at the scene."

Marc Gonzalez, director of security for prescription drug manufacturer Purdue Pharma's Law Enforcement Liaison and Education Program, underscores this point by describing a Professional Diversion Intelligence Enforcement Network case that arose from a simple traffic stop. The patrol officer noticed three prescription bottles in the car with a different patient's name on each container.

When he discovered the names didn't match that of any occupant in the vehicle, he contacted the network. This call turned into a 3 1/2-year investigation where agents learned the crime family involved had recruited 14 doctors and five pharmacies in the conspiracy.

The Internet hails as the newest means of trafficking controlled substances, according to Mark Caverly, former section chief of the U.S. Drug Enforcement Administration's (DEA's) pharmaceutical and chemical Internet coordination section. Now the chief of the DEA's Liaison and Policy Section in the Office of Diversion Control, he says officers may encounter these cases during the course of their regular duties and must recognize investigations cannot be worked in a vacuum.

Such awareness is critical, stresses Burke, who remembers a case where a group of individuals were purchasing 600 hydrocodone at $3 a piece every week. They then sold the medications for $6 a pill on the street. "This is not an isolated case," he says. "There are millions of dosage units of prescription drugs coming through the Internet each month."

Is anyone out there?

Charlie Cichon, executive director of NADDI, believes it's more than just a lack of awareness on law enforcement's part that bars departments from making these cases. The problem also can be traced to budgetary and economic pressures. Agencies already lacking the manpower to handle illicit drug investigations may not be equipped to take on the complex online prescription drug diversion case.

"Agencies should designate at least one detective to work these cases," he emphasizes. But the number of specialists each department actually assigns to Internet diversion cases today is all over the board. The Los Angeles (California) Sheriff's Department employs one investigator to work drug diversion cases while the New York City Police Department has no one specialized in this area - neither does the Baltimore (Maryland) Police Department. Meanwhile the Virginia State Police retains 16 field agents to work drug diversion, and this unit's arrest statistics are higher than the 100+ troopers assigned to illicit drugs, Cichon points out. In fact, in 2005 the Virginia State Police unit investigated 1,139 complaints and made 356 arrests on 630 charges.

But does this mean Virginia has greater problems with online pharmacies than Baltimore or Los Angeles?

"No," Cichon says. "Just because the Baltimore PD does not have a detective assigned to work these cases, doesn't mean they don't have a problem with prescription drug diversion. This isn't something that happens in a single state or a single community. It can happen in the smallest rural town to New York City."

Identifying the problem

All law enforcers can learn to recognize a few things about illegal prescription sales. The first step is to be familiar with the problem, says Burke who spent part of his 32-year career heading the Cincinnati (Ohio) Police Department's pharmaceutical theft unit. "These sales are probably going on right under their noses," he says. "Officers need to be on the lookout for it and talk about it at roll call."

From there, officers can identify potential cases at routine calls. "The real knowledge comes from the grassroots - the detectives and uniform guys," Burke says. "They are the ones who deal with folks in their homes. The other professionals who must be aware of this issue are those in our drug units, who might be buying these prescription medications on the street or seeing them at search warrants."

When officers spot prescription medications on a routine call, Burke says it's crucial to inspect the bottle to determine who's prescribing the drugs and where they are originating from. Perhaps packaging within the home indicates the medications came from ABC Pharmacy in Dallas, Texas, but the residence is actually in Ohio. In this case it's critical to ask some questions or at least take the information down.

Later the officer can check into the pharmacy named on the bottle. Every pharmacy in every state is required to have a license and that brings with it specific regulations. For instance, federal law mandates licensed pharmacies maintain a physical location to store medications. Gonzalez suggests visiting the physical site whenever possible. If things appear questionable, federal regulations allow investigative agencies to seize and review the pharmacy's original records.

Officers might also confiscate loose pills for analysis, Gonzalez says, explaining that medication must be in the original manufacturer's container or prescription bottle, or it may be seized. And, when the name on the prescription bottle differs from residents of the home, it shouldn't be in their possession. Once confiscated, an officer can investigate further to ascertain the type of drug and who's supplying it.

To assist in the identification process, Purdue Pharma analyzes its own seized medications free of charge. The company also marks its controlled substances or medications with the potential for diversion or abuse with Radio Frequency Identification (RFID) tags. By simply scanning the RFID, investigators acquire information about the drug from the day it was made until the day it left the legitimate distribution chain. To obtain scanners for this purpose, law enforcement agencies may submit an application to the FBI Law Enforcement Executive Development Association (FBI-LEEDA) at www.leedafbi.org.

What you don't know, the computer can tell you
Often it's something on a computer hard drive seized as evidence that leads investigators to a rogue Internet pharmacy. Investigators with the Virginia State Police's computer evidence recovery unit probe seized computers for media, such as invoices, that indicate the subject may have ordered drugs online. Ledgers also may be printed off.

"There's much they can look for that would point them in this direction," says 1st Sgt. Harvey Smith of the Virginia State Police drug diversion unit.

Some progressive agencies, such as the Ventura County (California) Sheriff's Department, also search the Web to pinpoint illicit pharmacies in their jurisdictions, says Gonzalez, who also is president of the California Chapter of the National Association of Drug Diversion Investigators, where he provides training in pharmaceutical diversion investigations. Detectives can derive a wealth of data from a simple Internet search - if they know what they are looking for, Caverly adds.

In 2005, the DEA initiated 100 new Internet investigations involving the online sales of pharmaceutical controlled substances. These inquiries resulted in the seizure of $44 million in cash, property, computers and bank accounts and led to many arrests. Over the course of these investigations, the DEA has found the following to be common characteristics or red flags indicating an illegal pharmacy:

The drugs for sale. Rogue pharmacy Web sites offer a limited number of medication selections, primarily controlled substances, such as Schedule I or II drugs. "There may be 10, 12 or 15 medications for sale, and they are going to be drugs that are commonly abused," Caverly explains. "They also may advertise lifestyle drugs, such as Viagra, but mostly it will be controlled substances."

Payment method. Most illegal pharmacies refuse third-party payments from legitimate health insurance companies. Payments by credit card or COD are the only means of payment accepted.

Anonymity.

The illicit Web site will not provide an address or identify the physician's name, or if a physician is named, it will be a more common name, such as Dr. John Smith. "In this way, they are anonymizing the process," Caverly explains.

The price of the medication. "When you talk about the Internet, the issue of cheap drugs comes up," Caverly says. "Illegal sites are not offering cut-rate medications for senior citizens. The prices are typically four to 10 times the amount you would pay if you had a legitimate prescription from your doctor."

One physician. Is a single doctor writing all the prescriptions for this pharmacy? This is a lucrative business where doctors may receive anywhere from $5 to $80 for every prescription they write, reports "No Prescription, No Problem" found on Prevention.com.

Geographic area.

If the pharmacy dispenses medication all over the country, that may be a red flag, says Cesar Arias, a pharmacist who investigated drug diversion with the Florida Department of Law Enforcement until his retirement.

Setting up a Web unit

But before powering up the computer, Gonzalez, the former head of the Professional Diversion Intelligence Network/Drug Enforcement Administration, a task force that investigates pharmaceutical drug diversion nationwide, says it's vital an agency has the following on hand:

Standalone computer.

The system cannot have government access. "Some of these people [who run Internet pharmacies] are so sophisticated they can tell when they have a government computer and will exclude it completely," Gonzales explains.

High-speed modem.  CD-ROM and burner.

"You are going to be copying these Web sites for evidence later," Gonzalez explains.

Relationship with online service providers, such as AOL. "If the Web sites have any type of IP address, say AOL, you can serve subpoenas and search warrants, and these organizations will be highly cooperative in providing information," he says.

Fax line. "Many times the company will fax you information," he adds.

Undercover identification and credit card.

An undercover street mailing address for deliveries. Common carriers will not deliver to P.O. boxes.

Advanced skills required

But just setting up for Web searches and following the elements of good investigation may not be enough. These are not "run of the mill" cases.

Internet technology can obscure the source of the product and provide a degree of anonymity to those selling and shipping it. The parties to a transaction can be dispersed geographically and usually never meet. Thus the regulatory and enforcement issues cross state, federal and international jurisdictional lines. Not to mention the challenges of interviewing experts in the health field, who come with a highly specialized knowledge base and skill set.

The officer working these cases needs familiarity with computers, ISPs, pharmacology and commonly diverted prescription medications.

Prescription drug abuse is far more than an affliction of the rich and famous, it affects everyone and every community, and will take the combined efforts of all to fully address the problems it creates.

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