New Year's Day 2003 stands out sharply in the memory of Robert Forman,
Ph.D., a clinical scientist affiliated with the University of Pennsylvania's
Center for Studies of Addiction and Treatment Research Institute.
Forman learned that an acquaintance was addicted to opioid medications and
obtaining them via the Internet. Forman started perusing the Internet for Web
sites offering to sell such medications without a prescription. "I was
amazed by what I found," he told Psychiatric News.
He was so dumbfounded by the plethora of such sites that he had located
that he and some colleagues decided to launch an explorative study to get a
better idea of their prevalence and content.
Between March 3, 2003, and September 7, 2004, they conducted 47 Internet
searches for such sites. The searches were intended to replicate what Internet
users would undertake if they conducted the searches themselves using terms
such as, "codeine," "Vicodin,""
OxyContin," "no prescription codeine," "no
prescription Vicodin," and "no prescription OxyContin." Each
search was limited to the first 100 sites listed because any Internet search
usually presents the results that are most relevant to the search term
The searches yielded 302 Web sites offering to sell opioid medications
without a prescription, the team reported in the July American Journal of
Psychiatry. The harvest of such Web sites was especially rich when they
prefaced their searches with the words "no prescription." Although
both Google and Yahoo provided access to such Web sites, Yahoo generated
significantly more sites than Google did.
"The whole phenomenon was absolutely jaw-dropping at first—and
still is," Forman said.
George Woody, M.D., a professor of psychiatry at the University of
Pennsylvania and one of the study investigators, told Psychiatric
News that he was both surprised and troubled "by the breadth and
depth of offers to sell prescription opioid medications on the Web without any
meaningful medical evaluation showing that the person requesting the
medication had a problem that required it."
How much Internet users, especially young people, are tapping these Web
sites for opioid medications is not known, the study investigators stated in
their study report. However, three national drug-use monitoring studies have
cited marked increases in prescription opioid use, especially by youth, during
the past five years. These increases could well be due to young people's easy
access to opioid medications via the Internet, suspected the researchers.
And that leads to the question: Why are such Web sites allowed to exist?
One reason, the researchers explained in their study report, is because many
are located in countries that do not require prescriptions for opioid
medications or do not enforce prescription regulations that are in effect in
the United States. For example, of the 302 Web sites that were found to be
selling opioid medications without a prescription, 189 (65 percent) were
registered in 44 countries outside the United States. That leaves, of course,
the remaining 113 (35 percent) that were registered in the United States. The
U.S. Drug Enforcement Administration is taking action against some of these
sites, Forman said, but unfortunately many still abound.
Indeed, during their searches for Web sites selling opioid medications
without a prescription, the researchers came across Web sites selling numerous
other controlled substances as well. These included sedatives, stimulants,
steroids, marijuana, opium poppies, coca leaves, nitrous oxide, psilocybin,
and peyote. Only cocaine, ecstasy, heroin, and LSD seemed to be missing.
All things considered, Wood advised, psychiatrists "should be aware
of the possibility that their patients may be purchasing opioid medications
[or other controlled substances] on the Web and should ask them about it,
especially if their patients are suspected or shown to have a substance use
The study was funded by the National Institute on Drug Abuse Clinical
"The Availability of Web Sites Offering to Sell Opioid
Medications Without Prescriptions" is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/7/1233>.▪