The U.S. Drug Enforcement Administration has released a notice that provides guidance to prescribers, pharmacists, law enforcement and regulatory authorities, and the public concerning the application of current laws and regulations regarding use of the Internet for prescribing, dispensing, purchasing, or importing controlled substances. Controlled substances include narcotics (painkillers), stimulants, depressants, hallucinogens, and anabolic steroids.
The DEA takes issue with the practice of some Internet pharmacies. The DEA is aware that some Internet sites are engaged in the illegal sale of controlled substances. Consumers may be illegally purchasing controlled substances from these Internet sites without realizing that they are committing a crime.
The Internet is a tool expediting communications and business, but the Controlled Substances Act and the DEA regulations on controlled substances still determine when and how these substances may be obtained.
According to the Federal Register, only practitioners may prescribe controlled substances. These practitioners must be registered with the DEA and licensed to prescribe controlled substances by the state(s) in which they operate. The actual physical location of the pharmacy that purchases, stores, and dispenses controlled substances for prescription orders processed by the Internet site must be registered with the DEA, and the pharmacy must have a license from the state in which the controlled substances are stored and dispensed.
Pharmacists must receive written and manually signed prescriptions for Schedule II substances. They may receive oral or faxed prescriptions for Schedule III, IV, and V substances, provided they confirm the legitimacy of the prescription and the practitioner. That confirmation includes verifying the full name and address of the patient; the drug name, strength, dosage form, quantity prescribed, and directions for use; and the name, address, and registration number of the practitioner. As of press time in July, the DEA did not permit the filling of a prescription received via the Internet.
The DEA is currently engaged in a project to determine the requirements for secure, electronic transmission of controlled substance prescriptions between practitioner and pharmacy—requirements that will automatically certify the authenticity of the prescriber, and protect the contents of the prescription.
The Internet is often a tool that facilitates communication between practitioner and patient; however, this dynamic can be abused. It is illegal to receive a prescription for a controlled substance without the establishment of a legitimate doctor/patient relationship.
In a section of the notice addressing abuses observed in human medicine, the DEA indicates it does not intend to limit the ability of doctors who engage in telemedicine, but points out that there are a number of Internet pharmacy sites that are not legitimate. These are sites that do not require a prescription from a doctor, but request that the patient complete a medical questionnaire, to be reviewed by a doctor.
The DEA warns: "The medical questionnaire often has most of the questions set so that if the default answers are not changed, the questions are answered in an appropriate manner to obtain the desired drug."
If the site asks that the customer waive certain rights, does not name the doctor or the doctor's qualifications, the site is "operating in a manner that is not consistent with state laws regarding standards of medical practice and may be engaging in illegal sales of controlled substances," according to the DEA.
The DEA stresses that any request to have a controlled substance shipped to the United States from a foreign country is illegal, unless the request is made by a registered DEA importer.
Additional information can be found at www.deadiversion.usdoj.gov/ecomm/index.html.