Stanford Medicine Newsletter Updates For the Local Community

Follow the money to track illegal Internet drug sales

Fall 2007

Play eases the anxiety of Bernard Dannenberg's young patient.

By Keith Humphreys
Professor of psychiatry and behavioral sciences

The drug dealer of the future is sleek, efficient, sophisticated—and WiFi enabled. As highlighted in a U.S. Senate Judiciary Committee hearing in April, the once-distinct worlds of drug dealing and the Internet are merging, resulting in unprecedented access to potent painkillers like Vicodin and Oxycontin for non-medical use. The fear this situation generates knows no partisan limits: liberal Sen. Dianne Feinstein and conservative Sen. Jeff Sessions are reaching across the aisle to promote greater controls on Internet drug trafficking.

Addictive and potentially lethal medications are available without prescription from more than 2 million Web sites around the world, according to studies conducted by the Treatment Research Institute at the University of Pennsylvania. Many of them are based in countries that impose few legal controls on pharmaceuticals. A no-prescription pharmacy in Tajikistan or Tanzania—which might be little more than a truck with a well-stocked medicine cabinet and a wireless-enabled laptop computer—can sell painkillers to Americans with no fear of local law enforcement.

This growing phenomenon may be fueling the rising tide of prescription drug abuse among adolescents. The 2006 Monitoring the Future survey by the University of Michigan found that 12th graders are five times as likely to have used Oxycontin and 12 times as likely to have used Vicodin as they are to have used heroin in the past year. The average parent or teen probably considers abuse of these drugs less dangerous than abuse of heroin, but in fact they are pharmacologically quite similar, all being potent opiates with high risk of addiction and overdose.

Tech-savvy world

Most adolescents are more tech-savvy than their parents and understandably have less fear of ordering a drug on their home computer or cell phone than they would of venturing out into the street to find a dealer. Many a teenager is home alone when the mail comes, and it takes only a few teens to supply a large number of young people with Internet-purchased drugs.

What to do? Feinstein and Sessions should be commended for taking the important first step of amending the Controlled Substances Act, which was originally passed when Steve Jobs and Bill Gates were 15 years old, to cover the Internet trade of abusable medications. The next step is to develop strategies that limit Internet trade in dangerous non-prescription drugs, while preserving the right of patients with legitimate prescriptions to purchase needed medications online.

The Drug Enforcement Agency has pursued the traditional law enforcement approach of arresting dealers and seizing drugs. This works well for pharmacies physically based in the United States, but most Web-based drug dealing originates in other countries. Even if we were fortunate enough to put all domestic illegal Internet pharmacies out of business, the traffic would simply shift entirely overseas at the speed of a few mouse clicks. Traditional border control methods likewise will have little impact: U.S. Customs and Border Protection can’t inspect more than a fraction of the foreign mail that enters the country each day.

Track transactions

To succeed at suppressing this new form of drug dealing, we will have to recognize a fundamental difference between street and Internet drug deals. Tracking financial transactions on the street—for example, the names and addresses of all the people who contributed to the $5,000 in small bills found on an arrested drug dealer—is very difficult for law enforcement. In contrast, on the Internet, even the smallest financial transactions are electronic, creating a traceable record.

Many a teenager is home alone when the mail comes, and it takes only a few teens to supply a large number of young people with Internet-purchased drugs.

Law enforcement agents could pose as teenagers wanting to buy painkillers without prescription over the Internet, much the same way they currently catch online sexual predators. Once the phony transaction was processed, the information on the seller could be immediately shared with the credit card company and its associated bank. These entities, in turn, could cancel the ability of the seller to do any further electronic transactions online. This process would involve some cost for the credit card companies and banks, but it would benefit them by getting them out of a dirty business.

Policing the financial transactions rather than the drugs themselves may seem an unusual departure from traditional enforcement approaches. But just as the Internet has demanded new ways of thinking about every other area of life, it also requires new ideas for combating dangerous drugs. Efforts to seize Internet-purchased drugs at the border or in far-off nations will have minimal effect, but we don’t need those familiar tools to tackle this problem. The best approach was well summarized by one of the witnesses at the Senate hearing, Dr. Thomas McLellan of the Treatment Research Institute: Just follow the money.

Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford University School of Medicine and an expert on addiction medicine. This opinion piece originally ran in the San Jose Mercury News on May 28, 2007.

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