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Minnesota News: The Internet and the Abuse of Prescription Drugs (Part 2)
Repritned from the January 2009 Minnesota Board of Pharmacy Newsletter.
As was noted in the last quarterly Newsletter, the Board recently disciplined five pharmacists and one pharmacy for involvement with Internet Web sites that offered to arrange for the sale of legend drugs. The Web sites paid physicians and a physician assistant, licensed in other states, to write prescriptions based on their review of questionnaires filled out by customers. Those purported prescriptions were then made available electronically to the pharmacists who worked at two licensed Minnesota pharmacies. The pharmacists shipped legend drugs to customers located across the country. Controlled substances were shipped by one of the pharmacies. The actions of the pharmacists violated a number of state and federal laws and rules.
The last Newsletter contained information about a law passed by the Minnesota Legislature earlier this year that establishes that prescriptions for controlled substances and certain other drugs (butalbital, tramadol, muscle relaxants, and erectile dysfunction drugs) are not valid unless the prescriptions or orders are based on a documented patient evaluation, including an in-person examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment. Pharmacists are prohibited from knowingly dispensing prescriptions that do not meet the criteria for a valid prescription. The ways in which the requirement for an in-person examination can be met were explained in the October 2008 Newsletter.
Congress passed a similar law in October 2008 – the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. This law specifies that “no controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act may be delivered, distributed, or dispensed by means of the Internet without a valid prescription.” It defines “valid prescription” to mean a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a practitioner who has conducted at least one in-person medical evaluation of the patient. (That is, the patient must be in the physical presence of the prescribing practitioner.) A practitioner who has not conducted an in-person evaluation is allowed to write a controlled substance prescription for a patient – but only at the request of a practitioner who has conducted an in-person evaluation of that patient.
Under this new federal law, the requirement for an in-person evaluation does not apply when a practitioner is engaged in the practice of telemedicine. Some illegitimate Internet Web sites try to legitimize their actions by claiming that the physicians working for them contact customers by phone and are therefore engaged in the practice of telemedicine. However, Minnesota law is stricter than the federal law in this regard. First, physicians in other states who wish to provide telemedicine to Minnesota residents must pay a fee and register with the Minnesota.
Board of Medical Practice. In addition, prescriptions for controlled substances, butalbital, tramadol, muscle relaxants, and erectile dysfunction drugs are valid when issued by a consultant practitioner who is providing services by means of telemedicine – but only if a referring practitioner has performed an in-person examination. Typically, customers of the illegitimate Web sites have not been referred to the physicians working for the Web site.
The Ryan Haight Act also requires Internet pharmacy Web sites to identify the business, pharmacists, and physicians who are associated with the Web site. This information must be displayed on the home page of the Web site. The new law also empowers a state attorney general to shut down an illegitimate Web site across the country, rather than only barring sales to consumers of his or her state.
The Minnesota Pharmacists Foundation (MPF) recently launched a program designed to increase awareness about the dangers of prescription drug abuse. The program is called AWARxE and it was inspired by the death of St Cloud resident Justin Pearson. Justin passed away on Christmas Day in 2006 from an overdose of prescription drugs – which he ordered online and obtained from pharmacies around the country, including at least one in Minnesota. The Minnesota Board of Pharmacy is one of several organizations that is partnering with the MPF in this effort. Among other activities, AWARxE is partnering with the DARE program to connect local pharmacists and physicians with DARE officers to provide education in schools and communities. Pharmacists wishing to learn more about volunteering or about AWARxE in general can visit the Web site at www.awarerx.org.
