The number of web sites advertising or selling controlled prescription drugs has fallen in the past year, but 85% of those still in existence do not require a prescription, and some have begun selling prescriptions for controlled drugs that can be filled at local pharmacies, according to new US research.

Some site also sell medical consultations which enable Internet users to get controlled drugs online without a proper prescription, adds the study, which is the fifth annual report on the subject published by the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

CASA’s researchers found a total of 365 web sites advertising or selling controlled prescription drugs during 210 hours of research in first-quarter 2008, compared to 581 sites in the same period in 2007. Only two of the 365 sites were certified by the National Association of Boards of Pharmacy (NABP) as Verified Internet Pharmacy Practice Sites, the same number found certified in 2007.

“This decline in the number of web sites advertising or selling controlled prescription drugs may reflect efforts of federal and state agencies and financial institutions to crack down on Internet drug trafficking. Nevertheless, in spite of those efforts, anyone of any age can obtain dangerous and addictive prescription drugs with the click of a mouse,” said Joseph Califano Jr, CASA’s chairman and a former US Secretary of Health, Education, and Welfare. “This problem is not going away. It is morphing into different outlets for controlled prescription drug trafficking like Internet script mills and membership sites that sell lists of online pharmacies, and different payment methods,” he added.

The report found that, of those sites which did not require prescriptions, 42% explicitly stated that no prescription was needed, 45% offered an “on-line consultation” and 13% made no mention of a prescription. The researchers also discovered that: - of the few sites that require prescriptions, half permit them to be faxed, allowing significant opportunity for fraud; and - benzodiazepines - such as Pfizer’s Xanax (alprazolam) and diazepam - continue to be the most frequently offered drugs for sale, with 90% of sites selling them, followed by opioids such as hydrocodone and oxycodone at 57% of sites, and stimulants - eg Novartis’ Ritalin (methylphenidate) and Shire’s Adderall (mixed amphetamine salts) - at 27% of sites.

In 2007, the US Drug Enforcement Administration (DEA) reported that 11% of prescriptions filled by traditional pharmacies were for controlled substances compared to 80% of prescriptions filled by Internet pharmacies, say the researchers, who point out that there are no controls blocking access to these sites by children and teens.

In April, the Senate passed the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which seeks to control Internet trafficking of controlled prescription drugs, and the House Judiciary Committee’s subcommittee on crime, terrorism and homeland security held a hearing on the issue in June.

“We congratulate the Senate, urge the House to take prompt action and the President to sign the bill into law,” said Mr Califano. “Further delays cannot be justified since these rogue Internet sites put a drug dealer in any home or college dorm room with a computer or lap top.” He also applauded federal and state actions to reduce trafficking and MasterCard, Visa, American Express and PayPal for their efforts to shut down illegal access to these drugs using their payment mechanisms.

The CASA report recommends that Internet search engines should block all advertisements for controlled prescription drugs that do not come from licensed and certified online pharmacies, and that the USA should negotiate treaties with foreign governments to help shut down Internet trafficking of controlled prescription drugs.