Go E-Mail the Doctor

Online Pharmacies Offer Relief to the Uninsured, Vulnerable, and Desperate

We've all received spam offering online prescriptions. Usually spammers come on with remedies for depressed limp cocks and diet pills for those who want to slim down. Then there are murkier offers of painkillers and tranquilizers. Some of these sites are obvious scams, demanding blank Western Union money orders, envelopes of cash mailed to Mexico, or a phone call to California that's answered with an unintelligible accent. Some are the real deal.

There are online pharmacies—known in Net parlance as "ops"—that FedEx their promise from a garage pharmacy to your door. Lately, these setups have attracted sensationalistic media attention charging quackery or just lowdown dirty drug dealing. Self, where ads revolve around fitness and vitamins, revived the old wheeze "a fool is his own physician." Message boards are full of rumors about stories on Dateline and 60 Minutes in the works. In reality, however, ops serve the needs of Americans who don't have health insurance, can't afford regular doctor visits, live in remote areas, or need to evade local prescribing guidelines.

Patrons include folks from every walk of American life. Many have children. Not the types to buy drugs illegally with the associated thrills and spills. More likely their insurance doesn't cover painful conditions like fibromyalgia, or surgery has left them with complications, or they don't want a psychiatric paper trail regarding their use of tranquilizers or antidepressants, or they have absorbed painkillers into their metabolisms and have no intention of giving them up. Op customers know what medicines they react well to. They have been prescribed them in the past. They cannot afford the money and aggravation of having a doctor refuse them meds they feel comfortable and functional on. The head of a leading op told me anonymously, "We're dealing with an upper socioeconomic bracket. Less than 1 percent of the patients we call are incoherent, can't spell their own name or repeat their phone number. I see the doctor have to briefly compose himself after these calls, but they are few and far between."

illustration: Insu Lee

On bluntly titled message boards like findrxmeds.com and drugbuyers.com, you can find businessmen, artists, stewardesses, housewives. J.R., who lives in the Ozarks, has a bulging T-12 disk from an auto crackup but can't shell out $800 for an MRI. Katie, a flight attendant who lost two friends on 9-11 and is terrified to go back to work, is suffering from anxiety disorder on top of fibromyalgia. She was told by her chiropractor that she could buy pain medicine online. Dee, from suburban New York, once had a sympathetic doctor who was prescribing her 120 mg Percocet a month for her migraines, but then lost his ability to write narcotic Rx's. Madeline, a native New Yorker, can't get over 9-11 and has chronic back and leg pain that started with a subsequent apartment fire: "My whole world changed for the worse and with a deadly finality that day. It'll mark me forever. It was like being fucked in the ass with an elm tree. That pain requires serious coverage. If I didn't get it from the ops, it'd be a worse scene for me."

Financially, mentally, and spiritually, the nation is in a depression. Jobs are hard to find and few provide affordable health coverage. Medicaid is only available to the zero-dollar destitute and useful mainly for emergency room visits, and in this day of welfare reform the few doctors who accept Medicaid frequently refuse to write painkiller prescriptions. New York state requires a triplicate form. So getting prescriptions is difficult for many Americans.

A doctor may write for benzodiazepines—the Valium family—once or twice before attempting to shuffle a patient off to a psychiatrist, and this after charging $100 to $250 per visit. Physical conditions that require narcotic analgesics come with the looming threat of the institution known as the pain clinic, the approximate inverse of that American gulag, the rehab. There you can be subjected to a battery of expensive tests, have your brain creepy-crawled by intrusive and dated psychological exams, receive useless treatments like biofeedback, and still not receive the medication you feel is right for you. Many pain clinics simply drain the patient's insurance money and waste their time. And even sympathetic doctors are in a tricky position, because they're required to report the Rx's they write to the DEA. If they write too many, they jeopardize their license.

Most reputable ops originate out of Florida, where offbeat businesses sprout like palm trees—tropicalrx.com, erxonline.com, aaamedsworldwide.com, norcoworldwide.com, and buymeds.com, the last now in limbo due to legal challenges. What people seek from ops is controlled-substance painkillers or tranquilizers in the Schedule III-V categories—not Schedule II narcotics like OxyContin, morphine, or Dilaudid. The most popular painkiller is the semisynthetic opioid hydrocodone compounded with acetaminophen, offered with anywhere from 325 to 750 mg of acetaminophen combined with 5, 7.5, or 10 mg of hydrocodone. Hydrocodone, originally invented as an antitussive, has dozens of formulations and generics, including Vicodin, Vicodin ES, Vicodin HP, Lorcet 10, Lortab 10, and Norco 10. In addition to relieving pain, hydrocodone can cause euphoria in sufficient doses, providing an "awake" feeling like that of a heroin-cocaine speedball. It has a longer half-life than many painkillers and is highly addictive.

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