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.

Ops also do a large trade in benzodiazepine tranquilizers such as Xanax, Ativan, Klonopin, and Valium, which can be difficult to obtain from a physician on a regular basis—2 mg "sticks" or diskettes of Xanax meet with special hostility from doctors. Other items for sale include muscle relaxants like Soma and Flexeril, potency or hair-loss remedies for the easily embarrassed, and antidepressants like Prozac and related SSRI medications. Pressed on doctors by drug salesmen who emphasize that they're not controlled substances, they are now shoved down patients' throats as a cure-all for anything from low-grade depression to post-traumatic stress.

Ops can function out of office suites or people's bedrooms. Two very visible and overpriced Florida ops, buymeds.com and tropicalrx.com, shared the same e-mailing list for potential customers. But customers got sick of Pharmanet, the garage pharmacy used by Buymeds. One never knew if the medicines had been sitting in the Miami sun, were old to begin with, or were exposed to heat in transit. With any op there are the usual e-commerce hassles—nondelivery, shorted quantities, credit card overbillings—but many of these seem to be solved quickly as with any other business.

Two of the better ops, norcoworldwide.com and aaamedsworldwide.com, are located near each other in north-central Florida. After an online form listing physical complaints is filled out, a phone consultation is scheduled via e-mail. This basically consists of a few questions, not as coldly put as might appear. "What are you taking now? We offer those in 30, 60, and 90 quantity per month, which would you like? Do you know they're addictive? You're not getting them from anyone else, are you?" Click. The consultation costs $120, but medications are reasonably priced: at Norco, 90 tablets of Lortab 10 and Xanax 2 mg are $82 and $77, respectively. With the consultation good for two refills, prescription prices, apart from the overnight shipping ($28), are only slightly steeper than at many chain drugstores.

International ops (IOPs) present something of a legal risk, especially on quantities of three months or over, which the DEA can construe as enough for resale. Individuals who have ordered from IOPs have received what's known as a "love letter" from the DEA reporting that a package has been seized. If the recipient ignores it, likely nothing will happen. But challenge of the seizure notice sets the stage for legal repercussions from the DEA, and nobody wants that. Some IOPs are quite respectable and deliver slowly but surely, for instance www.pharma24.cc, located in Gibraltar. Under cold and cough remedies, Gibraltar features Perduretas Codeina retard 50 mg, which provides instant pain release when bitten into and chewed. Gibraltar also features one of Europe's most popular pain relievers, Contugesic 60, a time-released codeine derivative, dihydrocodeine. Invented around 1900 for upper respiratory infections and neuralgia, dihydrocodeine is described as a speedier version of codeine, and can offer up to 10 hours of pain relief.

The most offbeat of the IOPs is a secretive individual in the United Kingdom known as the Bioman, who makes no pretense of being a doctor or pharmacist. He goes so far as to offer free samples of Peduretas Codeina, Spanish Ambien, Contugesic 60, Aldonto (Spanish time-release tramadol), and an array of antidepressants, actually fronting samples before payment. Then he sends 20 tablets, all in the original blister packs in a discreet envelope. If you like the 20, you send $20 cash and he'll send 40 more pills. He'll continue doing it in quantities of 60 for three months at a time. The Bioman knowingly never sends enough pills to be construed as for resale.

Surprisingly, there is less overprescribing with ops than with unscrupulous Dr. Feelgoods who give patients enormous prescriptions before either cutting them off abruptly or passing them on to the rehabs they collude with. The limit on ops is usually 90 tablets, and if you use an op that shares the same mail-order pharmacy as your last op before the 25-day legal limit, your order will be bounced. In addition, it becomes cost-prohibitive to go to too many ops. Since ops are cheaper, safer, and easier to use than street-corner dealers, they avoid all Medicaid fraud or drug dealing criminality, and provide a legitimate prescription bottle if a drug test becomes necessary. It's less than a shock to learn that many of the same doctors' names turn up on bottles for different ops; some of the more courteous and obliging have earned word-of-mouth fame. The ops have put a great many street dealers out of business. In the long run, you're paying $1.25 to $2.50 for a pill a dealer would price at $5 to $6, without risk of arrest, burn, or no-show.

It's a free country, and that extends to choosing what medical technique is best for you, be it holistic, acupuncture, or pharmaceutical. The ops are performing a necessary service. Perhaps they're the first step toward the British system, in which many typical minor narcotic remedies are available over the counter and heroin is a legal drug for those who decide to live out their lives on it. Ops have gotten health care for the uninsured. They've cut into the business of the kind of callous doctor who'll tell someone to take Advil for a broken rib. They've even reduced street-corner drug dealing. Whatever the shady accusations, the bottom line is that ops have assuaged people's nerves and eased their pain in a war-torn, depressed America.


Names have been changed to protect anonymity.

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