Joseph A. Califano, Jr.

May 16, 2007

Statement of Joseph A. Califano, Jr.
Chairman and President
The National Center on Addiction and Substance Abuse
(CASA) at Columbia University
Senate Committee on the Judiciary Hearing on Rogue Online Pharmacies: The Growing Problem of Internet Drug Trafficking
May 16, 2007

Mr. Chairman Leahy and Members of the Committee:

Thank you for the invitation to testify today.

The National Center on Addiction and Substance Abuse (CASA) at Columbia University has studied the nation's problem of controlled prescription drug abuse and has documented for four consecutive years the Internet availability of these drugs.

In 2005, CASA released its landmark report, Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. This report revealed that our nation is in the throes of a growing epidemic of controlled prescription drug abuse involving opioids like OxyContin and Vicodin, depressants like Valium and Xanax, and stimulants like Ritalin and Adderall.

From 1992 to 2002, prescriptions written for such controlled drugs increased more than 150 percent, 12 times the rate of increase in population and almost three times the rate of increase in prescriptions written for all other drugs.

Mirroring this increase in prescriptions has been an increase in abuse of these drugs. From 1992 to 2003, the overall number of people abusing controlled prescription drugs increased 94 percent, seven times faster than the increase in the U.S. population. The number of 12- to 17-year olds who abused controlled prescription drugs jumped 212 percent and the number of adults 18 and older abusing such drugs climbed 81 percent.
In 2003, 15.1 million Americans abused controlled prescription drugs, exceeding the combined number abusing cocaine (5.9 million), hallucinogens (4.0 million), inhalants (2.1 million) and heroin (.3 million). Abuse of controlled prescription drugs has grown at a rate twice that of marijuana abuse; five times that of cocaine abuse; 60 times that of heroin abuse.

Particularly troubling are the implications for our children. From 1992 to 2002, new abuse of prescription opioids among 12- to 17-year olds was up an astounding 542 percent, more than four times the rate of increase among adults. In 2003, 2.3 million 12- to 17-year olds (nearly one in 10) abused at least one controlled prescription drug; for 83 percent of them, the drug was an opioid. Teens who abuse controlled prescription drugs are twice as likely to use alcohol, five times likelier to use marijuana, 12 times likelier to use heroin, 15 times likelier to use Ecstasy and 21 times likelier to use cocaine, compared to teens who do not abuse such drugs.

In 2005, 15.2 million Americans abused these drugs including 2.1 million teens.
The explosion in the prescription of addictive opioids, depressants and stimulants has, for many children, made their parents' medicine cabinet a greater threat than the illegal street drug dealer. But, perhaps the most wide-open substance supermarket in the world is the Internet, which has become a pharmaceutical candy store, its shelves stacked with an array of addictive prescription drugs offering a high to any kid with a credit card number at the click of a mouse.

For four years now, CASA, in collaboration with Beau Deitl & Associates, has been tracking online access to controlled prescription drugs. In the first quarter of each year, we have devoted 210 hours to documenting the number of Internet sites advertising and dispensing controlled drugs, the prescription requirements if any, the types of drugs sold, the advertised country of origin and any controls on sale to children. These findings are a snap-shot of availability at a given point in time and show trends from year to year. They do not capture the total number of sites advertising or selling controlled prescription drugs online.

Today CASA is releasing the fourth in its series of annual reports entitled "You've Got Drugs!" IV: Prescription Drug Pushers on the Internet. Here are the report's disturbing key findings:

? From 2006 to 2007, there has been:

A 70 percent increase in the number of sites advertising or selling controlled prescription drugs over the Internet, from 342 to 581;

A 135 percent increase in the number of sites advertising controlled prescription drugs, from 168 to 394;

A seven percent increase in the number of sites selling controlled prescription drugs, from 174 to 187.

? Eighty-four percent of the sites selling controlled prescription drugs do not require a prescription from the patient's physician. Most of the 16 percent of sites that ask for a prescription (57 percent) simply ask that it be faxed, allowing a customer to forge it or use the same prescription many times to load up on these drugs.

? There are no controls stopping sale of these drugs to children.

? Over the four year course of our analysis, the number of selling sites has climbed steadily from 154 in 2004 and 2005 to 187 in 2007.

Since there are no controls preventing sale of these drugs to children, all a child needs is a credit card number and access to a computer and You've Got Drugs! Online purchase of controlled prescription drugs happens beneath the radar screens of Internet providers, financial institutions, shippers and parents. Attempts to crack down on this illegal trafficking are complicated by outdated federal law written before the Internet and inadequate state laws.
Although there is a mechanism in place for certifying Internet pharmacy practice sites--the National Association of Boards of Pharmacy, Verified Internet Pharmacy Practice Sites? (VIPPS®)--the process is voluntary. Of the 187 selling sites found in 2007, only two were certified.

The widespread threat to the public health demands that Congress now take action to:

? Clarify federal law to prohibit sale or purchase of controlled prescription drugs on the Internet without an original copy of a prescription issued by a DEA-certified physician, licensed in the state of purchase, based on a physical examination and evaluation; and,

? Require certification of online pharmacies to assure that they meet rigorous standards of professional practice.

The Feinstein-Sessions Bill--S.980, the Online Pharmacy Consumer Protection Act of 2007--is a step in the right direction. We have some suggestions to strengthen that Bill that we can discuss with your staff.

The report we are releasing today makes other recommendations that I hope you will consider as well, including actions that can be taken in collaboration with Internet search providers, financial institutions and shipping services.

Mr. Chairman and members of this Committee, substance abuse and addiction--involving alcohol, nicotine and illegal and prescription drugs--is the nation's most serious domestic problem, implicated in crime, most killing and crippling illnesses, domestic violence, child abuse, homelessness, poverty, teen pregnancy and the wildfire spread of AIDS and other sexually transmitted diseases. I have titled my new book, High Society: How Substance Abuse Ravages America and What to Do About It, because this problem permeates our social problems. We Americans are four percent of the world's population and we consume two-thirds of the world's illegal drugs.

This problem is all about our children. A child who gets through age 21 without smoking, using illegal drugs or abusing prescription drugs or alcohol is virtually certain never to do so. Over the past 12 years, the fastest growing drug abuse among our nation's children involves prescription drugs. I applaud the work of this Committee to curb the availability of these drugs to our children and pledge to do anything I can to help in your important endeavors.

I am submitting our report along with my Statement for the record.

Thank your for attending to this critical problem and for the opportunity to speak with you today.