Could increasing Internet use help explain the recent surge in prescription drug misuse in the U.S.? That’s the hypothesis put forth by a new study published in Health Affairs.
Between 1997 and 2007, Americans’ household access to the Internet went from 18% to 61%; between 1999 and 2003, online sales of prescription drugs grew from $160 million to $3.2 billion.
In the new study, researchers compared states’ growth in high-speed Internet access with their rates of admission to rehabs for problems associated with prescription drugs. The researchers controlled for factors like differences in prescribing patterns between states.
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“In general, for every 10% increase in Internet use, what we’re seeing is a 1% increase in admission to treatment facilities for the most commonly prescribed drugs, things like painkillers and stimulants,” says lead author Dana Goldman, Norman Topping Chair of Medicine and Public Policy at the University of Southern California.
According to national survey data, only 0.1% of painkiller abusers say they get their drugs over the Internet, but these surveys mainly include those who occasionally misuse drugs, not those who are addicted. Occasional users are known to get their drugs overwhelmingly from family members or friends for free — a supply source that can’t exactly support a long-term addiction.
But the National Drug Intelligence Center at the Department of Justice notes that large quantities of mild or moderately strong opioids are purchased online by drug dealers (some rogue online pharmacies do not require a valid prescription for drug purchases), which may represent a way that drugs originally purchased online get to users on the street, without users knowing where they originated.
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“[This study] provides some suggestive information that Internet prescription mills exist and [that treatment admissions] are correlated with greater access to the Internet,” says Dr. Russell Portenoy, chair of pain medicine and palliative care at Beth Israel Hospital in New York City.
But he adds, “to the authors’ credit, they say that this is a hypothesis-generating study and I agree.” In other words, he says, the study cannot prove that increasing Internet use causes increased addiction treatment admissions, only that the two are correlated.
Goldman, however, thinks the link is likely to be causal. “One of the things that gives me a lot confidence in that is that we looked at the relationships with drugs that you can’t really get on Internet like heroin. When you replicate the [findings] using heroin, you don’t find any association [with increased Internet use] and the same is true with cocaine and alcohol,” Goldman says.
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Either way, the findings remind us that rogue pharmacies can be an important illegal source of prescription drugs and that the problem cannot be addressed through current abuse-related policies like increased scrutiny of pain patients or better education of legitimate doctors.
“We have to figure out how to regulate this in ways that are not going to restrict access for legitimate patients,” says Goldman. “The laws [about online prescribing] are quite reasonable — it’s really a matter of enforcement and how much effort is put into policing this.”