Illegal prescribing and dispensing through the Internet continues to thrive. Some of the same methods are being utilized today as several years ago; however, some new twists have developed in the past year or so.

I found that at least 25% to 30% of my daily e-mails are advertisements for illegal prescription drug operations. The question always remains as to which ones will actually send drugs, which ones are total scams, or which ones are sending the receiver a counterfeit replacement. Once again, we need to remember that very legitimate on-line pharmacies exist, but I never seem to get e-mail advertisements from these establishments.

What is not new is that the sites often employ physicians with borderline licenses, usually sanctioned in one or more states, being paid a fee for each prescription written. These physicians combine with equally questionable pharmacists to create a team operating illegally while distributing millions of dosage units of controlled substances, many of which are abused by the receiver, or are sold to others to promote growing prescription drug addictions.

The only semblance of a doctor-patient relationship is usually an on-line questionnaire designed on the honor system. Although past history dictates that if you give the wrong answers, your drugs will usually still be shipped promptly.

Schedule II drugs are virtually impossible to find, with CIII and CIV dominating the illegal market. Hydrocodone tablets will cost the Internet "patient"close to $3 per pill, but a strong market will still allow for them to double their money on the street. Credit cards can still be used, but a strong part of this market now uses popular shipping companies and sends the drugs cash on delivery (COD).

In one situation, prescription drug dealers having a cash flow problem would stop the shipping truck driver in the morning, even though their delivery would not occur until that afternoon. They would purchase 1 of the 2 packages with cash, and tell the driver that they would be able to pay for the other package later in the afternoon. It was obvious to the driver that the trafficking profits from the morning package would pay for the afternoon supply.

Although offshore pharmacies are still in business, some of these Internet sites are now flourishing within the United States, closing up and moving to new physical and Web site addresses periodically. COD charges have become popular with scam-wary receivers who do not want to give out credit card information, or have been ripped off when no product showed up at their doorstep.

I recently received an e-mail from an Ohio law enforcement officer working as a school resource officer in a high school. He told me that he had caught a 16-year-old student selling Xanax to students on a regular basis. During his interview with the youth, he found out that the Xanax was being purchased from the Internet. He was frustrated with the fact that he was having trouble getting to the source of the drugs—the Internet pharmacy.

Unquestionably, millions of dosage units of controlled substances are being distributed to a drug-addicted and/or drug-trafficking population within the United States. Since the supply is seemingly endless, it is no wonder that prescription drug abuse seems to be rising each year, with increased incidents of overdoses. It may also be one of the main reasons that a recent government study indicated a substantial rise in prescription drug abuse for those adolescents aged 12 to 17.

As I have mentioned before, this is not an easy problem to solve, but local, state, and federal law enforcement agencies are attempting to stem this illegal tide of prescription drugs. It is important that we strike a significant blow to this prevalent and still growing national illegal drug source.

John Burke, director of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 32-year veteran of law enforcement. For information, he can be reached by e-mail at burke@choice.net, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.