Feel My Pain

Many of the laws regulating prescription drugs come down to one thing: There must be a valid doctor-patient relationship. The problem is, federal and state laws stop just short of providing a clear definition. As far as Gonzales is concerned, the second a physician gives advice to a person, a valid relationship is born.

And as for the Costa Rica connection? Gonzales assured me that was just a third-party billing outfit. His company, he said, is based in Las Vegas.

Although Gonzales agreed to answer follow-up questions, CRDRX.com later e-mailed that I would be hearing from its lawyers.

I then got Liddy's Pharmacy owner Bruce Liddy on the phone. Like Gonzales, he assured me that what he was doing was not only legal but helpful to chronic pain sufferers ignored by local doctors.

Liddy had felt the government squeeze before. His wife, Melinda, used to run a storefront in the same city called Discount Medicine of Canada. It was one of a handful of Canadian-themed storefronts in Florida where customers could look through catalogs of meds available from Canadian pharmacies. The Florida Department of Health didn't like the smell, so it ran a sting in 2004 and won a permanent injunction in 2005 to close the shop. Melinda then went to work at her husband's pharmacy.

I then spoke to the Houston DEA office again. At this point, I told them I had bought hydrocodone from the CRDRX.com site. This time, talking was enough to pique an interest. However, a public information officer said that would have to be handled through the DEA's national office, home of the brisk woman who had kicked me aside weeks earlier.

Next move was to figure out what, if anything, authorities were doing in Florida. I contacted a spokeswoman at the Florida Department of Health, as well as the head of the department's Board of Pharmacy. Neither expressed awareness of the connection between Discount Medicine of Canada, Liddy's Pharmacy and CRDRX.com. However, Pharmacy Board Director Stacey Wolf asked for any information I had on Liddy's Pharmacy.

I then left a few messages with the DEA's Las Vegas field office.

I explained that I had bought drugs from a company that might be based in their city and that I might buy more.

I asked if Gonzales needed a license to operate. I said I'd like to know what laws, if any, Gonzales and I had broken.

I never heard back from the Las Vegas office, so I called the Los Angeles field office, which handles Las Vegas's public affairs.

For the third time I informed a DEA office that I'd purchased drugs online. A spokeswoman there listened to my story and said she'd get back with some info. She never did.

I tried to purchase drugs with the same spiel through www.rxconsults4u.com, a North Carolina-based online referral service that has contracted with a pharmacy in Stafford. However, they balked at my medical records. No way would they approve a consultation without any indication of an existing condition.

I now had a better understanding of the online market. Some services appeared to have standards and to really want to help. Some had no scruples, but they're all lumped together.

So, in some corners of the law enforcement community, a real problem is ignored: the chronic pain sufferers, those who honestly need their meds and feel they can't get them any other way. And as long as these overlooked folks have access to what they feel is competent, compassionate health care, they will keep the online services in business. It's simply an online version of the failure of the "war on drugs": The natural law of supply and demand is far more powerful than any law the government can dish out.

Some government officials believe there is a more evenhanded approach to enforcing drug laws, an approach that doesn't make physicians too nervous to treat their patients.

In 2001, the National Association of Attorneys General implemented guidelines "supporting balance between the treatment of pain and enforcement against diversion and abuse of prescription pain medications."

In 2004 the DEA issued -- then almost immediately withdrew -- similar guidelines. The DEA then implemented an "interim" policy, still in effect today.

Baffled by its withdrawal, the National Association of Attorneys General issued its open letter to the DEA, stating that the administration's interim policy "emphasizes enforcement and seems likely to have a chilling effect on physicians engaged in the legitimate practice of medicine."