Feel My Pain
Editor's note: This story originally was published online at www.houstonpress.com on Wednesday, June 7. We ran the story earlier than we'd planned because of sudden interest on the part of the U.S. Drug Enforcement Administration. This story was undertaken in part to show the lengths to which some chronic pain sufferers are driven to obtain adequate treatment and relief. Originally another component of our story was to have been to have the drugs tested for purity. Neither the reporter nor the Houston Press intended to be a subject of this report, but events, like our drugs, got away from us.
The pills came while I was out sick.
Sixty-one tablets of generic Vicodin, a prescription painkiller, came to the Houston Press office from a Florida pharmacy. It was my first successful buy in several weeks of investigating the online drug market. To see how easy it would be for prescription drugs to get into the wrong hands, I told a Costa Rican-based online referral service that I had back problems. That story -- meant to show how an addict or a minor could get these drugs -- came back to bite me in the ass. Not just a nibble. We're talking saber-toothed fucking tiger.
The morning of June 7, two agents of the Drug Enforcement Administration walked into the Houston Press office and confiscated my drugs.
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For weeks, I had tried to explain to various DEA offices that I was investigating the online prescription drug market. I called DEA offices across the country at every step of the way: before I bought drugs, after I bought drugs and when I intended to buy more drugs. This was the first time anyone with the DEA had expressed interest.
For the last few years, print and broadcast journalists have run investigations on these kinds of sites. Some shed insight, some have ignored part of the reason they exist in the first place: Study after medical study has shown that, in the United States, chronic pain is undertreated. The American Medical Association, the American Academy of Pain, the American Pain Institute and countless other medical organizations blame a large part of this on the Drug Enforcement Administration.
In January 2005 the National Association of Attorneys General sent an open letter to DEA Administrator Karen Tandy, requesting a visit to discuss the DEA's interest in doctors prescribing opiate-based painkillers. Texas Attorney General Greg Abbott did not sign the letter.
"We hope that together we can find ways to prevent abuse and diversion without infringing on the legitimate practice of medicine," the letter stated. It was signed by 31 attorneys general.
The letter addressed concern that doctors were reluctant to adequately treat patients with chronic pain out of fear of DEA interference. The DEA has arrested dozens of doctors in the past five years for what they say was illegal dispensing of pain medication prescriptions.
This of course leaves legitimate chronic pain sufferers in the lurch. Often immobilized by pain, they feel demonized by law enforcement and abandoned by the health care industry.
By 1999 technology had come to the rescue. Online companies offered help: For a fee, they could hook up a prospective patient with a physician for a telephone consultation. If the doctor believed there was a legitimate complaint, he or she would forward a prescription to a contracting pharmacy, and the meds would be delivered overnight.
Federal and state authorities took interest. Convinced that most of these sites were pill mills approving scrips for any life-form in possession of a credit card, the DEA ran sting operations to investigate where the drugs came from.
However, the sites vary wildly in their standards, as I found out when I undertook my own investigation in May. I wanted to see if it was really as easy as the DEA claimed to get narcotics, and if customers were really getting what they paid for.
I started by calling the DEA's national press office. I wanted to tell them that I was investigating the online drug market and would be making buys. I encountered a brisk woman who simply could not be bothered. She informed me that the national DEA press office was for major media, not local outfits. She told me to contact the local office.
So I did. I called the local public information officer in Houston, and was told they would only respond to questions in writing. I wanted to chat about the whole thing first, but the DEA does not chat. So I started my research.
Searching for pharmacies, I found www.offshore-pharma.com. Without faxing any records or talking to a doctor on the phone, I ordered generic Xanax for $28 on May 12. My money went to a bank in Panama; I was told my drugs were coming from Pakistan. I have yet to receive them.
However, I did receive an anabolic steroid, Sustanon, from another pharmacy. That cost $46 with shipping, and showed up in my post office box straight from Greece.
But rogue pharmacies are anomalies.
The industry is dominated by third-party referral services, which are split into records online pharmacies (ROPs) and no-records online pharmacies (NROP). As their labels indicate, the NROPs do not require customers to fax medical histories, but they still require a telephone consultation.
The ROPs outweigh their counterparts, and their standards, as questionable as they are, indicate that it's probably easier for a teenager to buy Vicodin at school than online. And OxyContin, Painkiller Public Enemy No. 1, is even harder to get. Few online services offer Oxy, and when they do, it isn't cheap.
Since ROPs require faxed medical records and copies of a driver's license and credit card, followed by a telephone consult, it is highly unlikely that the average teenager can buy Oxy online.
But Vicodin is like Skittles, if you can find someone sketchy enough to sell it. And believe you me, I found them. I wish I never had.
After some cursory Googling, I found www.crdrx.com, an ROP whose stock photos of smiling, white-coated medical professionals and promises of speedy delivery beckoned. I could almost hear the doctors saying, "Dude, check our prices. It's a freaking steal. "
And the prices aren't bad: $89 for a telephone consult, $145 for 60 tabs of hydrocodone (generic Vicodin) and $24.50 for two-day delivery (assuming I was approved). Since I have no history of back pain, and no recent doctor visits indicate anything other than hypochondria, I was worried I'd be turned down. But I picked up a copy of my last physical and lab work from my doc, and I faxed them to CRDRX's Las Vegas fax number.
I also had to submit a questionnaire, wherein I had to explain the nature and severity of my pain. I explained that shortly after losing my insurance in January, I got into a car accident, and my pain has been an earth-shattering eight ever since.
I also had to download and fax in a credit card authorization form. Although I was faxing info to Las Vegas, the company listed on the form was in San Jose, Costa Rica.
"Instituto Medico de Capacitacion y Asesoria Laboral, S.A.," the form said. This roughly translates to Medical Institute for Career Training and Development.
Although my medical records showed little other than I was a living, breathing human being, I was approved for a consult. The following evening, I received a voicemail from a man identifying himself as Dr. Jordan Steinberg. He was calling from New York.
I called Dr. Steinberg the next morning and laid it out: no insurance, car accident, mucho pain, me want hydro. After a few minutes, Dr. Steinberg approved me. He also took the time to warn me that hydro was highly addictive and that if at any time I felt like I was taking the drug more than I needed to, there was no shame in seeking help. If that happens, he said, I should call him or a local doc.
Two days later, after taking a sick day, I returned to work to find a UPS package from Florida on my chair. Inside was my hydro, compliments of Liddy's Pharmacy in Lakeland, Florida. The prescribing doctor was some guy named Frantz Achille.
Medical boards in New York and Florida showed no trace of a Jordan Steinberg, but Achille turned up in the Sunshine State. Later, I left a voicemail for Dr. Steinberg explaining who I was. In his subsequent voicemail to me, he explained that he was a medical resident with a heavy school loan to repay. While he wasn't licensed to prescribe, he relayed all his consultation notes to Dr. Achille for final say.
Now that I had made a successful buy, I called CRDRX's customer service line, explained the situation and asked to speak to a representative. The guy who answered the phone (who said he was in Costa Rica) said he'd have company president George Gonzales of Las Vegas call me. He wouldn't release Gonzales's number.
I soon received a call from a man identifying himself as George Gonzales. I told him that, based on my experience, it appeared that anyone with even a minimal medical record could buy narcotics from his site.
Gonzales wouldn't tell me the name of his company (it's not the Web site URL), but he assured me he wasn't doing anything illegal. A search with the secretary of state's office in Nevada found no record of George Gonzales operating a pharmaceutical company or any company related to prescription drugs in that state.
Gonzales said if anyone broke the law, it was me.
"Do we depend more on the veracity, of the truthfulness, of the individual patient or client?" he asked. "Yes, we do. Hopefully, they'll send us legitimate records, and if the records looked altered in any way, shape or form, we do not offer the prescription."
He said company safeguards eliminated about 70 percent of fraudulent shoppers.
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.
For that matter, he said, it's just as easy for someone to hoodwink doctors in person, collecting as many scrips for as many drugs as they want.
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."
According to chronic pain sufferers, it wasn't so much a chill as an ice age. So I wanted to talk to folks who used online referral services, to feel their pain, as it were. So I checked out www.drugbuyers.com. The administrator and moderator graciously let me post my queries, and for the most part I received stories about people in pain fed up with the DEA, HMOs and sensationalist media that demonize an entire segment of the population. For the most part, their stories made sense: I ain't getting help where I should be getting it, so why wouldn't I go online?
Now, here's where we get to the part about the stupidest fucking thing I've ever done in my life, including chewing and swallowing a wad of tobacco when I was eight, just to impress my older brothers.
One poster asked if I had discovered the difference between ROPs and NROPs. I said I had, and explained that one service gave me a consult with laughable medical records, while the other just laughed at me. Someone followed up, asking which online service approved me for the dope.
In the interest of being open and honest and encouraging informed debate, I explained my experience, naming CRDRX.com. It was nothing I hadn't already talked to Gonzales about; it was not an ambush. Unfortunately, I hadn't truly realized that, in a black market, almost anything goes.
A person with the e-mail name "Carlos," who identified himself as a CRDRX.com employee, read my post and decided to exact revenge. Carlos apparently got access to my CRDRX.com account -- separate from the Drugbuyers.com forum. A shrewd operator, Carlos suggested to the forum that my CRDRX.com password might be the same as my Yahoo password. Fortunately for Carlos, I'm an idiot.
Someone went into my personal Yahoo e-mail account, which contained a mixture of professional and personal e-mails. That person deleted every single file.
While doing so, that person could have printed out and copied everything in there. According to a subsequent post on the forum, Carlos allegedly had done this sort of thing before. He was never banned from the forum. It appeared that most people on the forum stood up for Carlos. After all, he was just an honest dude running a drug referral service based in Costa Rica, and I was a biased, bloodthirsty, probably baby-killing journalist who never gave a rat's ass about them in the first place.
Carlos's last victim was never identified as a reporter. It just appears that if someone says something Carlos perceives is negative about his company, he posts their personal information on a public forum. This appears to be tolerated by the people at Drugbuyers.com. They hate journalists more than they hate the idea that if they express skepticism about a particular company, their private information can be exposed.
Knowing that Carlos and whoever Carlos spends quality time with were now reading my private e-mails, I freaked. Being called an asshole reporter is just part of the deal, but I had never been personally violated in the course of a story.
I tried to remember what was in that Yahoo account -- GPS coordinates for the Detroit Denny's where Hoffa's buried? Details of my underground chinchilla farm? My eBay bid for Mussolini's toothbrush? Whatever it was, I didn't want anyone to have it but me.
I panicked. I called our company's attorney and told him what had happened. Our company is usually a voice of reason; unfortunately, I was so freaked at that point that I was impervious to all manner of reasonable thinking. The rest of the world ceased to exist. It was just me and Carlos.
After speaking with the attorney, I sent Carlos a private message, asking him what the next move was. He replied in Spanish. (An earlier stupid move on my behalf: In school, I opted for German instead of Spanish. Scheisskopf!)
"I think that it's safe to say that all of your information is nearby and you should be very careful in how you go forward with the article."
Terrific. Now what is that? A threat? In a foreign language, no less. I couldn't pinpoint any skeletons in that account, but there was communication with some sources for other stories -- shit that was now hanging over my head. The sword of Carlos. I looked at my calendar: 6/6/06. Grrreat.
Naturally, I did what any rational, competent adult would do in this situation: I screamed variations of fuck for quite some time. Fortunately, this was at night, and the place was mostly empty. This time, I called my editor at home. Same thing again: another voice of reason thwarted by a toxic mixture of anger, powerlessness and self-loathing. Reason can't remedy that recipe. Only one thing can: Lone Star. And plenty of it.
The date 6/7/06 was actually worse than the Day of the Number of the Beast. In fact, it officially qualifies as the worst day of my life, and that's because it was my fault.
Around 9 a.m., I got a telepathic message directly from the King of Bad Ideas, Lord of Planet Dumbass. I posted a desperate message on an online forum read by media folks from all across the country. I regurgitated the Saga of Carlos and stated that I felt like my company wasn't backing me up. I'd like to say I don't know what came over me, but I do. Hysteria, impatience, selfishness. It was a bonehead move that made my company out to be villains when, in truth, they had no idea what was going on.
Right after I penned this marvelous opus, things got really bad.
That's when the DEA agent called. He had the public information officer with him, and they wanted to talk business. They wanted to know what drugs I had and where I had them. They wanted me to come in for a meeting. They wanted my notes. They wanted to know everything about the companies I had bought the drugs from.
The agent said he thought my heart was in the right place, but I had crossed the line. That's when I told him that that was one point of my story, just like it was the point of a brilliant weeklong series the Hartford Courant ran in 2005. That series talked a lot about teens getting steroids online. I had spoken with one of those writers, just as I had spoken with a reporter in Kentucky who bought Lortab for a story -- Lortab he opened up in the presence of a sheriff's captain. Kentucky, by the way, is one of three states that have implemented strong enough pharmacy laws that most online services won't ship to them. The other two are Nevada and Tennessee. (That's right, folks, another shock of a lifetime: Texas isn't one of those states.)
I told the Houston agent that we wanted to have the drugs tested to see if they were the real thing. He said it's best that he send an agent to take them off my hands, lest they loose themselves in the community. He said he was sending an agent or two to the office to pick them up.
The U.S. Department of Justice has a policy that deals with accusations of criminal misconduct against the media. This policy generally requires personal approval from the U.S. Attorney General before a member of the media can be charged, arrested, indicted or prosecuted. It reads in part: "This policy statement is thus intended to provide protection for the news media from forms of compulsory process, whether civil or criminal, which might impair the news-gathering function."
Not wanting to be impaired, I immediately called my editor, who immediately called the lawyer, and shortly after that is when the confluence occurred: the perfect storm. The twin attacks of the DEA and my reckless e-mail were working their ways up the company ladder.
Thus, while I was having my ass handed to me in my editor's office, I got a visit from two DEA agents who wanted my drugs, including the Xanax whenever it arrives. Since the DEA likes giving their investigations cool James Bond names like Operation Gear Grinder (for real), I figured they could come up with something for me like Operation Dumbass.
But at least the DEA has my bottle of Vicodin and my tube of steroids. So, you know, Houston's much safer now.
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