This Article  • Extract  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA

To the Editor: Although the US Department of Justice has raised concerns about the sale of illicit drugs such as ecstasy, psilocybin, and gamma-hydroxybutyrate (GHB) over the Internet,^1-3 I am unaware of any articles in the legal or medical literature about the online sale of opiates without a prescription.

Methods
Between March 4 and April 1, 2003, 2 raters examined the first 100 links generated by a Google (http://www.google.com) search using the term no prescription codeine. Links were categorized as "commercial" if they offered to sell opiate-containing medications without a prescription, or made a referral to 1 or more online pharmacies that sold opiate-containing medications without a prescription. Sponsored links were not examined because their listing in Google is purchased by the owner of the Web site and not related to the site's actual ranking in Google.⁴

The first rater created a spreadsheet listing the name and uniform resource locator of the first 100 links generated by the Google search and then categorized each link by examining the resulting Web pages; the second rater used this list to repeat the categorization process independently. Any discrepancies in their ratings were resolved by viewing the links together and reaching a consensus. A domain name registration service (available at http://www.register.com) was queried to determine the countries in which the commercial opiate Web sites were registered.

Results
Fifty-three of the first 100 links generated by the no prescription codeine search were categorized as commercial opiate sites. There was 97% agreement in the categorization of Web sites by the 2 raters. Thirty-five of the commercial opiate sites also offered to sell other abusable medications including barbiturates, stimulants, benzodiazepines, and "date rape" drugs⁵ such as flunitrazepam and GHB. No Web sites offering to sell heroin, cocaine, marijuana, or ecstasy were identified in this search. Twenty-three of the commercial opiate sites were registered to owners outside the United States.

Comment
Little is known about the unregulated sale of opiates over the Internet. These preliminary findings indicate that opiate-containing medications may be available online without a prescription.

Robert F. Forman, PhD
Treatment Research Institute
University of Pennsylvania
Philadelphia

1. National Drug Intelligence Center. National Threat Assessment 2002. Washington, DC: US Dept of Justice; December 2001. 2. National Drug Intelligence Center. Information Bulletin: Drugs, Youth and the Internet. Washington, DC: US Dept of Justice; October 2002. 3. National Drug Intelligence Center. National Threat Assessment 2003. Washington, DC: US Dept of Justice; January 2003. 4. Brin S, Page L. The Anatomy of a Large-Scale Hypertextual Web Search Engine. Presented at: Seventh International World Wide Web Conference; April 14-18, 1998; Brisbane, Australia. Available at: http://www7.scu.edu.au/programme/fullpapers/1921/com1921.htm. Accessibility verified July 24, 2003. 5. National Institute on Drug Abuse. InfoFacts: Club Drugs. Washington, DC: US Dept of Health and Human Services; November 2002.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:889.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Availability of Web Sites Offering to Sell Opioid Medications Without Prescriptions
Forman et al.
Am. J. Psychiatry 2006;163:1233-1238.
ABSTRACT | FULL TEXT  

Innovations: Alcohol & Drug Abuse: Narcotics on the Net: The Availability of Web Sites Selling Controlled Substances
Forman
Psychiatr. Serv. 2006;57:24-26.
ABSTRACT | FULL TEXT