Medical Marijuana Use Winning Backing
LOS ANGELES, Oct. 29— The Clinton Administration has condemned it as a cynical hoax, the Republican Presidential candidate, Bob Dole, has denounced it as dangerous, and in a letter released today, former Presidents George Bush, Gerald R. Ford and Jimmy Carter call it a threat to the public health of ''all Americans.''
But in the battle over Proposition 215, the California initiative that would legalize the medical use of marijuana for people with AIDS, cancer and other diseases, polls show voters leaning away from politicians' dire warnings and toward the likes of Anna Boyce, a 67-year-old nurse shown in television advertisements that began appearing this week.
Describing her husband's death from cancer, she tells viewers: ''The nausea from his chemotherapy was so awful it broke my heart. So I broke the law and got him marijuana. It worked. He could eat. He had an extra year of life. Proposition 215 will allow patients like J. J. use of marijuana without becoming criminals. Vote yes on 215. God forbid someone you love may need it.''
Three recent California polls show a majority siding with Mrs. Boyce and Proposition 215, which would require only a ''doctor's recommendation'' for marijuana use by patients with AIDS, cancer, glaucoma ''or any other illness for which marijuana provides relief.''
A Field Poll ending Oct. 9 showed that 56 percent of those surveyed would vote for the measure, a private poll in the same period by the campaign for Proposition 215 found 57 percent supporting it, and a Los Angeles Times poll released last week found 58 percent in favor. The opposition never topped 36 percent in the three polls.
Advocates of tough drug policies are deeply concerned, seeing before them the prospect of a precipitous loosening of control over marijuana use in the nation's most populous state.
''We believe the vote of Californians on Proposition 215 is the most important vote they will cast in the 1996 elections,'' said Joseph A. Califano Jr., the former Secretary of Health, Education and Welfare who founded the National Center on Addiction and Substance Abuse at Columbia University. In terms of drug policy nationwide, he added, the vote on 215 is ''unquestionably the most important vote that will be cast in this election,'' particularly because California has been a trend-setter on social issues.
The public support for Proposition 215 highlights a shift in public opinion: even the initiative's foes acknowledge that people are siding ever more decisively with the idea that seriously ill patients should have access to anything that will ease their suffering.
A poll commissioned by Mr. Califano's center found that 58 percent of Californians said marijuana should be available to the dying.
But Gen. Barry R. McCaffrey, President Clinton's drug policy director, complains that the initiative goes much further than help for the dying. He issued a strongly worded statement today, calling 215 a ''falsely labeled, cynical initiative.''
National medical groups have refused to endorse marijuana treatment, he said, adding that the initiative was actually a ''stalking horse for legalization'' because it did not specify that a doctor's prescription be written. It would also send the message to teen-agers that ''marijuana is medicine,'' he said.
''We should ask ourselves whether we really want Cheech and Chong logic to guide our thinking about medicine,'' General McCaffrey said.
Mr. Califano's group, which researches drug abuse and seeks to promote public concern over it, on Monday released the results of its own poll, which showed that Californians' support for the initiative had dropped to just 46 percent.
But proponents of the initiative immediately dismissed the survey as a flawed poll that prompted negative results from respondents and deviated too much from others to be credible. They also objected to opponents' warnings that the initiative would open the door to virtually a blanket legalization of marijuana. Patients in Florida and Ohio already have protections similar to those that 215 will provide, they say.
''At a certain point, the other side needs to stop trying to scare people and confuse voters, and we need to start thinking seriously about how this is really going to work in California,'' said Dave Fratello, a spokesman for the pro-215 campaign, which held its own news conference immediately after Mr. Califano's.
General McCaffrey is not ready to contemplate any such thing. He plans to spend three days in California working with the local police and elected officials to fight the initiative.
A force against the initiative is the mounting alarm nationwide over a recent doubling in marijuana use among teen-agers and voters' concern, as found in the poll sponsored by Mr. Califano's group, that Proposition 215 would lead to increased recreational use of marijuana.
But in its favor there is public sympathy for people like Judith Cushner, a former breast cancer sufferer who described on California television how marijuana had helped her through the pain of chemotherapy. She warned, ''Someday, you may need it.'' In another advertisement, Dr. Richard Cohen, who has defied California law and prescribed marijuana for many cancer patients, says, ''Morphine works. Marijuana works. Let us physicians treat you with every medicine that can help.''
Backers of the initiative have $750,000 to spend on such commercials in the week before the election, Mr. Fratello said. Opponents have managed to raise only $30,000 overall, leaving them fuming that they have been hobbled by the lack of money for advertisements and that denunciations by politicians like Gov. Pete Wilson and Senator Dianne Feinstein are not enough.
''We've been telling people for months that the only way to stop this is to send some money and let us get on the air,'' said the manager of the campaign against 215, Stu Mollrich. ''And nobody's done it.''
Dianne Feinstein
Testimony before the U.S. Senate
Statement of Hon. Dianne Feinstein, U.S. Senator from California
U.S. Senate Committee on the Judiciary
May 16, 2008
Senator Feinstein: [Presiding.] We will reconvene the hearing and continue on. Mrs. Haight, I just want to say welcome. It is wonderful to have you here again. As you know, it was the death of your son that really brought my attention to this issue. And as Mr. Califano has continued on with it, we see how extensive it is and how many people are able to really receive drugs that otherwise would require the prescription of a physician. So I thank you, and although Ryan is not with us, he has made a major contribution to this effort. I want you to know that.
Mr. Califano, I think your report is excellent. I would certainly recommend it to everyone to take a look at this and read it. And Senator Sessions and I have put forward a bill which, as you say, does certain basic things. I believe I would be supportive of adding that banner that you spoke of, Mr. Heymann, to the legislation, and I will talk with Senator Sessions about doing that, see if we can do it. As you know, we have changed some sentences in this.
I think you have raised what for me is a very disturbing part of this, and that is, the world community is now such that the Internet facilitates all kinds of criminal enterprises as well as legitimate enterprises, and Government becomes not able to regulate. I had to leave to vote, and it was a big vote. This is a vote on Iraq. If any of you have any other suggestions of how Senator Sessions and I might tighten up our legislation, the floor would be open to you. I will start with you, Dr. Heymann.
Mr. Heymann: Thank you very much, Senator Feinstein. Of our recommendations, the banner is in some sense the least important. Again, our total focus is on the international aspect. That is where we think it is going, where it substantially is, and we think that is the growth area, and we are very anxious, careful to urge you not to close one of two doors and just let the traffic go through the second door. That will not reduce anything.
Our most important recommendation is that a monitoring group inform MasterCard, Visa, American Express, Paypal whenever it finds their logos at the bottom of an offer to sell a prescription drug over the Internet without prescription.
Senator Feinstein: In other words, that our bill create this group and empower this group to at least inform—is this what you are saying?
Mr. Heymann: We think that one the financing companies are informed, present Treasury regulations require them to take action to stop the transaction and to report the transaction to law enforcement, the purported transaction.
Mr. McLellan: And they do it every day.
Mr. Heymann: And they do it. But they say—we do not believe that they know who it is—they are not monitoring the website with the rigor—the websites, the Internet, with the rigor that they have to if we are going to make it dangerous for someone to sell in exchange for a credit card payment.
So we would like perhaps Treasury to make it perfectly clear that that is required whenever they get information, a lead that someone is selling narcotics without a prescription over the Internet using their credit card, and we would like to have an organization, a very small one—we called it an Internet monitoring group— whose full-time business it would be to monitor the Internet and, with the push of a button, send to the credit card companies, to Paypal—to the Internet service providers, too, because we want something from them—information about who is offering to sell without a prescription.
Senator Feinstein: I would invite Senator Sessions to become involved in this, too, and sort of open it up. My concern is the term ‘‘monitoring group,’’ which is not an official organ of Government, that it seems to me it would be the responsibility of a Government agency to do this and be empowered with authority to even shut down the site?
Mr. Heymann: Shutting down the site is, let’s say, our second most important option. But that will be less useful because it will quickly be replaced. And to monitor sites even now will require a medium sophisticated program because apparently most of the sites are hijacked websites. I was working on it with Mathea Falco a month or two ago, and we played it out, and the site turns out to be the University of Oregon. Somebody has just hacked into the University of Oregon, put up there an offer to sell drugs, and so you have to get behind that offer, which will only, I am told, last for hours. It is a hijacked front. You have to get behind that to who is the real seller, and for that it takes a medium sophisticated program.
Senator Feinstein: Yes, sir, would you like to add something? Then Mr. Califano.
Mr. McLellan: If I could just add to that, the Treatment Research Institute has worked with Drug Strategies and Harvard in doing this, and we think the simplest of all strategies is to simply follow the money. The reflex impulse is to close something down and have a Government action. Please keep in mind now 88 percent of these sites and the figures behind the sites are offshore in countries where it is not necessarily illegal for them to sell drugs to Americans. It is illegal for us to buy. Please keep in mind also that there are issues of entrapment and less than perfect boundaries about authority for the Government agencies. That is why we specifically suggested a nongovernmental group provide actionable evidence. If you had somebody going on a site and actually attempting to purchase and the credit card number were exercised by that company, that is actionable evidence. And in hearings that were conducted by Professor Heymann, we have heard nothing but support from the credit card companies, the delivery agencies, the whole chain of supply, the money supply. So we think that may be the strongest, if imperfect, way of bringing this to a restricted end.
Senator Feinstein: Mr. Califano, did you want to say something?
Mr. Califano: I share your concern. I would not have it as an independent agency. I think if something like this is going to be done, it should be done by Government that is going to be responsive, not a private agency. I do want to second something that Phil said, though. If you notice in our CASA report, just on the sampling of sites we took, of the 152 sites we identified in 2004, by 2005 all but 29 of them were gone. As we have done this in that 210-hour period, in the course of just those 210 hours, sites disappear and pop up again. So that is a very difficult problem. I do think that it should be against the law to have on the Internet any pharmacy that has not been certified, and I think that alone can have a substantial impact here. And there is a system in place for certifying pharmacies, and that can be helpful. I think the other parts of your law are—I think it is a good statute, and my instincts would be to give a good portion of this authority to the DEA, which is the right agency to go after this stuff. I think it is terribly important. And I also think there is an education campaign here that is important, that we need, whether through the Internet or other places, to educate parents and children about the dangers of abusing these prescription drugs. That is one thing. I think we need to have the Food and Drug Administration be required to press these pharmaceutical companies to formulate these drugs in ways that make them much harder to abuse. OxyContin, all you have to do is crush it, and you could snort it, and you have got your heroin high. That is an inexcusable kind of approval, and I think also when there are addictive drugs that are being allowed to come on the market, before they come on the market, the Food and Drug Administration should have a plan—require the pharmaceutical company to have a detailed plan about what to do on the first indication of abuse. That was not true with respect to OxyContin. The plan came afterwards. Aside from all the criminal conduct of those individuals, I think things like that are necessary as well.
Senator Feinstein: Thank you. Mr. Rannazzisi, do you have a comment to make on this, specifically whether it be a Government responsibility or some private entity?
Mr. Rannazzisi: Well, ma’am, we reviewed that proposal, and at this moment in time we are not prepared to provide a recommendation or comment. But I would like to get back to something that we have discussed before with certification in the pharmacies. We look at this as two separate problems. There is a our domestic problem and our international problem. Obviously, we have no regulatory control over international pharmacies, and most of these are not even pharmacies. They are just storefront operations. But we do have regulatory control over the domestic pharmacies, and as we talked about certifying, DEA does not certify pharmacies to operate on the Internet. DEA registers pharmacies to procure and dispense controlled substances pursuant to a legitimate or valid prescription. If you look at the first placard up there, that is a comparison of a brick-and-mortar pharmacy, your normal brick-and-mortar pharmacy that operates in your community every day. That is an average number. They dispense about 88,000 tablets of hydrocodone a year, hydrocodone combination products. Now, if you look at the 2.9 million, that is a rogue Internet pharmacy. Now, remember, a rogue Internet pharmacy is a DEA registrant. Somewhere down the line on that Internet site, they are going to have to get their drugs, if they are domestic, from a brick-and-mortar pharmacy that is servicing that Internet site. The 2.9 million is the average. We took 34 known and suspected Internet pharmacies and looked at their purchase records for 2006. Nearly 99 million hydrocodone combination products were sold out of those pharmacies 99 million. So you could see the great difference. If you look at the second placard, the cyber pharmacies, as compared to the brick-and-mortar pharmacies, your average brick-and mortar pharmacy does about 89 percent of noncontrolled substances as compared to 11 percent of controlled substances. Now, if you look at those cyber pharmacies, about 95 percent—they are not full-range pharmacies 95 percent of their sales are controlled substance sales as compared to about 5 percent, about 425 prescriptions a day. So you could see there is a major difference between the brick-and-mortar cyber pharmacies and—
Senator Feinstein: What are you saying? I mean, do not mince words. What are you saying?
Mr. Rannazzisi: What I am saying is that those are rogue pharmacies that are dispensing outside the scope of good practice. They are doing something illegally.
Senator Feinstein: So are you saying do not worry about them, just let them continue?
Mr. Rannazzisi: No. I am saying that we have to do something about, yes, absolutely, and we are.
Senator Feinstein: I am sorry. I am not aware of what you are doing.
Mr. Rannazzisi: OK. For starters, we are starting to look at their purchase records. Every Internet pharmacy that we have seen has a purchase footprint. We know based on their sales that they are Internet pharmacies. So what are we doing? In addition to going after them criminally, we are also going after them—we are taking their registrations—
Senator Feinstein: How many have you gone after criminally?
Mr. Rannazzisi: Organization-wise, I could not tell you the exact number. I could get back to you on the exact number.
Senator Feinstein: Yes, we would like to have the number.
Mr. Rannazzisi: Absolutely. But I can tell you that we have been shutting these pharmacies down using our regulatory authority and immediate suspension authority. We have gone after them and immediately taken their registration so they cannot dispense and procure controlled substances.
Senator Feinstein: Let me just say something. I introduced this bill with Senator Sessions in 2004. We have heard nothing from you. There is no comment on the bill, there are no suggestions, there is nothing—which indicates to me that it is an agency that is not taking this very seriously, to be very candid with you.
Mr. Rannazzisi: Well, I take exception to that, ma’am. We do take it seriously. In fact, you know, as you can see, using our regulatory authority, we are shutting these down. We are going after the distributor instead of the—
Senator Feinstein: I would like to know how many you have shut down, and today you cannot answer that question.
Mr. Rannazzisi: I will give you an exact number.
Senator Feinstein: I appreciate that. Senator Sessions, would you like to take over? I know a second vote has been called. Or perhaps we should recess again?
Senator Sessions: I may not be able to come back after this vote, so I would appreciate the opportunity to share a few thoughts with the panel.
Senator Feinstein: You go ahead.
Senator Sessions: And thank you for your work on this legislation, your commitment to it. These charts up here are stunning to me. I thought it was bad, but it is worse than I thought.
Senator Feinstein: It is.
Senator Sessions: That is a stunning, stunning chart, and I really should not be surprised based on the experience that I have had in which you see people want these drugs, they learn how to make money off of them, they may be personally addicted to them, they just want to try them, whatever.
Senator Feinstein: Senator, will you continue then?
Senator Sessions: Yes.
Senator Feinstein: I will go and vote and try and come back. Senator Leahy may be back in the interim.
Senator Sessions: Thank you.
Senator Feinstein: Thank you.
Senator Sessions: [Presiding.] All right. Let me ask this. Mr. Rannazzisi, you talked about—I believe, Mr. Heymann, you served as Deputy Attorney General. I remember him here a number of times, know his experience. He has indicated that there are sites up all over saying ‘‘OxyContin without a prescription.’’ Now, how can you get OxyContin without a prescription? I mean, how can this be? Publicly or all over the Internet, hundreds of sites, apparently.
Mr. Rannazzisi: From our experience, those sites are probably operating overseas because OxyContin or oxycodone products are Schedule II. The level—
Senator Sessions: Which means they have to have a—
Mr. Rannazzisi: A written prescription.
Senator Sessions: And if you go to a physician and the pharmacy, they account for every single pill.
Mr. Rannazzisi: That is absolutely correct.
Senator Sessions: Everything is done to the nth degree. The prescriptions have to be maintained and kept so your people can—now, Mr. Secretary, Mr. Heymann, you have been through this Government rigmarole over the years. Both of you have. I am aware of how hard it is for the DEA to get a foreign country to cooperate or move quickly against these sites. It is just a nightmare for agencies. Could the State Department, if they made it a high priority, a condition of good relations or trade, is it a feasible thing to think that we could pressure these companies in the foreign countries?
Mr. Califano: I think the odds of the State Department giving this a high priority are very, very low, and I will just give you— I go all the way back to the Johnson years. When we first saw heroin coming out of the ghettos and into broader society, I talked to Dean Rusk, and I said, you know, ‘‘We have got to do something with Turkey.’’ That is where all the heroin was coming from in 1967. And he said, ‘‘Well, we have to be very careful about Turkey. We need Turkey as an ally in the cold war, and we have to be very measured in our response.’’
The same attitude existed when I was Secretary of HEW. In that 21/2 years, trying to get the State Department—with someone as distinguished and as special as Cyrus Vance being the Secretary— we could not get the State Department to give this subject any priority.
Senator Sessions: Secretary Shultz was not very interested in it, either.
Mr. Califano: Secretary Shultz was not interested in it. And I dare say that if you went to Condoleezza Rice and said, you know, ‘‘We are getting killed by all this stuff coming in’’—it is prescription drugs. It is all illegal drugs, the marijuana, the heroin, the cocaine pouring in here, heroin from Afghanistan. We are going to have the cheapest heroin in the history of the country because of what is happening, the way it is coming out of there. If you said, ‘‘Make that a priority,’’ I do not think it is real. That is why I think we need something like this statute—
Senator Sessions: Now, you think it is impractical—Dr. McLellan, you nodded, and I think Professor Heymann—to expect that we could solve this problem in that fashion. We probably should not go into the details of it because our time is short. But is it being shipped from these foreign countries?
Mr. McLellan: One of the things that is being missed is it is not just registered pharmacies in Afghanistan. Remember, they are called ‘‘rogue pharmacies.’’ These are little factories that are making Vicodin and OxyContin knock-offs. By all means, they have opiate in them, but they are very difficult to regulate, too. And as Phil said, they pop up and they shut down. I repeat, taking nothing away from all the typical Federal ways to go at this, I suggest right now follow the money. Get the source of the dollars and squeeze that neck with the cooperation of existing— and they are very cooperative. The credit card companies, the banks behind those companies, and the delivery agencies want to stop this.
Senator Sessions: Well, we have a group of people—a small group, maybe—who think the Internet is a crime-free zone; that is, nothing is a crime on the Internet. And it is religion with them and that to mess with it at all is a heresy of some kind, a sinful act. But do not want to mess up the Internet and turn it into a lawsuit creating mishmash of regulations and all. Professor Heymann, your idea was that the credit card companies could work with this in a way that they would be happy with?
Mr. Heymann: The answer, Senator, is yes. But we simply do not think that law enforcement—we think DEA has the least chance of being effective as a law enforcement agency operating in the Ukraine or in Somalia because it would require an extradition for DEA to make a case. So, first of all, we will not get any cooperation. Second of all, DEA’s concern is making a case before an American court.
The State Department will also have difficulty, but now and then it may very well be able to press the Ukraine or Somalia to bring a case against a rogue seller in those places. But we think the problem is one of scale. My calculation is that every year, just OxyContin and Vicodin are going to more than half a million high school students. Every year.
Senator Sessions: A half a million?
Mr. Heymann: Half a million. And so we have to find a way to deal with that problem with scale. One case is not going to help much. That is why we want the credit card companies to systematically go after everybody who is—and they are trained to do this. They are doing it under money-laundering legislation that you have passed, and they are very good at it, and they are very accustomed to it. We want them to track down which is the bank that is making payment to a dealer. And if they find the bank, they can have a contract, which it is very hard for us to regulate a bank, the United States to regulate a bank in the Ukraine.
Senator Sessions: My vote time has expired. I hope I have not missed it. If you do not mind, we will return, I am sure.
Mr. Heymann: I would appreciate that, Mr. Sessions.
[Recess at 11:28 a.m. to 11:46 a.m.]
Chairman Leahy: [Presiding.] You know, it is interesting. This is an example of C–SPAN. While I was on the floor voting—and this last vote is still going on—I had two or three Senators in both parties come up to me and talk about this hearing and what they have been seeing, some of the information they are getting and saying, ‘‘We have got to talk with you and with Senator Feinstein and Senator Sessions about this.’’ They did not realize what the problem is. So in case you are wondering, even with this back and forth whether it carries, it does.
Now, we have learned today—and this is a question for everybody on the panel. We have learned today about online rogue pharmacies. They are using electronic forms rather than in-person consultations to give out bogus prescriptions for prescription drugs, including highly addictive painkillers. And it appears that one of the loopholes used by what are, I think we would all agree, unscrupulous online pharmacies that allow access to drugs illegally on the Internet. I want to emphasize that the drug store my family and I go to, and others, if you have tight controls in there, it can be very helpful, both to be able to go online or to call and use a touch-tone phone. But what Senator Feinstein has done is introduce legislation to require in-person consultation with doctors for any purchase of controlled drugs over the Internet. I cannot imagine how that would in any way inconvenience—it certainly would not inconvenience anybody in our family. I think Senator Feinstein’s legislation could be a first step in attacking the serious problem. So let me ask the person from DEA, do you support legislation to require in-person consultations for prescriptions used to buy controlled drugs over the Internet?
Mr. Rannazzisi: DEA, the Department of Justice, and the administration are looking at all different measures that could be implemented. At this point in time, we are not prepared to make a recommendation of a specific measure.
Chairman Leahy: When will you be?
Mr. Rannazzisi: I cannot give you an answer right now, sir. I could tell you right now that all levels of the Department, the Domestic Policy Council, HHS, we are all looking at this together. We are having regular meetings to discuss these issues.
Chairman Leahy: Do you have any recommendations that have been made?
Mr. Rannazzisi: Not at this point in time, sir, no.
Chairman Leahy: Thank you. Secretary Califano?
Mr. Califano: Let me just note—and it is in our CASA report we are releasing today. This is the American Medical Association. ‘‘Physicians who prescribe medications via the Internet shall establish or have established a valid patient-physician relationship. The physician shall obtain a reliable medical history and perform a physical examination on the patient.’’
Chairman Leahy: So by this you would agree with Senator Feinstein?
Mr. Califano. There is no question about that. The four elements of a doctor-patient relationship are that the patient has a medical complaint, that a medical history is taken, that a physical examination has been performed, and that some logical connection exists between the medical complaint, the medical history, the physical examination, the drug prescribed. So it is right on. And the Federation of State Medical Boards agrees with you, too, Senator Feinstein.
Chairman Leahy: Professor Heymann?
Mr. Heymann: As I remember Senator Feinstein’s proposal, it requires at least one meeting, one live meeting with a doctor. That seems to me to be exactly right.
Chairman Leahy: Ms. Haight?
Ms. Haight: Yes, I agree with that totally. That is how it has always been in hospitals.
Chairman Leahy: Dr. McLellan?
Mr. McLellan: Well, I think it is completely appropriate for all legitimate pharmacies, all legitimate physicians, and especially those in the United States. I remind you that more than 80 percent of everything we are talking about has essentially nothing to do with the United States—
Chairman Leahy: I understand. I am trying to figure out, though, what kind of laws are in place that make it easier to block those others, which goes to what Professor Heymann has said about the First Amendment things. You are going to have to have certain legal requirements if you are going to block activity which then becomes illegal and do it constitutionally.
Mr. Heymann: Senator Leahy, our answer to that was to have Internet access blocked for sellers of prescription narcotics only at the request of the households. In other words, any Internet service provider would have to ask every household to which it provides Internet service, ‘‘Do you want this to be blocked?’’ If they said yes, they would then block any further offers to sell drugs.
Chairman Leahy: How many did you find on Mother’s Day when you went on?
Mr. Heymann: Well, they have not done that yet, but I literally— you know, the Google number at the top—
Chairman Leahy: Someone has a BlackBerry nearby.
Senator Feinstein: Me. Sorry.
Chairman Leahy: You are getting a lot of supportive testimony,
Senator Feinstein: Do not block that.
[Laughter.]
Chairman Leahy: Go ahead.
Mr. Heymann: The google number at the top was 800,000. I looked and my search was for ‘‘Buy OxyContin without prescription.’’ It was not Vicodin. It was not steroids. It was a single drug, though many of them would overlap. And I only looked at the first 20 or 30, but each of them looked to me like a purchase—like an offer to sell a highly addictive narcotic to anybody without bothering with a prescription.
Chairman Leahy: Well, the thing that gets me—I mean, I want to find some way to stop it. I think everybody agrees, parents would agree, we do not want pornography to go to our kids. But kids can move around pretty quickly, usually a lot better than parents can, on the Internet because they live on it. I told the story of a 4-year-old grandson wanting to do an interactive—I think it was Disney or something like that, a perfectly appropriate thing where you could draw pictures, do interactive things. He wanted to use the computer to do it. And I said, ‘‘Fine, but I have to get the site for you,’’ because I wanted to make sure that is exactly the site. The site came up, and he said, ‘‘Yes, that is the one,’’ took the mouse out of my hand and said, ‘‘I better take over now because it gets very complicated.’’
[Laughter.]
Chairman Leahy: You mentioned OxyContin. We know how they misrepresent how addictive their drugs were in marketing and advertising. The press has been full of this, especially the last couple of weeks. According to court records, the makers of the drug, Purdue Pharmaceuticals, agreed to pay more than $600 million in fines and penalties. And three of its top executives admitted they were responsible for misleading those who bought and prescribed the drugs. Do we need to change how we regulate these kinds of painkillers? We will go one, two, three, four, five. Go ahead, Mr. Califano.
Mr. Califano: I would make a note of a couple of things. One, a quarter of these sites we know claim to be in the United States. That has been consistent over the 4 years we have done this sample. About half of them say they are overseas, and about a quarter of them are unknown origin. So there are sites in the United States.
Two, with respect to what happened with Purdue Pharma, my own view is if those guys had been street drug dealers, they would be in jail, and they did just as much damage as street drug dealers. So they walked.
And, last, vis-a-vis Senator Feinstein’s point, I would like to quote—we have a quote from Joe Rannazzisi in our report that we are releasing today, and let me read it. ‘‘A legitimate doctor-patient relationship includes a face-to-face consultation where a licensed physician can examine the physical symptoms reported by a patient before making a diagnosis and authorizing the purchase of a prescription medicine. Filling out a questionnaire, no matter how detailed, is no substitute for this relationship.’’ And I realize he does not have authority to support in a formal way what you propose in your bill, but that certainly supports it.
Mr. Heymann: We think that there has to be somewhere—and I am about ready to concede to Senator Feinstein and to Joe that perhaps it should be a governmental responsibility. There has to be someone who is monitoring the Internet to see if somebody—to see the long list of people who are offering to sell prescription narcotics without a prescription.
Once that is done—and I suggest you put it in the Office of Justice Programs, Senator Feinstein. I do not think it is DEA because it is not law enforcement, and the law enforcement is the focus for DEA. And Mr. Califano has already commented on the likelihood that the State Department would be very vigorous. It will not be very vigorous. I would give it to OJP, the Office of Justice Programs, and tell them to set up a small unit. We are talking about five, ten people. A few thousand dollars will create the programs, and then whenever they get information, send it to the credit card companies and expect the credit card companies to cutoff the credit and track down who is getting it, and send it to the Internet service providers and expect the Internet service providers to add it to their list that is cutoff from any family that does not want these ads coming into their house.
Chairman Leahy: I have actually gone beyond my time. I am on Senator Feinstein’s time. I am going to hand it over to her. Does anybody wish to add very, very briefly to what was said?
[No response.]
Chairman Leahy: OK. Thank you. Senator Feinstein, I cannot thank you enough for bringing up this subject, and I can assure you we will work on it, and the Committee will followup on it.
Senator Feinstein: [Presiding.] Well, thank you very much, Mr. Chairman, and thank you for having the hearing because I think it was very constructive. I myself think that we have to develop this second part of it, and we will proceed to do so. I do not know what is wrong with DEA, but something is. All during the methamphetamine discussion, which has gone on for 10 years from when I introduced the first bill in 1996 to the last bill that we did with Senator Talent, I have asked for DEA help, and DEA is nowhere. And now once again, on this issue, which clearly by your own chart is a big issue and clearly by the statement that Secretary Califano read, you have got to agree with it. And yet I do not know whether it is partisan or what it is, but I cannot get help on these matters from DEA. So I would like to just publicly ask for help. I would welcome DEA’s suggestions. I know Senator Sessions will as well. We would like to make this as strong a bill as possible; that people who sell drugs illegally over the Internet without a physician’s prescription, without a physician visit, should be prevented from doing so; and if they continue, shut down. That is my view, and we are trying to get as close to that as we possibly can.
I do not know that the Internet should be able to facilitate acts which are not legal in this country. But when you have young people who, as Senator Leahy testified and Mrs. Haight testified with her son, are so facile on the Internet, are young, want to try any- thing, can have exposure to a whole illegal field of very powerful drugs, it is extraordinarily dangerous. Dr. Heymann, I am amazed. This was on Mother’s Day that you pulled up 800,000 sites? Or was it hits?
Mr. Heymann: Let me send you what I pulled up, Senator Feinstein.
Senator Feinstein: Well, could you define for me again what it was?
Mr. Heymann: I put into Google, ‘‘Buy OxyContin without prescription.’’ I believe the number was 800,000 hits. In an instant, 800,000 hits. I looked through the first 20 to make sure we were not picking up a lot of other things, and the first 20 were overwhelmingly offers to sell OxyContin using a credit card to whoever pushed a button on that website.
Senator Feinstein: Do you remember how many of these were in country as opposed to out of country?
Mr. Heymann: You cannot tell from the website, though Dr. McLellan has some judgment on that.
Mr. McLellan: Yes, in fact, our group was the group that discovered this. Dr. Robert Forman had the first article about this, and we have been tracking it scientifically since then. And, by the way, 800,000 is about the same number for that substance since 2002. And I say that because, to the credit of DEA and the credit of a lot of law enforcement, there have been a lot of busts in this country, and they have knocked out huge rings, and it does not stop because they pop up just as fast. The market is overwhelming. There is a very brisk business in this, and it is not going to go away simply by local law enforcement. You can tell the registry of a site by digging into, you know, where it is—that takes a lot more work. It is almost not worth it because literally tomorrow, if you stopped my website today, literally tomorrow, and in another country, in the snap of a finger, I would have another one up.
Senator Feinstein: And the drug, Dr. Heymann, that you were looking for was OxyContin?
Mr. Heymann: It was OxyContin, and Vicodin would have been many more, I suspect. Many more than 800,000. It was OxyContin.
Senator Feinstein: All right. Does—
Mr. McLellan: Two million nine hundred thousand.
Senator Feinstein: Two million nine hundred thousand?
Mr. McLellan: For Vicodin.
Senator Feinstein: Hits for Vicodin?
Mr. McLellan: If you put ‘‘No prescription Vicodin’’—
Senator Feinstein: Would you turn on your microphone, please?
Mr. McLellan: Sorry. If you put the words ‘‘No prescription Vicodin’’ in Google, right here, right now, you will have no less than 2,500,000 hits.
Senator Feinstein: So, clearly, I mean—
Mr. McLellan: And 88 percent of them are direct offers to sell. I should just say one quick thing. Remember, a telephone is a computer. Now it is clear that if you have a purchase and you give them your website, they will text message you. Some of these pharmacies will text message you, ‘‘Need a refill?’’ And if the kid says ‘‘Yes,’’ you get billed in ring tones, almost as though they are trying to make it impossible for Mom and Dad to check as to what is actually being bought.
Senator Feinstein: Clearly, there is a big problem, and clearly, DEA ought to be producing some solutions. I would like to ask for those solutions. I would like to ask, respectfully, for DEA’s views, any suggestions you might have as to how we can take actions which can effectively stop this. I just hate to think that we have to throw up our hands and say it cannot be stopped.
Mr. Rannazzisi: Ma’am, if I may, we have never said that it cannot be stopped, and we will provide any technical advice that you need, and I think we have to your staff in the past. But the fact remains that when you do a search like that, most of those are portals or information sites. When you get right down to it, when you get right down to the anchor sites that are selling the drugs, there are far fewer than 800,000, or whatever the number is. And domestically those sites are being serviced by one pharmacy or two pharmacies or a hundred pharmacies. Each pharmacy is servicing—I do not know how many.
They could be servicing 30, 40, 50 websites. So the key is not the sites. The key is those pharmacies. The key is to hit the pharmacies and to shut them down. The sites are going to regenerate.
Senator Feinstein: Well, then, why doesn’t DEA shut them down in this country?
Mr. Rannazzisi: We are. We are using our regulatory authority—
Senator Feinstein: Again, I have asked you how many have you shut down, and you cannot give me a number.
Mr. Rannazzisi: And I told you, ma’am, I will give you an exact number that we have shut down.
Senator Feinstein: I was just handed your written remarks, which during 2006, SOD has coordinated over 90 investigations resulting in the arrest of 64 individuals and the seizure of approximately 14 million dosage units of controlled substances and approximately $30.9 million in United States currency.
Mr. Rannazzisi: Yes, ma’am. You wanted the number of pharmacies.
Senator Feinstein: So at least you were doing something.
Mr. Rannazzisi: Well, in all of our investigations, we follow the money, and we put people in jail. That is what our job is. But you wanted an exact number of pharmacies that we shut down, and I told you I would get back to you on that.
Senator Feinstein: OK. Fair enough. Fair enough.
Mr. Rannazzisi: OK.
Senator Feinstein: I think the other thing is any suggestions DEA might have for legislation which is aimed at shutting them down. I recognize the Constitution, I recognize the difficulties, but we have to find a way to do this.
Mr. Rannazzisi: Yes, ma’am.
Senator Feinstein: I think that is probably it, unless somebody else has something that they would like to say. I would like to thank you all very much. I know some of you came from long distances, and it is very much appreciated. So thank you, and this hearing is adjourned.
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