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Source of Drugs for Prescription Opioid Analgesic Abusers: A Role for the Internet?


Theodore J. Cicero, PhD, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, CB 8134, St. Louis, MO 63110, USA. Tel: 314-362-0459; Fax: 314-362-5630; E-mail:


Objective.  There has been a sharp increase in the abuse of prescription opioid analgesics in the United States in the past decade. It has been asserted, particularly by several governmental and regulatory agencies, that the Internet has become a significant source of these drugs which may account to a great extent for the surge in abuse. We have studied whether this is correct.

Design.  We asked 1,116 prescription drug abusers admitted for treatment, through standardized questionnaires, where they obtained their drugs. We also attempted to purchase scheduled II and III drugs from a random sample of Internet sites offering such sales.

Results.  Dealers, friends or relatives, and doctors’ prescriptions were listed as a source of drugs with equal frequency (≈50–65%), with theft and forgery far behind at 20%. The Internet was mentioned by fewer than 6% of the total responders. Because these data suggest either lack of availability or that our sample has not yet realized that the Internet is a potential source, we attempted to purchase scheduled II and III opioids and the unscheduled opioid, tramadol, from a random sample of 10% of the sites listing such sales. We were unsuccessful in purchasing a single scheduled opioid analgesic, but found that tramadol, as an unscheduled drug, was freely available.

Conclusions.  The assertion that the Internet has become a dangerous new avenue for the diversion of scheduled prescription opioid analgesics appears to be based on no empirical evidence and is largely incorrect.