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Federal law prohibits buying controlled substances such as narcotic pain relievers (e.g., OxyContin®, Vicodin ®), sedatives (e.g., Valium®, Xanax®, Ambien®), stimulants (e.g., phentermine, phendimetrazine, Adderall®, Ritalin®) and anabolic steroids (e.g., Winstrol®, Equipoise®) without a valid prescription from your doctor. This means there must be a real doctor-patient relationship, which by most state laws requires a physical examination. Prescriptions written by "cyber doctors" relying on online questionnaires are not legitimate under the law. Buying controlled substances online without a valid prescription may be punishable by imprisonment under Federal law. Often drugs ordered from rogue websites come from foreign countries. It is a felony to import drugs into the United States and ship to a non-DEA registrant. Buying drugs online may not be only illegal, but dangerous. The American Medical Association and state boards of medicine and pharmacy have all condemned the practice of cyber doctors issuing online prescriptions as unacceptable medical care. Drugs delivered by rogue websites may be the wrong drugs, adulterated or expired, the wrong dosage strength, or have no dosage directions or warnings.

The analysis showed that fewer web sites are selling and promoting controlled substances than last year (361 vs. 581); in the new report, 206 sites were found to advertise drugs and 159 offered drugs for sale. However, only two are "legitimate" pharmacy sites, meaning they have received certification by the National Association of Boards of Pharmacy as a Verified Internet Pharmacy Practice Site (VIPPS). To receive VIPPS accreditation, a pharmacy site must comply with the licensing and inspection requirements of their state and each state that they dispense prescriptions in.

Half of the sites that require prescriptions allowed faxed copies, creating a "significant opportunity for fraud." The drugs most frequently offered for sale were drugs such as Xanax and Valium, followed closely by opioid painkillers including hydrocodone (contained in drugs like Vicodin, Lortab), codeine, and oxycodone (contained in drugs such as OxyContin and Percocet). The number of sites offering stimulants for sale increased to levels not seen since 2004.

The report showed many sites do not require prescriptions: 85% of online pharmacy anchor sites did not require a prescription to buy controlled drugs. Of that group, 42% specifically said that no prescription was needed. 13% never mentioned a prescription. 45% offered an "online consultation." The study also shows that many sites get their drugs from overseas: Slightly less than a fourth of online pharmacy anchor sites said the drugs would ship from a U.S. pharmacy. 40% said they'd come from outside the U.S. 36% didn't say where the drug would be shipped from.

The states’ attorneys general actions against online pharmacies all have been based on similar legal theories concerning violating state licensing laws and laws requiring doctors to prescribe only medications pursuant to bona fide physician-patient relationships[17].