PHARMACEUTICAL ROULETTE | Dangerous Doctors Online

Doctors Medicate Strangers on Web

By Gilbert M. Gaul and Mary Pat Flaherty
Washington Post Staff Writers
Wednesday, October 22, 2003

Third of five articles

SAN ANTONIO -- At his worst, Ernesto A. Cantu was injecting himself 10 times a day with Demerol, swallowing tablet after tablet of hydrocodone, taking Ambien to sleep and using Valium for anxiety.

"I became addicted," the stocky 60-year-old doctor said. "It's an illness."

Even as Cantu wrestled with his own addiction, he was writing thousands of prescriptions for painkillers for customers of the Internet pharmacy Those orders were based on brief telephone conversations with patients Cantu never examined or even met. All together, he approved more than 1 million doses of hydrocodone and other dangerous drugs, court records show.

At least five of Cantu's customers were addicts or later became addicted, according to state and federal records. An Alabama patient suffering from chronic alcohol abuse and depression overdosed on hydrocodone and was hospitalized for nine months. A San Francisco patient addicted to narcotics developed liver damage after receiving multiple orders of the painkiller Darvocet. A New Jersey mother previously treated for substance abuse received more than 800 doses of hydrocodone from Cantu and other doctors.

Cantu earned as much as $1,500 a day for writing Internet prescriptions. In nearly eight months, he said, he made $147,000. Other online doctors have made as much as $500,000 a year.

"This is not Albert Schweitzer on the other end of the computer box," said Lee S. Anderson, a physician and president of the Texas State Board of Medical Examiners. "The people who are doing this know exactly what they are doing -- and they are doing it for the money."

Across America, doctors beset by troubled histories work for rogue Internet pharmacies, grinding out tens of thousands of prescriptions each year for narcotics and other controlled substances. What passes for medicine in these online transactions is mostly a fiction. There are no medical records, examinations, lab tests or follow-ups.

The doctors are recruited by middlemen who link them to Internet customers seeking access to the coveted drugs. The result is a virtual pain-management industry that feeds millions of doses of highly addictive drugs into the shadow market for pharmaceuticals, bypassing the normal checks and balances in the physician-patient relationship.

"It's an easy way to make big bucks," said Jerry Ellis of the Drug Enforcement Administration's Houston office. "It's not like any of the doctors are truly practicing medicine or caring for the patients."

Internet pharmacies have attracted doctors with substance abuse problems, legal setbacks and financial woes.

Among them:

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