Joseph A. Califano

Testimony before the U.S. Senate
Testimony of Joseph A. Califano, Jr., Chairman and President, National Center on Addiction and Substance Abuse at Columbia University, and former Secretary, Department of Health, Education and Welfare, New York, New York

U.S. Senate Committee Committee on the Judiciary
May 16, 2008

Thank you, Mr. Chairman, for the invitation to testify today. The National Center on Addiction and Substance Abuse at Columbia University has studied the Nation’s problem of controlled prescription drug abuse and has documented for 4 consecutive years the Internet availability of these drugs.

In 2005, CASA released its landmark report, ‘‘Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S.’’ This report revealed that our Nation is in the throes of a growing epidemic of controlled prescription drug abuse involving opioids like OxyContin and Vicodin, depressants like Valium and Xanax, and stimulants like Ritalin and Adderall. From 1992 to 2002, prescriptions written for such controlled drugs increased more than 150 percent, 12 times the rate of increase in our population and almost 3 times the rate of increase in prescriptions written for all other drugs.

Mirroring this increase in prescriptions has been an increase in the abuse of these drugs. From 1992 to 2003, the overall number of Americans abusing controlled prescription drugs rose 94 percent, 7 times faster than the increase in the U.S. population. The number of 12- to 17-year-olds who abused controlled prescription drugs jumped 212 percent, more than triple.

In 2003, the number of Americans who abused controlled prescription drugs exceeded as you said, Mr. Chairman, the combined number abusing cocaine and all other illegal drugs except marijuana, and they are on course to exceed abuse of marijuana on the track they are on. Abuse of controlled prescription drugs has grown at a rate twice that of marijuana abuse, 5 times that of cocaine abuse, 60 times that of heroin abuse.

Particularly troubling are the implications for our children. From 1992 to 2002, new abuse of prescription opioids among 12- to 17- year-olds was up an astounding 542 percent, more than 4 times the rate of increase among adults. In 2003, nearly 1 in 10 12- to 17- year-olds abused at least one controlled prescription drug; for 83 percent of them, that drug was an opioid. Teens who abuse controlled prescription drugs are twice as likely to use alcohol, 5 times likelier to use marijuana, 12 times likelier to use heroin, 15 times likelier to use Ecstasy, and 21 times likelier to use cocaine, compared to teens who do not abuse such drugs.

In 2005, 15.2 million Americans abused these drugs including more than 2 million teens. The explosion in the prescription of addictive opioids, depressants and stimulants has, for many children, made their parents’ medicine cabinet a greater threat than the illegal street drug dealer. But, perhaps the most wide open substance supermarket in the world is the Internet. The Internet has become a pharmaceutical candy store, its shelves stacked with an array of addictive prescription drugs offering a high to any kid with a credit card at the click of a mouse.

For 4 years now, at CASA, in collaboration with Beau Deitl & Associates, we have been tracking online access to controlled prescription drugs. In the first quarter of each year, we have devoted 210 hours to documenting the number of Internet sites advertising and dispensing controlled drugs. These findings are a snapshot of availability at a given point in time and show trends from year to year. They do not capture the total number of sites advertising or selling controlled prescription drugs online, which may be many times the numbers I am using now.

Today CASA is releasing the fourth in its annual series of reports entitled ‘‘ ‘You’ve Got Drugs!’ IV: Prescription Drug Pushers on the Internet.’’ Here are the report’s disturbing findings. From 2006 to 2007, there has been a 70-percent increase in the number of sites advertising or selling controlled prescription drugs over the Internet, from 342 to 581; a 135-percent increase in the number of sites advertising controlled prescription drugs; a 7-percent increase in the number of sites selling controlled prescription drugs. Eighty-four percent of the sites selling controlled prescription drugs do not require a prescription from the patient’s physician, and most of the remaining 16 percent of sites that ask for a prescription simply ask that it be faxed, allowing a customer to forge it or use the same prescription many times to load up on these drugs.

There are no controls—no controls—to stop the sale of these drugs to children. Over the 4-year course of our analysis, the number of selling sites has climbed from 154 to 187. Since there are no controls preventing sale of these drugs to children, all a child needs is a credit card number and access to a computer and ‘‘You’ve Got Drugs!’’ Efforts to crack down on this illegal trafficking are complicated by outdated Federal law written before the Internet and inadequate State laws.

There is a mechanism in place for certifying Internet pharmacy practice sites. It is the National Association of Boards of Pharmacy, which verifies Internet pharmacy practice sites. However, the process is voluntary. Of the 187 sites found selling in 2007, only two were certified.

The widespread threat to the public health demands that Congress now take action to: clarify Federal law to prohibit the sale or purchase of controlled prescription drugs online without an original prescription issued by a DEA-certified physician based on a physical examination and evaluation; and require certification of online pharmacies to assure that they meet rigorous standards of professional practice.

The Feinstein-Sessions bill is a step in the right direction and an important step. We have a few suggestions to strengthen it that we can discuss with your staff, but we really applaud, Senator Feinstein and Senator Sessions, what you have done in introducing this bill.

The report we are releasing today makes other recommendations that I hope you will consider.

Mr. Chairman, just in closing, substance abuse and addiction— involving prescription drugs, alcohol, nicotine, all of it—is the Nation’s most serious domestic problem. It is implicated in most crimes, most killing and crippling illnesses, most domestic violence, most child abuse, most homelessness, poverty, most teen pregnancy, and the wildfire spread of AIDS and other sexually transmitted diseases. I have titled my book on this subject ‘‘High Society,’’ and I will give you one simple fact. We Americans are 4 percent of the world’s population; we consume two-thirds of the world’s illegal drugs.

This problem is all about kids. A kid who gets through age 21 without smoking, using illegal drugs, or abusing prescription drugs or alcohol is virtually certain never to do so. Over the past 12 years, the fastest growing drug abuse among our Nation’s children involves prescription drugs. I a

[The prepared statement of Mr. Califano appears as a submission for the record.]

Chairman LEAHY. Thank you very much, and the report will be part of the record.

Professor Philip Heymann is currently the James Barr Ames Professor of Law at the Harvard University Law School. Professor Heymann has served at high levels in both the State and Justice Departments during the Kennedy, Johnson, Carter, and Clinton administrations, including serving as the Deputy Attorney General for the Justice Department from 1993 to 1994. He served as the Assistant Attorney General in charge of the Criminal Division from 1978 to 1981. He spent a lot of time in this room, I might add he was Acting Administrator of the State Department’s Bureau of Security and Consular Affairs, Deputy Assistant Secretary of State for the Bureau of International Organizations, and numerous other high-level positions in Government. He was also a former associate prosecutor and consultant on the Watergate Task Force. He also helped establish the Keep Internet and Neighborhoods Safe project and developed proposals to reduce illegal Internet prescription drug sales to youth. He is a graduate of Yale University and Harvard Law School and clerked for former Supreme Court Justice John Harlan.

Professor, the floor is yours. We applaud the work of this Committee to curb the availability of these drugs. We will do anything to help.

We are submitting our report along with my statement for the record, and we really appreciate, Senator Leahy, you and this Committee attending to this incredibly important problem.