To reduce steroid abuse, start targeting suppliers

April 11, 2007

Investigators in Florida and New York believe that tens of thousands of people across the country bought steroids and growth hormones illegally over the Internet from an Orlando pharmacy.

Authorities have implicated pro football and baseball players, bodybuilders, police officers, aging Baby Boomers, college students - and the wrestling team at Jupiter Christian School. Prosecutors say companies and wellness clinics with Web sites, including the Palm Beach Rejuvenation Center in Jupiter, sent prescriptions to Signature Compounding Pharmacy, which shipped the drugs to buyers.

One critical violation of Florida and New York law enabled millions of dollars to change hands: Doctors are required to have face-to-face visits with patients before writing prescriptions, but that almost never happened. Investigators say the network grew exponentially because doctors wrote prescriptions without ever seeing the person who wanted them. Prosecutors make the convincing argument that people who don't see doctors don't qualify as patients or deserve medical privacy protections, and should be considered customers.

The rise of compounding pharmacies also made abuses possible. Compounding pharmacies operate differently from the typical drugstore, in what has been an obscure niche of the market. They reformulate blends of hormones, painkillers, antibiotics and other drugs, in theory to meet the extraordinary needs of people with allergies or swallowing difficulties. Federal regulators paid little attention to these businesses until the Internet triggered their rapid growth. Florida now has close to 300 compounding pharmacies. Too many are prescription mills for steroids. Signature opened in 2002, shortly after the courts upheld the compounders' right to advertise.

It took an unexpected mix of ingredients - rogue doctors, renegade pharmacies, Web connections - to create the black market that fed potentially dangerous drugs to thousands. Prosecutors are in court today because government regulators did too little for too long.

The Florida Department of Health and Board of Medicine are overmatched trying to monitor Florida's 40,000 licensed physicians. Doctors can be indifferent about policing themselves. The U.S. Food and Drug Administration has failed to control compounding pharmacies, which have deviated wildly from their intended purpose. Regulators have given too many Internet businesses passes because they operated in cyberspace.

Prompted in part by the link to Jupiter Christian, state legislators are considering a pilot program for steroid testing in high schools. But the bill faces legitimate concerns about privacy invasion and offers little deterrent potential. The most effective way to keep steroids out of the schools would be to put distributors out of business.

Last year, Jupiter Christian became the smallest school to win a state wrestling title. Today, that achievement looks more like a problem than an honor.