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Chapman said he grew tired of Echols living with him in his three-story Victorian home. So Echols found a house a few doors down in the older, treed neighborhood -- the kind of neighborhood in which one might imagine a more established physician making a home. It was only a few months before when he had arrived broke at Chapman's door.
By July, the Internet business, with the DEA and the state medical board on Echols' tail, had soured.
Fragmented Law Enforcement
North Carolina's medical board doesn't have anyone devoted to ferreting out Internet pharmacists. Instead, it relies largely upon reports from the public and the Federation of State Medical Boards, said Dale Breaden, the board's public affairs director. Even that federation only nets a few catches each year. Its National Clearinghouse on Internet Prescribing buys medications from suspicious Web sites and pursues complaints against doctors and pharmacists connected with them. In the first three months of 2006, they placed three orders for drugs online and received two. In the clearinghouse's existence, they have only placed 44 orders. All but four prescription requests were approved, according to clearinghouse newsletters.
One problem is the fragmented nature of enforcement; i.e. just because a doctor has his North Carolina license taken away doesn't mean he's out of business. Case in point: Dr. Ranvir Ahlawat of Newark, NJ, surrendered his North Carolina license in March after allegations of online prescribing surfaced. But his medical license in New Jersey is still active, four months later. Pam McClure, a spokeswoman for New Jersey authorities, said the board couldn't comment on whether Ahlawat might be under investigation.
Efforts to make Internet pill mill activity a federal crime haven't made it out of committee. The federal Ryan Haight Act would prohibit doctors from prescribing medicine based on the kind of online questionnaires that Leisa and Ryan Kelly used. The bipartisan legislation also would allow state attorneys general to shut down illegal sites, even if the sites are operated out-of-state.
Martin, of Mercy Horizons, believes doctors who prescribe online to patients they don't know should be prosecuted. "That's drug-dealing," he said. "If you break your finger, would you want a hospital to examine you over the phone and tell you what to do?"
The rehabilitation center has seen an increase in recent years of patients who get drugs online. It wasn't too many years ago that Martin first heard about Internet pharmacies. A patient told him he had Vicodin delivered to his house.
"We were used to people just getting drugs the old-fashioned way -- buying it off the street or doctor-shopping," Martin said. "We now have patients that have stolen family members' credit cards, strangers' credit cards and neighbors' credit cards and had the pills delivered to them."
By making doctor shopping unnecessary, online sites allow a level of privacy that can make prescription drug dependency harder to treat. "It does present a problem, because it's more difficult to keep someone away from their source when their source is the Internet and the mail," Martin said.
Alanna Brewton, a counselor at Mercy Horizons, said people will work out deals with delivery truck drivers to make sure they only come at times when their addiction won't lead to them getting caught. "'If you can come at this time tomorrow, I'll give you a couple of extra bucks,'" she described. "Then their wife or their spouse won't be home. It's kind of like having your drug dealer come to your door every couple of days with a supply."
People with such problems now might wind up at Mercy Horizons only after family members find the credit card bills noting the online purchases. And Martin recalls that one patient, in an effort to escape detection, had her drugs mailed to an elderly couple next door. But the couple was immediately suspicious and called police; the patient ended up in rehab.
Some patients end up buying drugs online while they're recovering from accidents, counselors said. They get dependent on painkillers like hydrocodone, but their doctors aren't aware they're having problems. Looking for help, the patients type symptoms in a search engine -- and the results that pop up advertise easy access to narcotics.
The Final Days
Candy Kelly believes her daughter and grandson spent the last few weeks of their lives drinking and planning their suicides together. The last time she spoke with her daughter, Kelly was told that Ryan was sleeping. Candy heard the despair in Leisa's voice, but didn't think she sounded suicidal. "She was barely speaking, but that was not unusual. There was no indication that it was that serious. It was a normal depressed state."
