MEDICAL ROULETTE NO GUARANTEE YOU'LL GET WHAT YOU BUY WHEN YOU ORDER PERSCRIPTIONS OVER THE INTERNET.

Byline: Barbara Correa Staff Writer

If you're like most busy e-mail users, the mere mention of Rx or ``Vi(at)gra'' in the subject line is enough to prompt an immediate delete. But could consumers skeptical of medication spam be missing out on cheap prescription drugs?

The short answer, according to industry watchdogs and consumer groups, is probably not.

That's because the majority of e-mail spam advertising cheap drugs comes from suspect operations that don't require prescriptions. While that's attractive to people who may be ordering drugs they are embarrassed about, like Viagra, it makes it almost impossible to gauge the companies' legitimacy.

Prescription drug fraud - whether it's peddling counterfeit medications or dispensing pills without a prescription via online medical consultation - is one of the nastiest cons to hit the Internet so far.

While it's been a problem since the beginnings of online retail, rising drug costs, an aging population and the publicity surrounding discount drug purchases from Canada have prompted more consumers to log on to fill their prescriptions. And fraudulent drug sellers have cropped up to meet that demand.

``There's been over $15,000 worth of consumer fraud in the last six months, where people either order medication and never get it or they suspect medications are counterfeit, made them sick or had no effect,'' said Carmen Catizone, executive director of the National Association of Boards of Pharmacy, which started certifying online pharmacies in 1999. To date, the group has approved 14 Web-based drug stores, and is processing applications from 25 more, he said.

According to the Food and Drug Administration, one of the easiest ways to spot a suspect Web site is that it won't provide a mailing address or phone number. It also will advertise explicitly that it doesn't require a prescription, but instead will process one based on an online consultation with a U.S.-licensed physician.

There are several problems with the online consultation. For one thing, the licensed physician claim can't be substantiated by the customer without a license number, so they're buying on blind faith. On the other side, online anonymity allows buyers to easily misrepresent themselves and order whatever drugs they want.

``That's what's frightening, where kids have accessed (such sites),'' said Patricia Harris, director of the California Board of Pharmacy.

Secondly, it's difficult to argue that an online questionnaire is equivalent to a traditional doctor's consultation.

But there is some legal wiggle room in defining consultation, said Harris. ``They can't dispense a prescription without a good-faith consultation. The medical establishment has defined that ... there is some gray area. There's consultations with video cameras where you can do a legitimate exam.''

She said that since the board won legislation several years ago allowing it to fine a Web site up to $25,000 for offering strictly e-mail consultations, it has cited seven or eight online operations. But there is no way regulators can keep up with the proliferation of new sites.

``Criminals will always be seeking a new way to peddle their product. Years ago, the only place was in the backs of magazines but the Internet provides an entree right to (consumers') computers,'' said Jason Brodsky, a spokesman for the FDA.

The FDA published its final report last month after a six-month examination of the counterfeit drug market. The study recommends implementing authentication technology in packaging to reduce fraud, but says such measures wouldn't be ready until 2007. Until then, it concludes, the agency doesn't have the legal authority or resources to assure the safety of drugs purchased abroad or over unregulated Internet sites.

Meaning consumers are on their own.

``I faxed my prescription in and it's been two weeks,'' said Muriel Coleman, 65, a volunteer at the Pasadena Senior Center and first-time online drug buyer. ``I'm going to give them until the end of this week. The only thing I can figure is that so many people are doing this that they are backlogged.''

Coleman ordered some allergy medicine from PeopleRx.com, a Canadian Web pharmacy with a New York state address. She said she decided to order after finding her medication for $33.50 at PeopleRx, compared to $91 at Rite Aid.

She said she'll try it again if the delivery arrives soon, but that for now she's withholding judgment.

The main motivation for seniors buying online is for lower prices - particularly on Canadian sites. Meanwhile, prices on fraudulent drug sites, which target people who don't want to go through a doctor for whatever reason, are typically more expensive than Canadian sites or legitimate U.S. online pharmacies.

For example, a site called GetDrugsHere.biz, which advertises no prior prescription requirement - sells ten 100-mg Viagra pills for $199, versus $90.99 on drugstore.com. Consumers buying off such sites fall into a few categories.

``It's people who don't want to see a doctor for some reason. Sometimes it's about privacy, like with Viagra; then there are drug abusers buying valium and codeine, etc.,'' said Catizone.

Legitimate online pharmacies like Microsoft spinoff drugstore.com have as much of a stake in educating consumers about the difference between them and fly-by-night fraudsters as do regulators.

``You're going to see us get much more aggressive in differentiating ourselves from illegitimate pharmacies,'' said Walter Conner, a spokesman for drugstore.com, which markets some of its products and offers via e-mail.

``The Internet is a perfect place to save money on drugs but on the other hand we have all these rogue and offshore pharmacies and ... they can send nice professional-looking e-mails too,'' he said.

Except that they usually don't. An individual name in the message line or a string of unrecognizable coding is usually a sure tip-off that the e-mail leads to an uncertified seller.

``Mothers used to worry about their kids going to a bad section of town for drugs. Well, the drug pusher is on the Internet now. Your kid can get any narcotic he wants,'' said Conner.

BUYER BEWARE

Here's a list of tips for smart buying from online pharmacies:

-- Check with the National Association of Boards of Pharmacy - www.nabp.net, [phone] - to determine whether a Web site is a licensed pharmacy in good standing.

-- Don't buy from sites that offer to prescribe a prescription drug for the first time without a physical exam, sell a prescription drug without a prescription, or sell drugs not approved by the FDA.

-- Don't do business with sites that have no access to a registered pharmacist who will answer questions.

-- Avoid sites that do not identify with whom you are dealing and do not provide a U.S. address and phone number to contact if there's a problem.

-- Don't purchase from foreign Web sites at this time - because generally it will be illegal to import the drugs bought from these sites, the risks are greater, and there is very little the U.S. government can do if you get ripped off.

Source: Federal Drug Administration

CYBER-SAVINGS

A price comparison shows certified U.S. online pharmacies are cheaper than the brick-and-mortar chains.

Viagra (10 25-mg tablets)

drugstore.com: $90.99

Long's Drugs: $109.50

Rite Aid: $103.99

Nexium (30 20-mg pills)

drugstore.com: $120.99

Long's Drugs: $145.95

Rite Aid: $141.99

Ortho Tri-Cyclen 28 (1 pack)

drugstore.com: $37.99

Long's Drugs: $43.95

Rite Aid: $42.99

Source: Daily News research

CAPTION(S):

4 photos, 2 boxes

Photo:

(1 -- 4 -- color) no caption (Prescription medicine)

Box:

(1) BUYER BEWARE (see text)

(2) CYBER-SAVINGS (see text)