Introduction: From Mumbai to Riga to New York

Tens of thousands of Web sites sell prescription drugs online.

Some of these sites are legitimate operations and enable seniors and other groups to buy reasonably priced medicines. But a large percentage of them allow customers to obtain controlled drugs without the required prescriptions.

These “rogue” Internet pharmacies comprise a multibillion dollar, global industry that is constantly evolving as it plays a cat-and-mouse game with law enforcers and government regulators.

A few years ago, these rogue operations were mainly based in the U.S. In October, Congress passed the Ryan Haight Act, which explicitly prohibits the online sale of prescription drugs in the U.S. without at least one in-person doctor visit, building on earlier legislation that regulates controlled substances. But it's become increasingly difficult to crack down on the rogue Internet drugstores because many of them are based overseas and often beyond the reach of U.S. law.

“They’ve become much more sophisticated,” said Carmen Catizone, executive director of the National Association of Boards of Pharmacies.

“Their drugs come from outside of the U.S., so there's less likelihood of them being caught or identified here.”

Today a shadowy, transnational network of illicit drug manufacturers, traders, doctors, Web site operators, spammers and criminals makes up the online pharma world.

From January to May 2009, our investigative reporting class tried to penetrate that world. We ordered and received generic Prozac — shipped from India — from what appeared to be a rogue site. We then tracked the opaque purchase transaction to see who was behind it.

“It generally would be a small group of people who are basically making all this work,” said Steve Wernikoff, an attorney with the Federal Trade Commission who has brought charges against illegal Internet pharmacies.

“They’re hiring the spammers, they’re arranging for the products to be sent, they're arranging for the Web sites to be set up.”

They also work out the payments through the credit card system.

Our reporting also examines the complicity in the business of drug manufacturers as well as drop shippers, middlemen who transport drugs across the globe.

We documented the cases of doctors who signed off on thousands of prescriptions for patients they had never met. And we took the pulse of domestic and international law enforcers to see who is winning the battle against rogue e-pharma.

The Stabile Investigative Class of 2009