And the type of medication prescribed can tip off a pharmacist. According to the center's report, the majority of prescriptions filled at a traditional pharmacy are noncontrolled medications. Only 11 percent are strong medications, such as opioids and barbiturates. By contrast, 95 percent of prescriptions from online pharmacies are for controlled substances.
Foster said the number of sites trafficking prescription drugs may have declined due to profiling and regulatory crackdowns on companies selling too many controlled drugs.
Constantly submitting prescriptions for controlled drugs tips off pharmacists as well.
"I'm not averse to filling oxycodone," said Abbot. Though he does not keep a large amount of controlled drugs in stock, if a true need arises, Abbot said he can get the medications within a day. As for the patient, "if they're legitimate, they'll wait," he said.
There are about a dozen legitimate online pharmacies, including Walgreen Co. and CVS Caremark Corp., that provide online prescriptions and medications. These companies have been voluntarily certified by the National Association of Boards of Pharmacy.
But getting certified, which can cost about $8,000 for the initial certification plus yearly fees, can be too expensive for smaller online pharmacies.
Although the CASA report suggested that federal regulations and low-cost accreditation for online pharmacies be mandatory to prevent blatant drug abuse, with or without prescriptions, as of now the companies do not seem to be suffering for lack of official and legal certification.
But Foster said some pharmacies don't always check with doctors or verify the information before filling prescriptions. Indeed, online companies may target financially strained pharmacies and doctors who have retired to cooperate with their business practices and even earn some money.
But these practices are decried by the rest of the pharmacological community.
"Any pharmacist that knowingly fills such prescriptions should not be permitted to practice pharmacy," Holycross said. "It is dangerous for the patient and society."