Photo by Shaul Schwarz/Corbis
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The Mexican Connection
By Miriam Karmel, July-August 2003
Millions head south of the border for cheap drugs. But is it safe? A special report
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Whenever Barbara Eriksen makes the 70-mile trip to Nogales from her home in Tucson, Arizona, she calls her grandmother first. "I'm going to Mexico this week," she says. "What do you need?" And her grandmother, 87-year-old Lydia Padilla, comes up with a list of drugs.
Sometimes Eriksen can't find an exact match for her grandmother's prescription in Mexico. Instead of Relafen for arthritis, the farmacia might carry Relifex. So, with the pharmacist's help, Eriksen substitutes. "You know the milligrams you're looking for," she explains. "You give them the American name, and they match it."
Eriksen knows that her grandmother's doctors would be skeptical of the substitutions. But she also knows that if she doesn't fill the prescriptions in Mexico, where most drugs are cheaper, her grandmother might not be able to afford her drugs at all.
As with drugs from Canada, the price difference between Mexican drugs and their American counterparts can be significant. For example, Prilosec costs about $4 per 20-mg pill at U.S. discount pharmacies; at the Mexican pharmacies we called, the average price for that pill was 84 cents. And that difference has turned Mexican pharmacies into a huge tourist attraction. In Nogales, the farmacias begin appearing as soon as you pass through the turnstile that separates the U.S. from Mexico. A block or two from the border, there's a street with one pharmacy after another. Outside, touts hand out fliers guaranteeing bottom dollar for everything from Alphagan to Zocor. Inside, Americans who look as if they've just stepped off a golf course get their prescriptions filled.
The practice is commonplace. According to Marvin Shepherd, director of the Center for Pharmaco-economic Studies at the University of Texas at Austin, between 25 and 40 percent of all U.S. residents traveling to Mexico return with prescription products. Nearly half of these drug buyers are over 50. And they come from all over. One study, conducted in the city of Nuevo Laredo, reported drug-buying tourists from 37 states and as far away as Massachusetts and Minnesota.
Mexican drugs aren't only cheaper, they're also easier to come by. Except for narcotics or other controlled substances, medicines in Mexico are sold without a prescription. It's as easy to pick up something to treat high cholesterol as it is to buy a $20 "Rolex" from the street vendor. But there's a problem: The drugs you buy could be just as phony as the watch.
"You're running a big risk if you're assuming the Mexican drug is the same as the U.S. drug," says Shepherd, who has been crusading against the personal importation of drugs for years. He says his message hasn't sunk in: People still think anything with a familiar brand name must be safe.
Maybe it is safe, maybe it's not. People buying drugs in Mexico ought to be concerned about four potential problems: counterfeits, expired drugs, unfamiliar fillers, and bad substitutions.
Fake drugs are big business. According to Lewis T. Kontnik, a principal with the authentication consulting firm Reconnaissance International, an estimated 5 to 7 percent of the world's drugs are phony. Though the statistics are hard to pin down by country, Kontnik says, some experts put the number in Latin America at 25 percent. In one example, counterfeits of an Australian anti-inflammatory drug surfaced in Colombia. They looked like the real thing, down to the detailing on the pills, but they were made of boric acid, floor wax, and yellow leaded highway paint.
In late 2001, 14 pharmaceutical companies formed the nonprofit Pharmaceutical Security Institute to track the problem. But according to Tom Kubic, PSI's executive director, counterfeiting is tough to prove. Most fake drugs have no active ingredients, so if you take one, you may not suspect mischief—you just won't feel better. Adds consultant Kontnik, "In a sense, pharmaceutical counterfeiting is a perfect crime."
Even if a drug you buy in Mexico is legitimate, it may be degraded due to improper storage. There's no way to tell this by looking at the product.
But let's say you find a Mexican version of your prescription that has been properly stored. Still, there's one more reason for caution: It might contain filler ingredients different from the American version. Though these fillers are not the active ingredients, they can affect the rate at which your body absorbs the active ingredients. So switching back and forth from American to Mexican versions of a drug can cause problems. (For the same reason, physicians discourage alternating between a brand-name drug and its generic. Either one could be fine; it's the switching that's the problem.)
Michael Piñón, a clinical pharmacist and president of the El Paso Area Society of Health-System Pharmacists, tells of a patient who had been stabilized for several years on the anticoagulant Coumadin. Suddenly, the Coumadin levels in her blood fell, putting her at a risk for a blood clot or stroke. Eventually, Piñón discovered that the woman had switched to a generic from Mexico. It took three months to restabilize her.
Sticking to one formulation is especially important with drugs with a "narrow therapeutic index"—that is, a very small difference between the dose that is beneficial and the dose that is toxic. Medicines for hypertension, cardiac conditions, schizophrenia, depression, and diabetes tend to be in this category.
Especially risky are Mexican generic drugs, for which the manufacturing requirements are not the same as in the U.S. "Under no circumstances can I recommend a generic drug sold across the border," says Randy Ball, who chairs a council of the Texas Society of Health-System Pharmacists.
Then there's the issue of bad substitutions. Jude McNally, a poison control specialist at the University of Arizona, recalls a woman who filled a prescription for a migraine medication. The farmacia clerk sold her an "equivalent" product—the barbiturate Phenobarbital. "Not even close," McNally says. If she had taken the drug, it would have made her sleepy. Combined with driving or alcohol, the effects could have been tragic.
A common, potentially dangerous substitution is of one dosage for another. If your doctor prescribes a 20-mg daily dose, a farmacia might sell you 40-mg pills to split in half. But not all drugs can be safely split. Some have a sustained-release action. Others have a coating that can't be broken without compromising the drug's potency. This could be true even if the pill is scored.
Assuming you find the right drug, you may not receive the services a U.S. pharmacist provides, including an explanation of the potential side effects. Or a language barrier could prevent the exchange of vital information concerning how to take the drug. In general, there are no records kept and no patient labels on the bottles. And should you have an allergic reaction, it may be hard to trace the drug and treat the problem.
And here's one final reason to think seriously before you buy Mexican drugs: It's illegal. Many people think it's all right to bring a three-month supply of drugs into the U.S., but that's not true, says Bradford Stone, spokesperson for the FDA. There is a three-month rule, he says, but it applies only to extenuating circumstances, such as if an AIDS or cancer patient wants a treatment that is legal in Mexico but not yet approved here. "While we can appreciate the cost issue," says Stone, "saving money on prescription drugs isn't one of the circumstances."
The government doesn't devote much manpower to enforcing this ban, but people who return from Mexico with prescription medications can have them confiscated and can even be fined.
Given the risks, why do so many Americans—about 73 million in 2000—buy Mexican drugs? Money, of course.
Even the staunchest critics of the practice are sympathetic. "If the choice is going south and having medication, versus having nothing, I would choose the former," admits Piñón. Marvin Shepherd agrees. "If I was that destitute I would probably go to Mexico and pray for the best."
"Nobody wants to go to Canada or Mexico," says Peter Wyckoff, executive director of the Minnesota Senior Federation, metropolitan region, a consumer advocacy group. "They'd rather buy in their local community. But because of the cost, they are forced to look at other alternatives." As he sees it, buying drugs across the border—north or south—becomes "a matter of survival for many older people."
Bringing back drugs from Canada is also illegal, of course. But Wycoff and others say it's less risky than buying in Mexico. For starters, Canadian pharmacies require a physician's prescription. And, as an FDA spokesperson says, "The Canadian regulatory system is more like our own than the Mexican."
Pharmacist Ball says that some Americans have two sets of standards: "People seem to be willing to accept risks across the border that they in no terms would accept on this side."
Moreover, Mexican drugs enjoy good word-of-mouth advertising. Many millions of Americans return north with effective prescription medications at a substantial discount. "People do this, do this successfully, and they do save a lot of money," says poison control expert Jude McNally.
Barb Henry of Pasadena, California, is one such person. "I never had a problem with what I bought over there," says Henry, a retired art school admissions director, who used to stock up on Premarin while vacationing in Ensenada with her husband. The Henrys had a favorite farmacia where the owner kept an enormous book about medications on the counter and the clerk "really knew what he was doing," she recalls.
Ultimately, the decision to buy prescription drugs in Mexico is up to you. As McNally says, "You have to take the responsibility to make sure it's the right dose and the right product. You take on all the responsibility."
Freelancer Miriam Karmel has written about medical issues for Utne Reader, Self, and other publications.
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