It’s unlikely that many Americans have prescriptions for drugs they buy in T.J. Dot, one of two gray-haired women emerging from a pharmacy near Sixth Street, shows me a white-and-purple box of Tafil, made by Upjohn of Mexico. Dot says she lives in Chicago but comes to Tijuana every year when she visits her brother and sister-in-law in San Diego. “Sometimes I have trouble sleeping, so I just cut one of these in half. It’s all I need,” she says. Tafil is the Mexican name for Xanax, a popular American tranquilizer. In her purse Dot has several boxes of Retin-A, which she is taking back to friends in Chicago. Informed that she needs a prescription from a Mexican doctor for the Tafil and is not allowed to bring in the Retin-A for anyone but herself, she says, “I won’t tell if you don’t.” (Ironically, the Food and Drug Administration spokeswoman had noted, “No one is going to stop your grandmother for having a little Xanax in her purse.”)
A few blocks away a gentleman of ripe years from San Diego says he comes to Tijuana “mostly for antibiotics. I have insurance, and small co-payments, so it’s cheap enough for me in the U.S., but if I need something I’m not taking regularly and I don’t feel like hassling around going to the doctor, I’ll come down here.” He adds that he has seen in an American Association of Retired Persons (aarp) magazine that drug companies earn as much as 40 percent profit on their sales. “Everywhere else — in Canada, Europe, Mexico — the drugs are cheaper than they are in the U.S. The pharmaceutical industry is definitely taking advantage, and you won’t believe the costs the government adds to the price.”
Sipping a soda while betting on a basketball game at the jai alai sports book is Lawrence Trimble, 57, a resident of Tijuana who works in San Diego. Trimble, a legal researcher, spent a decade in Europe. He says that a few months ago when he had an upper respiratory infection he did what he used to do overseas, “went to the pharmacy, told them my symptoms, and let them choose. I didn’t want to pay a $70 office visit to talk to the American medical priesthood. The pharmacy probably knows the best antibiotic for this year’s bug. They sold me an antibiotic manufactured under license for a German pharmaceutical company, and it cost six bucks. I saved at least $100. And I’m now taking penicillin for a toothache until I can get to see a dentist.”
It’s not the casual, individual purchaser that worries Lori Senini of the San Diego County Department of Health Services, although she thinks it foolish and potentially dangerous to use a prescription drug without a prescription from a physician. Senini is the county’s coordinator to the California Office of Binational Border Health, one of the agencies concerning itself with the farmacia boom.
“The big problem,” Senini says, “is the illegal sales of huge amounts.” Pharmacy drugs transported in voluminous quantities from Mexico to Southern California or beyond have become a concern of local, state, and federal agencies. “It’s a big issue,” Senini states.
The federal agencies “are really the ones who were picking it up. It’s really their issue. We can work to educate the communities, but they have the enforcement side.” Nonpyschotropic pharmaceuticals smuggled from Mexico usually end up in Hispanic communities, mainly in counties to our north. “Los Angeles and Orange have been pushing San Diego to do something, because we don’t have any programs as aggressive as theirs.”
In L.A., the smuggled prescription drugs are sold in mom-and-pop groceries, at swap meets, and at farmer’s markets. According to Senini, unlicensed doctors and dentists operate behind shower curtains at swap meets and farmer’s markets, dispensing services and pharmaceuticals.
To crack down on the sale of the illicit drugs, Los Angeles has formed an enforcement group called the Health Authority Law Enforcement Task Force. The task force employs a full-time pharmacist, who says that the lack of the standard controls required in U.S. pharmacies and the prevalence of untrained personnel vending the drugs have created a public health problem. Last year in Orange County, a child died after being treated by an underground pharmaceutical vendor.
The head of the task force says that since its founding two years ago, the task force has made 150 arrests and this has pushed the problem underground. Where the drugs were once sold openly, they now are kept out in the car or in the back room.
Senini does not know if the problem of illegal pharmaceutical sales is as exacerbated in San Diego as in L.A. and Orange Counties, since for San Diegans it’s a short trip across the border. County officials, she says, won’t commit resources to conduct even an educational campaign unless they are convinced we have a problem. To help convince them, last February enforcement personnel from the Los Angeles task force visited five swap meets and farmer’s markets in San Diego. They found Mexican pharmaceuticals for sale at three.
The task force was in town to attend a meeting between American agencies — the Food and Drug Administration, the Drug Enforcement Administration, U.S. Customs, the California Department of Health Services, and the San Diego Department of Health Services — and the Tijuana Association of Pharmacies. This first-ever meeting by American health authorities with a nongovernmental Mexican group was initiated by the National City–based Institute for Health Advocacy. The purpose of the meeting, at least from the American perspective, was to assess the level of training received by pharmacy personnel in Tijuana and to request that T.J. pharmacies stop selling the so-called date-rape drug Rohypnol and stop selling large quantities of any drugs to individuals or groups.
“We found out,” says Senini, “that there was no set credentialing system” for Mexican pharmacies. The Tijuana association seemed mostly interested in obtaining some kind of American recognition of “legitimate” pharmacies — pharmacies belonging to the association — and help in getting rid of the bad ones. The association agreed to a second meeting with the U.S. groups, but after canvassing its members decided to cancel it. Senini doubts that the Mexican government has much interest in stronger regulations for pharmacies. “This is probably not a big concern of theirs. But the whole thing is giving the Mexican pharmacies a bad name.”