Mexico’s “Russian Roulette” Pharmacies

Americans trying to avoid high drug prices run the risk of getting counterfeit and adulterated meds

A pharmacy in Cabo San Lucas (Wally Skalij/Los Angeles Times)

American drug prices are sky-high. Prescriptions cost more in the U.S. than any other country. It is understandable that many patients save money by filling their prescriptions abroad.

About 1.7 million Americans annually cross the Mexican border looking for inexpensive prescription meds. Hundreds of small pharmacies cram the main streets of bustling tourist towns in northern Mexico. Los Algodones, for instance, a town of 5,000 just across the border from Yuma, Arizona, has about 250 doctors and dentists catering to Americans who fill their orders at more than twenty drug stores. On the busiest days, about 15,000 Americans cross the border to fill prescriptions. Some of the local pharmacies advertise their specialty; one, for instance, is nicknamed “Viagraland.”

Drug prices in Mexico can be about 80% cheaper than in the U.S. For some without health insurance, that is the difference between taking the drug or not. Another draw is that Mexican pharmacies do not require a doctor’s prescription to fill medications other than controlled substances. And the U.S. government cooperates by allowing anyone to return with a three-month personal supply.

It seems like a win-win for American consumers.

Except for one major problem. Recent investigations by a UCLA-led team and the Los Angeles Times reveal there is danger lurking in many of the drugs dispensed by Mexican pharmacies. At 40 popular brick and mortar pharmacies in four teeming Mexican tourist towns, 68% sold controlled substances without a doctor’s prescription. More alarming was that 40% of those controlled drugs looked legitimate but laboratory tests revealed they were counterfeits that contained fentanyl, heroin, and/or methamphetamine (82% of what was sold as Adderall had methamphetamine, a third of the OxyContin had fentanyl, and another 11% of the Oxy contained heroin).

It is not surprising that investigators discovered the highest concentration of counterfeit and adulterated pills came from the pharmacies that catered mostly to tourists. Law enforcement officials believe that while Mexico’s huge crime cartels supply the counterfeit pills, the pharmacies are probably not buying directly from the gangs. Mexico’s pharmaceutical industry has an elaborate network of middlemen and agents, and the pharmacists may not know their products are dangerous fakes.

In addition to the dangers posed by adulterated controlled substances, there is a critical problem the FDA has highlighted at different times over twenty years: the drugs dispensed for life saving purposes or chronic illnesses by some Mexican pharmacies have no active ingredients. That has happened with the cholesterol drug Zocor as well as a fake version of Carisoprodol, a drug to treat muscle spasms. Others have been exposed for selling fake blood thinners. The Pharmaceutical Security Institute, a watchdog group established by major pharmaceutical manufacturers to identify counterfeits, discovered that 2/3 of the Xarelto and Eliquis prescriptions filled at Algodones pharmacies had none of the medication. A blood thinner that has no blood thinner ingredients could prove lethal.

Mexico’s drug watchdog, the Federal Commission for Protection against Health Risks, has sometimes investigated reports that Mexican pharmacies were dispensing fake or adulterated medicines. It has consistently concluded that no laboratory in Mexico legally manufactured any of the potentially deadly counterfeits. That is the bureaucracy’s way of tossing the issue to Mexico’s law enforcement since the cartels are the problem. In a country in which the cartels operate with seeming impunity to supply almost all the fentanyl, heroin and methamphetamine that ravages America, it is not surprising that stopping them from profiting from black market pharmaceuticals seems a hopeless task.

A former member of the FDA’s Office of Criminal Investigations shared with me a word of advice for Americans hoping to save money on their prescriptions. “There are honest dispensaries in Mexico. And there are others that are selling dangerous copies. It is Russian roulette filling a prescription there.”