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Authorities once thought only the elderly, chronically ill, or very poor crossed the U.S.-Mexico border for over-the-counter and prescription medication. But too often, it turned out, such analyses were based on hearsay. Today, purchasing pharmaceuticals in Mexico is so common, that, by one account, one in four U.S. tourists visiting Mexico comes home with pharmaceutical products.1 Tourists have emerged as a major and growing part of the Mexican prescription drug market.

Low prices and the ease of purchases help explain the appeal. At a pharmacy in Nuevo Laredo, for instance, the 1997 price for 90 Valium tablets was less than $10, compared to nearly $70 for the same at a Dallas drugstore.2

Purchasing medication in Mexico is relatively easy. Products requiring a physician's prescription in the U.S., such as Premarin, Retin A, and amoxicillin, are available over the counter in Mexico. Other more powerful drugs, considered controlled substances in the U.S., require a prescription in Mexico, but the prescription can be issued by Mexican physicians, dentists, homeopathic physicians, veterinarians, social service health professionals, nurses, or midwives.3 Controlled substances in the U.S. are drugs that are known to be highly abused or that have the potential for patient abuse or harm. In some instances, Mexican pharmacies have sold controlled substances even without a prescription.

U.S. law allows individuals to bring only personal supplies of drugs from Mexico into the U.S., but other restrictions on Mexican pharmacists and medical personnel are not fully enforced. The U.S. Customs Service allows individuals to bring a reasonable amount of pharmaceuticals into the country for personal use, usually a 90-day supply.4 But federal law dictates that each medication must have patient-specific drug labels, product labeling in English, and the approval of the U.S. Food and Drug Administration, which has not approved any Mexican pharmaceuticals for U.S. import. Texas law requires prescribers to be licensed to practice medicine in Texas and to be registered with the U.S. Drug Enforcement Administration--a combination that no Mexican physician has obtained.

Mexican prescription drugs are available not only in Mexican border towns, but at U.S. flea markets and ethnic grocery stores where Texas Department of Health (TDH) investigators have found injectable and oral antibiotics, herbal remedies, and controlled substances such as Valium and Rohypnol. Health department investigators have confiscated illegal Mexican pharmaceuticals and herbal remedies from flea market vendors across the state. Most vendors questioned by the investigators said they bought their drugs from suppliers who brought them by van or truckload from Mexico.5

An emergency room physician in Fort Worth treated two six-month-old infants within a week of each other, both of whom had been given injections by their mothers of drugs obtained at the same nearby flea market. One was injected with penicillin and the other with penicillin and eucalyptus, the second item an extract intended to be applied to the skin or orally taken in small amounts, and not injected, which can be poisonous.6 In another case, a 10-year-old girl was treated at a Fort Worth hospital for an irregular heartbeat. She told the physician that her mother had given her a penicillin injection that morning. The mother was not licensed to give injections, nor was the medicine obtained with a prescription.

The widespread availability of antibiotics along the border may be contributing to more drug-resistant bacteria, health officials suggest. Preliminary results of one study found higher rates of a drug-resistant bacterium in the Lower Rio Grande Valley than in other parts of Texas.7 The bacterium, streptococcus pneumoniae, showed particular resistance to penicillin. Earlier studies indicated increased resistance to alternative antibiotics such as tetracycline and erythromycin. The bacteria under study can cause "localized or life-threatening infections such as pneumonia, ear infections, septic arthritis, meningitis, and bloodstream infections."8 Along the border, many residents have diabetes, facing a higher risk of such a secondary infection.9

A 1996 study of prescription drugs brought into Texas through Laredo showed a dramatic difference between the medications authorities thought were coming across and the medications actually declared by individuals re-entering the U.S. Of the top 15 drugs brought across, 14 were classified as controlled substances, with the top two being Valium and Rohypnol, known as the "date rape drug." Other popular drugs identified in the study were stimulants used as diet aids, diethylpropion, phentermine, codeine, and an injectable narcotic painkiller called nalbuphine.

Some 60 percent of more than 5,600 declarations submitted between July 1994 and June 1995 came from men. The median age was 33 years for men and 35 years for women. Only 9.3 percent were more than 50 years old, suggesting that a young, male population has been purchasing pharmaceuticals for resale. In all, 39 different states were listed as states of residence. People said they came from as far away as Alaska, Minnesota, Massachusetts, and Florida. Nearly 65 percent said they lived in Texas, with Louisiana and Oklahoma ranking next.

While increased state and federal enforcement at the border could stem the flow of pharmaceuticals and other controlled substances brought into the U.S. through Texas, the price tag could be staggering and would impede general cross-border traffic. Furthermore, such enforcement might keep the poor and elderly from buying needed drugs at a reasonable price.

ENDNOTES

1 D. Lorey, ed. United States-Mexico Border Statistics Since 1900 (Los Angeles: UCLA Latin American Center Publications, 1990), and Table 1808 in E. Kristin McKeithan, MS, Marvin D. Shepherd, PhD., "Pharmaceutical Products Declared by U.S. Residents on Returning to the United States from Mexico," Clinical Therapeutics (Vol. 18, No. 6, 1996), p. 1243.

2 "The Other Mexican Drug Trade: Pill-Popping Deals by Prescription," The New York Times, (March 2, 1997).

3 F.L. Gurovish, C.G. Barnes, International Pharmaceutical Services: The Drug Industry and Pharmacy Practice in Twenty Three Major Counties of the World (New York: Pharmaceutical Products Press, 1992), pp. 335-353.

4 The amount of prescription drugs that would be considered for personal use is usually a 90-day supply, but this is left up to the judgment of each U.S. Customs agent. Interview with Karen Tannert, senior pharmacist, Bureau of Food and Drug Safety, Texas Department of Health, Austin, Texas, March 13, 1998.

5 Interview with Dennis E. Baker, Jr., acting chief of Bureau of Food and Drug Safety, Texas Department of Health, Austin, Texas, April 15, 1998.

6 Interview with Dennis E. Baker, Jr.

7 South Texas Health Research Center, "Drug-resistant bacteria found common on border," STHRC BULLETIN, Winter 1997, Vol. 4, No. 1, p. 1.

8 "Drug-resistant bacteria found common on border," p. 1.

9 Electronic mail communication from Jan E. Patterson, M.D., researcher at the University of Texas Health Science Center, San Antonio, Texas, April 25, 1998.

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