‘Tailgate’ Medicine Sales Rampant in Ethnic Areas : Health: Authorities raid markets and shops. But focus on narcotics leaves ‘swap meet’ drugs unpoliced.

The manager of the Eastside grocery store looked stricken as a state health inspector examined some unusual stock on the shelves along with the fruits, vegetables and sundries: an array of drugs either that are banned in the United States or supposedly available only with a doctor’s prescription.

The City Ranch Market had prescription eyedrops and nose drops, capsules of the antibiotic ampicillin, and Nordinet, an aspirin-based drug augmented by three illegal ingredients. An eight-gram tin of penicillin was priced at $1.75.

“I’ve been selling this stuff for years,” the manager, Meredeth Smith, said matter-of-factly. “We all have it. You can go into any store in the area and find it.”

Smith might have been overstating his case--but not by much.

In Latino and Asian-American enclaves throughout the city, unauthorized sales of prescription drugs have become commonplace in recent years, as immigration soars.

With new immigrants often finding it difficult to afford or get access to conventional health care, they bring the less formal practices of their homelands, purchasing familiar medicines over the counter without realizing that they are participating in a dramatically expanding black market.

Products referred to in law enforcement circles as “tailgate” or “swap meet” drugs are turning up in ethnic bakeries, butcher shops, family-run markets, swap meets, even video stores--where shopkeepers-turned-druggists peddle everything from powerful heart drugs to individual capsules of penicillin for $1.

State and local health officials stage periodic sweeps to seize such drugs and make an occasional arrest, sometimes responding to an illness or death caused by a misused dose. But government agencies admit that in an era of rampant hard-core drug use--of cocaine, heroin and the like--the sale of “swap meet” medicines goes essentially unpoliced.

“We’re only beginning to understand the extent of the problem,” said Prosy Abarquez-Delacruz, regional administrator of the state Department of Health Services’ food and drug branch in Los Angeles.

At many times, her agency has only one investigator--and never more than three--combatting the pharmaceutical black market in all of Southern California. The California Board of Pharmacy, meanwhile, devotes most of its efforts to regulating licensed pharmacies.

“It’s widespread, there’s no question about that,” Kenneth Sain, supervising inspector with the pharmacy board, said of the black market. “But there’s a severe limit to the amount of manpower that can be put on it.”

Health officials say the tailgate drugs endanger thousands of ailing people by exposing them to medications of unknown content, potency and dosage. The phenomenon, they say, is national in scope, but more common in the Southwest and West--and particularly in Southern California.

The bulk of the use is an all but invisible part of daily life in many communities. But sometimes the dangers are made tragically clear:

* In 1988, a woman purchased an injectable antihistamine at an indoor swap meet in Sun Valley and gave it to her 2-year-old son, who she said was ill with a cough and lung condition. The boy died of a lung abscess. Although medical examiners were unable to link the child’s death to the drug, the seller, 33-year-old Santa Elba Hernandez, became the first person in California to be prosecuted for such illegal sale of prescription medication. A search of her stall turned up antibiotics, antidepressants and other drugs.

* In 1991, a woman purchased a vial of penicillin in Lynwood and injected it into her son. The boy suffered a serious allergic reaction and had to be rushed to a Compton hospital, where he survived. No charges were filed against the mother.

* In El Monte the same year, a woman reported that her male companion attempted to inject her with a medication to terminate her pregnancy. State investigators said the drug--a muscle relaxant not approved in the United States and incapable of causing spontaneous abortion--was purchased at a swap meet. Again, no charges were filed stemming from misuse of the drug.

For frustrated investigators, the vast numbers of low-profile operators make such drug sales as difficult as weeds to eradicate. A case in point was provided by recent events at El Mercado (“The Market”), a frenetic indoor bazaar in Boyle Heights at which everything from electronic gadgets to blankets is sold.

Last month, a La Puente woman pleaded no contest and was ordered to pay $5,272 in fines after investigators found more than 500 types of prescription drugs at her stall. One of the products, an injectable growth hormone, has been linked to liver damage.

Allan Van Ginkel, a senior state food and drug inspector based in Los Angeles, had hoped word of the bust would spread throughout the swap meet and deter other merchants from selling unauthorized medicine. But that was hardly what happened.

Early this month, Van Ginkel--on an unofficial tour with a reporter--returned to El Mercado and found the La Puente woman’s stall free of contraband. Several stalls away, however, an unidentified kiosk was packed with outlaw medicine, including Terramicina, a form of tetracycline that came with Spanish-language instructions stating that the product cannot be sold in Mexico without a prescription.

Also found were Retin-A wrinkle cream, which can damage skin if not used properly, and an anti-inflammatory containing Dipyrone, a drug that has never been approved for use in the United States because it can cause, among other things, severe gastrointestinal bleeding and drastic reductions in white blood cell counts.

Van Ginkel was exasperated.

“Some of the people may not know it’s illegal, but at that stall I kind of find it hard to believe,” he said. “It just gets a little frustrating when they’ve already been hassled once.”

During the next hour, the inspector stopped at five stores around the Eastside--picked almost at whim--and found pharmaceuticals for sale at two groceries: the 1st Street Food Center and City Ranch Market.

At the 1st Street Food Center, Ajin, a vitamin compound containing sulfadiazine, a prescription antibiotic, was being sold by the tablet from a box at one check stand. Sulfathiazol, a topical powder historically used to treat bacterial infections but now considered likely to trigger allergic reactions, was priced at $1.49.

Although Van Ginkel had brief conversations with clerks at the various stops, alerting them to the questionable nature of their goods, he did not seize the products or issue formal warnings--as he would have had they been official inspections.

But at an official follow-up inspection of City Ranch Market this week, Van Ginkel said he found the drugs back on the shelf, seized them and issued a formal warning.

At other locations around town, investigators have confiscated potentially life-threatening folk remedies, found to contain high concentrations of lead, mercury and other heavy metals. One product advertised as a “dewormer” for infants contained toxic calamus and scorpion as well as borax, a chemical capable of causing severe kidney damage, and even death, in hours.

Investigators have also found cough medicines, vitamin supplements and assorted “miracle cures” laden with controlled substances such as phenobarbital and Valium.

In the home countries of many of the immigrants, many strong pharmaceuticals are legally sold without prescriptions. But typically they are available only at pharmacies, where a druggist or other health practitioner is on hand to provide basic information.

Here, that’s often not the case. Nora Alvarez, an AIDS educator at a Crenshaw district clinic, recalls walking past a market near USC recently as a man stood on the sidewalk selling birth control pills out of a truck.

“I was stunned,” she said. “How could people buy this medicine without someone explaining how to use it?”

The consumers of tailgate drugs tend to be poor, lack health insurance and may fear deportation if they turn to the conventional health system. Additionally, they often lack information about free public health clinics or the transportation to get there.

Much of the tailgate medicine found in Latino communities is manufactured in Mexican plants owned by U.S. drug companies, labeled in Spanish and intended for use in Latin America.

Officials are not sure how the drugs wind up here, but believe it’s a combination of large-scale smuggling and small-time couriers--who take advantage of U.S. border regulations allowing individuals to carry small amounts of many medications into this country for personal use.

“For (black marketeers) to have that kind of inventory, someone’s supplying them in a very big way,” said Abarquez-Delacruz, the state food and drug administrator.

The delivery system is different in Asian-American communities, where many of the products are traditional remedies either smuggled in from the Far East or concocted locally.

Authorities consider some of the products safe, but brand others as dangerous, ineffective and illegal. For example, a “heart tonic” from Japan contained toad venom, a traditional skin remedy that officials say caused the death in June of a Bay Area woman who ingested it.

Chuifong Toukuwan, a popular arthritis remedy, has been found to contain nine prescription ingredients and two heavy metals, according to a state report titled “Ethnic Drugs in California.”

Officials say they have made headway against such sales, but they acknowledge that ethnic drugs are not a top priority at overburdened regulatory agencies.

“The issue historically has been overshadowed by concerns raised by more traditional illegitimate drugs like cocaine, marijuana and heroin,” said Jeff Casey of the U.S. Customs Service in San Diego.

“To my knowledge, we haven’t worked on this for a while,” said Rosario Vior, spokeswoman for the U.S. Food and Drug Administration in Los Angeles.

Meanwhile, the lead agency in the matter--the food and drug branch of the state Department of Health Services--has but 24 investigators in Southern California to perform a burdensome array of services, from inspecting shellfish processors and food wholesalers to investigating cancer and AIDS fraud.

Still, Van Ginkel--the only local investigator who pursues black market drugs on a regular basis--last year helped stage eight raids that netted about $100,000 in illegal medication. Although he and his colleagues have arrest powers, they rarely use them, hoping the seizures will serve as enough of a deterrent.

Van Ginkel acknowledged that whole sections of Los Angeles and Orange counties--including Koreatown, the San Fernando Valley, Little Saigon and much of the Eastside--go largely unpoliced because of staffing limits. “There are communities we haven’t even touched,” he said.

Oversight was actually reduced when a multi-agency Los Angeles County task force, established to tackle the issue, disbanded last year.

Established in March, 1991, the task force backed a community education program on tailgate drugs that was also supported by major pharmaceutical companies such as Hoffmann-La Roche Inc. and the Upjohn Co.

But a few months after they joined the effort, drug company representatives backed out--without honoring a $70,000 pledge to fund the education effort. They also dropped out of a similar effort in Orange County by the Hispanic Pharmaceutical Education Committee, which subsequently broke up.

Assemblyman Richard Katz, (D-Sylmar) who served on the Los Angeles task force, believes the drug companies were fearful that their participation might suggest they felt responsible for any health problems caused by black market sales of their products.

“I thought there was a liability problem for these companies,” Katz said, clearly disappointed. “I don’t think $70,000 is a lot to ask, given it might save someone’s life.”

Spokesmen for the companies and the Pharmaceutical Manufacturers Assn., the industry trade group, declined to respond to the assemblyman’s comments.

Katz also criticized the state Department of Health Services, saying that some officials at the agency privately told him that black market pharmaceuticals are not vigorously pursued because the state saves money when poor people avoid the health care system and treat themselves.

“I felt that state Health Services was willing to turn their back on this issue,” Katz said.

But Frank Nava, chief of field operations for the agency, dismissed such a suggestion.

The agency encourages poor people to visit free health clinics to get the best care, he said. The self-medication practices, he added, are hardly a money-saver because the state winds up treating conditions complicated by the improper use of pharmaceuticals.

“It’s costing us more in the long run,” he said.