Hordes of Pharmaceutical ‘Ratpackers’ Ply the Border

The medicines cross the border in small quantities, bound for the black market. A hundred tablets of Viagra stuffed down someone’s pants. Valium tablets hidden in aspirin bottles resealed with tamper-resistant wrappers, or tiny vials of penicillin folded inside Mexican blankets.

They are carried into the United States by ratpackers, so named by customs agents because the smugglers are sneaky and inconspicuous. A single team of ratpackers can pass unnoticed by border inspectors six or seven times a day on their way to drop-off points, some just steps from the border.

When the medications accumulate in quantities large enough to make a profit, the cargo is hauled to Southern California and sold in unlicensed clinics, markets and swap meets patronized mostly by Latino immigrants. The back-room drugstores function as a northern duplicate of Mexican farmacias, purveying popular medications banned or restricted in the United States for self-treatment by immigrants skeptical of U.S. medicine and doctors.

U.S. Customs Service officials concede that millions of prescription drugs flow illegally into this country each year from such border communities as Tijuana, where dozens of farmacias line block after city block.

Customs inspectors, focused on more serious contraband such as cocaine, marijuana and methamphetamines, don’t consider illegal pharmaceuticals a priority. Their dogs aren’t trained to sniff out prescription drugs, nor is the agency staffed to do much more than random searches. In a national report documenting the threat of drugs flowing across the border, pharmaceuticals aren’t even listed.

Many of the drugs are brought back legally by U.S. residents, including Latino immigrants who feel more comfortable with medications from their homeland. But far more--nobody keeps track of the volume--are brought in for resale by underground networks of smugglers, some of whom may even declare the drugs for personal use and then sell them on the black market.

“If customs wasn’t allowing this stuff to come across, we wouldn’t have nearly as big a problem up here,” said a Los Angeles County narcotics officer who serves on a task force targeting back-room clinics.

Staggering Numbers in Recent Study

The widespread use of illegal Mexican pharmaceuticals has been highlighted in the past year by the deaths of children and police raids of Latino-owned businesses in Southern California. Some of the drugs found most often in the raids are banned in this country because of concerns over severe, sometimes fatal side effects.

Tracking the pharmaceuticals that make it across the border is difficult. What is smuggled cannot be measured and what is declared is a tiny amount of what makes it across. Even so, if a 1996 Texas study is any indication, the total amount of illicit pharmaceutical drugs that come into this country from Mexico is staggering.

The study, which prompted congressional hearings and a new law that limited the amount of controlled drugs that can be carried into the United States legally without a prescription, estimated that one in four U.S. residents who return from visits to Mexico bring back medicines.

Given that about 40 million people a year cross over from Mexico into the United States at the San Ysidro checkpoint alone, more than 27,000 people daily may be bringing in millions of dollars worth of medicines.

The study’s author, Marvin Shepherd, administrator at the University of Texas College of Pharmacy, concluded that most of the drugs cited in the study were controlled substances.

“The majority of drugs brought across the border are for illicit purposes,” Shepherd said. “They’re not for personal use. They’re resold on the street. We’ve seen people bringing in a combination of drugs they say are for personal use that would kill them if taken together. No doctor or pharmacist in his right mind would prescribe that combination.”

The Texas study tracked the number of Mexican pharmaceuticals imported through Laredo, Texas, between July 1994 and June 1995 and found that an average of 11,000 Valium tablets and 4,000 Rohypnol tablets were legally declared every day. They were brought across in small quantities allowed by law for personal use. Rohypnol, known as the “date rape” drug, can no longer be brought here legally. It has been banned in the United States since 1996.

Conflicting Rules Hinder Enforcement

Customs officials complain that conflicting guidelines leave them unclear on how many prescription drugs are legally permitted to enter the country. Customs rules allow a 30-day supply of drugs for personal use with a prescription, either by a Mexican or U.S. physician. The Food and Drug Administration allows a 90-day supply without a prescription but will permit a six-month supply in special circumstances such as serious medical conditions.

“If we had a system that was rigid and crystal clear it would be much easier to enforce,” said Dr. Michael Friedman, FDA deputy commissioner for operations in Washington. He said the guidelines are flexible to accommodate patients who are suffering serious illnesses and who go to Mexican pharmacies for alternative or less expensive treatments.

Congress recently added to the confusion when it voted last year to place limits on narcotics and other controlled substances, permitting 50 dosage units without a prescription.

“Sometimes you stand there scratching your head over how to proceed,” said Wesley S. Windle, Customs Service program officer for field operations in Washington.

Those who declare the drugs at the border generally are dealt with leniently, simply because of their honesty.

Arrests Are Rare

In most cases, the drugs are allowed through because the amount meets federal guidelines. When the amount is excessive or the drugs are banned, customs officers usually offer two options: Dump the drugs then and there, or return to Mexico to seek reimbursement from the stores that sold the medicines.

Last month, two women from San Bernardino County took the return option. They were caught carrying small bottles of injectable penicillin and prescription pills for back pain and arthritis. The women told a Times reporter that if the pharmacist didn’t buy them back, they would simply take a cab to the Otay Mesa checkpoint and try to sneak them across there.

When law enforcement does make an arrest, as in the case of an El Monte woman in 1996, the punishment can seem wildly erratic.

Maria Cardenas de Moreno had already been caught four times trying to smuggle prescription drugs across the border, but was let go each time without being arrested, according to court records.

When she was caught a fifth time with 1,000 ampicillin tablets, 12 Terramycin tablets, 235 bottles of injectable penicillin and 235 bottles of saline solutions, she was cited for illegal importation of the drugs and ordered to appear before a U.S. magistrate.

Her failure to appear in court after the fifth incident caused her arrest. She was sentenced to six months in federal prison, and promised never to sell pharmaceuticals or bring any drugs into the United States, according to court records.

But in December 1998 and February 1999, Cardenas, 45, sold a state undercover agent Mexican medicines at her El Monte botanica. She was arrested for violating her probation and sentenced in March to 14 months in federal prison.

Cardenas got her illicit medicines from Tijuana, where buying drugs in bulk is never a problem and farmacias are as common as the bars, shopping arcades and curio stands that lure Americans to the bustling border city.

San Diego-based tour buses that take tourists on day trips across the border include drugstores on their stops of places to shop.

The pharmaceutical delivery vans with padlocked cargo doors seemingly parked on every block in downtown Tijuana--dropping off packages of prescription drugs to pharmacies--symbolize the high demand for Mexican medicines.

Although many pharmacists and drugstore managers dispense medicines responsibly, others do not.

In Tijuana, there are pharmacists, store employees and even doctors willing to sell large quantities of prescription drugs for the right price. A few also offer advice or assistance in smuggling the drugs across the border.

“You can buy them at a very good price and sell them at a decent profit here,” said a veteran U.S. customs agent who has investigated prescription drug smuggling for 10 years. “Tijuana pharmacies can cut you a good deal if you’re a repeat customer.”

Striking a Deal on Tijuana Black Market

On a cool, rainy weekday morning in late March, a Times reporter wandered through the Viva Tijuana shopping complex, where 25 pharmacies are crammed into a single block a short walk from the border.

Dozens of hustlers crowd the street outside the complex, trying to steer tourists to the bars, waiting cabs and pharmacies nearby.

Outside a building with a pharmacy on the bottom floor and a patio bar upstairs filled with young Americans, a man approached. He was in his mid-30s, wearing an Oakland A’s cap with jeans and a green jacket--an agent for the medications black market.

“Are you looking for anabolicos [steroids]?” he asked in Spanish. “Valium, antibiotics, I can help you get whatever you need at good prices.”

Quantity is not a problem, he says.

Reaching into a shirt pocket, he pulled out the business card of a doctor with an office on nearby Via de la Juventud, and another for a pharmacy in the complex with a window sign in English promising “We try to be the best.” The card touts the drugstore’s Web site and a Chula Vista post office box.

He writes “Dino,” which he says is his name, on the back of each card. The doctor would write a prescription for any drug, he says, at $25 a prescription.

“Please be sure to show the cards to the doctor and the pharmacist,” Dino says. “I get $3 for every person I refer to the doctor, and the pharmacy also pays me a commission.”

The hustler also offers advice on how to avoid the sticky problem of getting caught at the border with a load of illegal pharmaceuticals, especially a large load.

“You’ve got to be smarter than the customs inspectors,” he says matter of factly.

Interested in purchasing 1,000 Valium tablets? No problem, he says. What about transporting them across the border, he is asked? Not to worry.

He suggests buying bigger bottles of over-the-counter drugs manufactured in Mexico, like aspirin. Dump the aspirin tablets and substitute the Valium.

“Then I’ll take you upstairs to the bar,” he says, pointing to the saloon next to another pharmacy. “There’s a place up there where we can put a [tamper-resistant] plastic wrapper back on the cap. That way, if you have to show it to the [customs] inspectors, it’ll look like it’s never been opened and the bottle will say aspirin.”

Then, like a stockbroker offering advice on the market, he volunteers: “But if you’re looking to make money, Viagra is what you should be into.”

Each sky blue pill comes inside a plastic bubble on a foil card in a box about the size of a matchbox. What about transporting the drug across the border without getting caught?

A clerk at a nearby farmacia shows how: He takes a pair of scissors and simulates cutting around the bubble, so the pill remains sealed.

“When you do it this way, you can put 100 or so inside a paper bag. Put the bag inside the crotch of your pants and nobody will know it’s there,” he says.

Pharmacists and doctors in Tijuana know that few people are ever arrested for transporting illegal prescription drugs into the United States.

Although no one answered at the doctor’s office recommended by Dino, another doctor explained how the system works.

“The worst that can happen is they’ll take them away from you,” said a man who refused to give his name, but who said he was a doctor at a clinic near Avenida Revolucion and Calle 3.

“For controlled substances, you’ll have to pay me $25 per prescription. What I do is completely legal. What you do en el otro lado [on the other side] is your business. Ninety or 900. I can get you whatever you need,” he said.

He is also accommodating.

“If you buy a large order from me and can’t take it all across in one trip, you can store it here,” he says. “Come back two or three times and take a few each time. Nobody gets rich, but everybody makes a little money this way.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Drug District

Tijuana is home to approximately 1,000 pharmacies, making it the fourth-largest medicine market in Mexico. Doctor’s offices that write prescriptions and pharmacies that sell drugs are shown with a black dot. They proliferate just 200 yards from the U.S. border.

Graphics reporting by BRADY MacDONALD / Los Angeles Times

About This Series

After two Orange County infants died following treatment and injections of medication received in back-room clinics serving Latinos, The Times assembled a team of reporters here and in Mexico to investigate this underground medical phenomenon. The team spent three months following the trail of dangerous medications from Mexico, through the border and into Southern California.

SUNDAY

The back rooms of some markets, dress shops and swap meets peddle drugs that are banned or tightly restricted in the United States because of severe side effects that can kill. These drugs are smuggled in from Mexico, where looser drug laws allow multinational drug companies to sell them much more freely.

TODAY

Millions of prescription drugs are pouring into the United States from border towns, virtually unchecked by customs inspectors more intent on stopping contraband such as cocaine.

TUESDAY

Economic, political and cultural forces push many immigrants to seek help from unlicensed medical providers using illegal or unproven drugs. These immigrants either reject the U.S. system of health care or conclude that it has rejected them.

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The entire series will be available on the Times Web site: www.latimes.com/mexdrugs