Part II

Buying medication on the black market in St. Maarten

By Judy H. Fitzpatrick

PHILIPSBURG--Ulcer medication (used for abortions), antibiotics, hormonal pills, birth control injections, erectile enhancers and painkillers are among the wide range of over the counter (OTC) and prescription-only medicines peddled on the black market in St. Maarten.

Netherlands Antillean laws stipulate that all medicinal products must be registered at the Inspectorate of Pharmaceuticals in Curaçao before they can be sold legally. Some 7,000 different types of medication are registered, only a fraction of which are OTCs and allowed to be sold outside of pharmacies.

Infringement attracts a fine of up to NAf. 5,000 (approximately US $2,577) which is considered by many as the equivalent of a mere slap on the wrist. The 50-year-old penalty is an issue Inspector of Pharmaceuticals for Country St. Maarten Ashanti van Heyningen says has to be revisited with a view to instituting stiffer penalties.

The industry

Customs Officer First Class Franklin Bernadina and his colleague Urvin Sjen-Liep Shi, who control ports of entry for illicit and medicinal drugs, said the medication was brought in on airlines in luggage by passenger "smugglers," most of whom work on behalf of peddlers.

The medication that slips through the official surveillance network is turned over to the peddlers – mainly hairdressers, barbers, shop attendants, street vendors and other persons who run small businesses.

While members of several immigrant groups, including Chinese, Guyanese, Indians, and Jamaicans, have been mentioned as medication smugglers and peddlers, Bernadina and Sjen-Liep Shi said the evidence clearly suggested that the biggest illegal importers and suppliers were persons from the Dominican Republic and Haiti.

Pharmacist Association President Dick Luttekes said persons from immigrant groups such as India, China, the Dominican Republic and Haiti sometimes visited his pharmacy with empty medicine packages from their respective countries seeking "refills."

Some smugglers, to whom the Customs officials referred as "courier messengers," are contracted by on-the-ground traders in St. Maarten to "collect" their medication from sources in the Dominican Republic or Haiti, and are paid about $40 for each package of medication they smuggle into St. Maarten. Bernadina and Sjen-Liep Shi frequently have confiscated boxes of illegally imported medication from smugglers from these two countries.

Most courier messengers are women who are legal residents of either Dutch St. Maarten or French St. Martin.

Conscious of the brisk contraband trade, Customs regards Insel Air and DAE flights from the Dominican Republic and Insel Air flights out of Haiti as "risk flights" and mounts control exercises for these flights periodically at Princess Juliana International Airport (PJIA).

During these exercises – one of which this reporter was allowed to witness – passengers' luggage is passed through an electronic baggage scanner manned by a Customs officer who can easily detect unusually large quantities of tablets or other medicinal packages.

Whenever contraband items are detected or suspected, the luggage is removed and checked manually in the presence of the passenger.

If an unusually large quantity of medication is found the officer contacts the Prosecutor, who determines whether the medication smuggler should be interrogated further, detained, fined, and/or have his or her contraband medication confiscated.

Bernadina estimates that the haul from the average once- per-week control exercise would double or even triple should every risk flight be controlled.

The biggest haul of contraband medications to date was recorded some time ago when a large consignment was intercepted at the former airport building. The biggest haul last year was seized on August 16 when a smuggler arrived on an Insel Air flight from the Dominican Republic with several large boxes of medication.

However, the smugglers were neither detained nor fined on those occasions.

Confiscated medication is stored securely and eventually destroyed in a controlled manner.

Netherlands Antillean laws stipulate that air travellers are only allowed to carry medication to last up to three months. A traveller would need permission from health authorities to travel with more.

If an individual is travelling with small quantities of sample medication, as in the case of distributors, for example, the packages should be clearly labelled as "samples" and he or she should be in possession of approval documentation officially stamped by the Department of Pharmaceuticals.

Bernadina said he had repeatedly encountered large quantities of antibiotic medication Ampicilina, which he said seemed to be very popular. Prescription-only medication Soladek solution 5ml, from the Dominican Republic, is also found frequently among items confiscated.

Consul General for the Dominican Republic Doris Elsa Vasquez Martinez and President of the United Haitian Community Castin Ironce said they were aware of the importation and sale of certain medications within their respective immigrant communities. However, they said these items were sold over the counter in their countries. They were unaware that it was against the law for individuals to peddle these medicines here.

Ironce said antibiotics Ampicilline and tetracicline and painkillers Saridon and Cafenol were usually sold by Haitian nationals only to other Haitians. These medications, he contended, are not dangerous. He said too that Haitians were not the only nationals engaged in this practice.

Martinez said she was aware that medicinal items such as cough syrups and pain and fever relievers were being sold by Dominicanos here. However, she is perturbed that Dominicanos are able to obtain antibiotics in large quantities to bring here for resale.

"It seems wherever there is a way to make money, people will find ways to do so," she said.

Asked whether it was easy to obtain medication under the counter in the Dominican Republic, Martinez said authorities there had never identified this as an issue to her.

Deterrent

But even though the Customs officers are aware of the sources of illegally imported medication, can pinpoint the risk flights and even know smugglers by face and name to intercept illegally imported medication effectively, they said the penalties in place, though mild, served as the major deterrent.

Bernadina, who has worked as a Customs officer for 14 years, contends that almost all medication smugglers get away with a mere slap on the wrist. No one has been jailed and only a handful have been fined.

"The punishment is usually confiscating their medication and then they can start back all over again, because it's always the same people moving back and forth," said an evidently frustrated Bernadina.

He said a lot of paperwork was involved when a medication smuggler was busted. This includes itemising each medication by name and volume and taking the seized items to a pharmacist to determine which are legal and which are not.

Bernadina said Customs officers tended to be more motivated to control for illicit drugs, through which their efforts are more likely to result in punishment of the perpetrators.

"I do it [control for medication] because it's my job, but no one wants to do all of this paperwork and then the [perpetrators] go free," Bernadina said.

It's not only Customs Officers decrying the mildness of the penalties.

Head of Pharmaceutical Affairs at the Inspectorate of Public Health George Vos: "We have been catching people in convenience stores and neighbourhood shops in St. Maarten selling items they are not supposed to and the prosecutor often decides not to prosecute because they consider it a minor crime. What they do is confiscate and destroy the items and maybe issue a fine of between 1,000 and 2,000 guilders."

However, Prosecutor Rienk Mud said the confiscation of the contraband medication and issuing a fine should be enough. He considers the current fine of NAf. 5,000 "serious money" and a strong enough deterrent for persons illegally peddling prescription medicines.

"If you're thinking of punishment in terms of years of imprisonment for these persons [as a penalty], I would say, 'No. Definitely not ... .' Everyone knows we are short on cell capacity. There are many armed robbers to fill our cells," Mud said.

Mud said that while he was aware of the constraints facing the Customs Department with staff shortages, he believed that if the culprits were fined repeatedly they would be deterred from engaging in the illegal practice.

"Customs has very limited capacity, so if there would be more people controlling then obviously then ... more people would have a fair chance of being checked at the border for these items and they would get fined each time. If they do it again the punishment could go up and we can think of conditional imprisonment, and if they continue then unconditional imprisonment. But for now, fining them would be an appropriate measure," Mud said.

"The smugglers probably know that their chance of getting caught is low due to lack of staffing at Customs, but if I have enough proof that something illegal is taking place then I would put a fine on such behaviour. If we know about the cases we would act, but if we don't receive the information we won't know what's going on and can't fine or prosecute."

Revealing

During the research for this series this reporter encountered antibiotics, a range of painkillers, erectile enhancing drugs and a host of herbal medications on the black market.

Pharmacist Association President Dick Luttekes said he had occasionally found clients with skin medication containing steroids, which he said could cause allergic reactions for persons with sensitive skin. He has also seen patients with antibiotics containing amoxicillin that had been bought on the street. Used incorrectly, these antibiotics are ineffective in 99 per cent of cases. However, they have the potential for "serious adverse effects."

This reporter visited several outlets during research for this series and in almost all cases was able to purchase some type of medication. Frequently the response from members of the public when asked where a particular medication could be purchased was to recommend visiting a place on A.Th. Illidge Road and/or one in St. Peters. General practitioner Dr. Glenn Bryson said there were also lots of selling points in Dutch Quarter, Sucker Garden and Garden of Eden.

The going rate for Ampicillin antibiotics is $5 per pack of 10. One shop offered it for $0.50 each. And in one case a primary school pupil who was holding the fort for her parents sold this reporter the antibiotics.

When asked about the best use for antibiotics the seller, a Dominican Republic national at one shop, said many Dominicano women popped one antibiotic pill after sexual intercourse to avoid contracting infections from their mates.

Vos said the Inspectorate had discovered a number of cases in which prescription-only medicinal products were being sold outside of pharmacies.

One such place is the brothel.

At one brothel, Viagra was purchased for $20 each. It was removed from a container, placed into a piece of tissue paper and given to the buyer, no questions asked.

The proprietor of the establishment in an invited comment later told this reporter that while he sold authentic Viagra and while he was aware that it was a prescription-only drug to be prescribed by a pharmacist, no one was forced to purchase it at his brothel. He said there were many sources outside of the established pharmacies here – such as Internet pharmacies and adult shops – that sold Viagra, Cialis and other erectile stimulants.

The proprietor said he obtained his supply of authentic Viagra at $10 each from his general practitioner and resold at $20 each. He said most of the men who purchased the Viagra used it at home and most of them were "French." He said too that Viagra was not a hot seller at his establishment. Only about four per week are sold.

"Even I use the Viagra," he told this reporter in the interview. "And nothing has happened to me. I use a maximum of four per month. Sometimes I would get headache for almost half a day after using it, but it works."

Other items frequently found on the black market are botox anti-wrinkle treatment, which Vos said should be applied by a physician, but was being used in several beauty parlours in St. Maarten.

"Botox can be very toxic if not used the right way and we have seen this product used in beauty parlours in St. Maarten by persons who have no medical training and this is illegal."

Prescription-only antibiotics containing nebacetine are also being sold in supermarkets and convenient stores. So too is the weight-loss product Reductil, which Vos said was derived from amphetamine, which can be addictive.

Amphetamine was used during the Second World War to keep pilots awake. "It is addictive and it brings up the blood pressure, which can be dangerous for people with heart conditions or people who have an unstable blood pressure, because when the blood pressure is raised you can get a stroke, so it's very important for a physician to know if your circulation functions correctly or not," he said.

Complaints to the inspectorate by persons who said they felt dizzy after using Chinese weight-loss product Qingzhimntianshou, which was being sold in the Netherlands Antilles, led to authorities analysing the product.

"We found that it contained a laxative that had been withdrawn from the market because it caused cancer. The product was also being sold in the Netherlands and tests done there also found that it contained amphetamine," Vos explained. "This means that the same product is being produced with different active ingredients. It should have one active ingredient."

The product has since been pulled from the market.

Read part three of this series tomorrow.

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