Buying medication on the black market in St. Maarten

Part III

By Judy H. Fitzpatrick

PHILIPSBURG--Like *Ruth (see part one) *Donna, has been purchasing her birth control injection for years from "a friend" who brings it in from the Dominican Republic.

Donna, who had been sent a number of questions on this issue to which she responded in writing, told The Daily Herald that she pays US $50 in exchange for a syringe and some liquid in a small unlabelled container, which she uses to inject herself as a three-month birth control. It also stops her menstruation for the same period. Initially her daughter administered the injection, but she now administers it herself.

Donna says while she applies the injection as prescribed by her street physician some of her friends overdose themselves by using more than one dose at a time. They expect that by overdosing, they would be covered and for longer periods. "There are also times when women just buy it with no instructions and go home and use it. That is a risk."

Donna said that on one occasion she "lost a lot of blood," after using the injection. On another occasion, the tip of the needle broke off in her buttocks and her sister had to "dig it out."

But as scary as her experience sometimes became, Donna is undeterred. Even though her medical insurance entitles her to free consultation at a family practitioner, Donna said she never sought professional advice about birth controls or advice on how to administer the injection correctly.

"I just figured they wouldn't give it to me. Plus, what's US $50, every three months," she said when asked why she never sought doctor's supervision.

"I started using it when I was 30 and this is something that is easily available from almost anywhere in Santo Domingo and on the street here. The ladies in salons especially and those in lotteries know how to get it and from who," she said.

Asked whether she was concerned about buying medication on the street, particularly in unlabelled containers, she said: "I have no reason to be concerned because nothing bad ever happened to me... or anyone I know who uses it. And that's a lot of people...."

She added: "You would be shocked at the things you can get on the street here from Haiti and the Dominican Republic. I have seen men and women buy things to make them bigger and women buy a lot of things to lose weight. I also know about a headache pill that was banned in Santo Domingo, which is on the street here. But it's dangerous because it can get rid of a headache in like five minutes, but eats away at your liver."

What do the medical officials have to say about Donna's experience and that of her friends who overdose?

Inspector of Pharmaceuticals for Country St. Maarten Ashanti van Heyningen said any medication which has to be administered with an injection should be administered by a medical practitioner.

President of the Pharmacists Association Dick Luttekes stressed that overdosing can have serious adverse effects. He also expressed shock at the cost Donna pays for the injection saying that US $50 would cover a doctor's visit and similar medication in the legitimate medicine supply chain.

Counterfeit & unregulated

The medical practitioners interviewed for this series stressed that persons who buy medications on the streets risk purchasing counterfeits, medication that could contain harmful or active ingredients in incorrect proportions; or products that contain no active ingredients at all.

There is also the possibility that medication bought on the street and used by the unsuspecting individual could interact with other medication being used by the individual and have damaging consequences for him or her; or they may have expired. The buyer could also be allergic to the medication or may not be given accurate information about the correct dosages and storage conditions, which could affect quality.

Chief Inspector at the Inspectorate of Health, Social Affairs and Labour VSA Rob Sardeman and Paediatrician Dr. Pieter Offringa said Caribbean people tend to overuse medication such as antibiotics. Both professionals say patients apply "pressure" on medical professionals to prescribe antibiotics for minor ailments, when its use is not necessary. "And when it is not prescribed, they go and get it on the black market," Sardeman said.

Counterfeit medication in the regular medicine supply chain is a major concern of Corporate Affairs Director of Pfizer Central America and Caribbean (Viagra producers) Alejandra Castro.

She told this newspaper from her office in Chile that in recent years the company has noticed a spike in counterfeit medicines in the legitimate medicine supply chain.

Counterfeit medicines are dangerous by their very nature, as they are not produced under safe manufacturing conditions and they are not inspected by the regulatory authorities, she noted. "Therefore, it is impossible for consumers to know what ingredients these products actually contain. Counterfeit medicines pose a serious threat to patients' health and safety. Patients who unknowingly purchase counterfeit medicines are denied the therapeutic benefit of the medicines their doctors have prescribed. Counterfeits pose a further risk because they may contain ingredients that are actually harmful," she said.

"A number of factors have contributed to this rise in criminal counterfeiting activity, among them, the growing involvement... of under-regulated wholesalers and re-packagers, the proliferation of internet pharmacies, advancements in technology that make it easier for criminals to make counterfeit medicines, the increased importation of medicines from China, Colombia and other countries, and the relatively small risk and penalty faced by counterfeiters with lack of legislation in our countries."

The safest way to avoid counterfeit drugs, she advised, is to purchase prescription medicines at a local pharmacy from a reputable pharmacist. "We always [advise persons against] buying medications from online pharmacies that aren't licensed in the country or that offer to write prescriptions or sell medications without prescriptions.

Fuelling the industry

Several reasons were suggested as factors fuelling the black market for medicines.

General Practitioner Dr. Glenn Bryson said the large number of uninsured patients help fuel the industry as these uninsured persons seek to cut their medical costs.

He said persons would quicker purchase a pill on the black market, rather than pay the US $25 consultation fee to see a doctor and spend more money to purchase the medication prescribed.

Others however, say this unregulated industry is fuelled by immigrant groups, who are more comfortable using medicines they are accustomed to "from home" and which contain instructions in a language they understand.

It had also been suggested that the black market is fuelled by folks who capitalise on the weakness of the poor – one of the most vulnerable groups in the society - to make a quick turnover, given the strong demand for health care products.

According to Bryson, persons who cut cost, by buying on the black market run the risk of compounding their medical problems and will most likely have to spend more money to fix what the medication on the black market made worse.

He cited as an example persons who incorrectly use the content of antibiotic capsules to treat wounds which later become infected and more costly to treat. Bryson noted that there had been cases in which patients who used this method to treat their wounds were diabetic, but did not find out until they visited their doctor.

Dominican Republic Consul General Doris Elsa Vasquez Martinez said while she can understand why persons without legal residence and medical insurance would turn to the black market as a cheaper solution for their medical issues that was not an approach she supports.

Former Justice Minister David Dick had estimated 20,000 undocumented residents in St. Maarten, while some believe this figure has inflated, sitting Justice Minister Magali Jacoba had said the actual number of illegal immigrants was 40,000.

If any of the figures quoted by these officials are anywhere near accurate, it would be safe to assume that the number of persons residing in St. Maarten without medical insurance is very high.

It is a commonly known fact that many employers refuse to register their workers for medical insurance, even though they are entitled to it once they are employed. This practice has resulted in frequent controls by the largest medical insurance service provider Social Insurance Bank SVB, to find and fine defaulters.

But according to SVB (Windward Islands) Head Reginald Willemsberg, even some undocumented immigrants covered by the SVB don't access the benefits available to them because of fears of losing their jobs.

"They usually work very hard and don't take care of themselves. Even when they are sick they continue working. When they do decide to go to the doctor is when their illness is at a critical stage and the cost to get them better is high," Willemsberg had told this reporter in an earlier interview.

An estimated 65 per cent of the 16,000 workers (10,400) currently registered at SVB are undocumented immigrants.

President of the United Haitian Community Castin Ironce dismissed the suggestion that Haitians turn to the black market due to lack of insurance. In most cases he said Haitian nationals bring in and sell medication because they are familiar with it. "Saridon [one of the pain relievers imported], for example, is good for fever. And that's why they [Haitians] bring it in."

Luttekes said immigrant groups, such as those from Haiti and the Dominican Republic, may be pushed to use medication from their countries when they migrate here because they are unfamiliar with the medication commonly used in the Netherlands Antilles as well as unfamiliar with the language on medicinal products. Most of the medications sold in St. Maarten are labelled in either Dutch or English.

But medical practitioners said this shouldn't be a problem as persons prescribing medication have a duty to explain their uses and purposes. - Read the conclusion in tomorrow's issue. Send feedback to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

*Not person's real name