~ Buying medication on the black market in St. Maarten ~
Conclusion – Part IV
By Judy H. Fitzpatrick
PHILIPSBURG--Health officials are increasingly concerned about the black-market sale of authentic and counterfeit erectile stimulants such as Viagra, but as their concerns mount, so does the availability of the drugs on the streets and via the proliferation of Internet pharmacies.
Head of the Netherlands Antilles Inspectorate of Pharmaceutical Affairs George Vos said the use of erectile stimulants, apparently without a doctor's supervision, was suspected to be linked to at least two deaths of men in adult entertainment centres in St. Maarten.
Erectile stimulants influence blood circulation and can be dangerous if used under the wrong circumstances. "Viagra, for example, can lower the pressure to such an extent that it can result in problems," Vos explained.
Paramedic personnel in St. Maarten had reported to him that, based on information obtained at the scenes of the two deaths, erectile stimulants (in one case in combination with something else) were suspected to have been used by the two men shortly before they died at the brothels.
Asked why autopsies were not conducted in the suspected cases, Vos said: "It can be done if we get the information on time, and if the prosecutor gets to know about it on time. It's something based on assumptions, and we have to do the investigation to confirm whether they are facts, but by the time you have enough indication that a prescription drug was involved, the person has already been buried."
He said too that autopsies could not be done without the permission of family. "In cases where there is foul play, the prosecutor can confiscate the body and have an autopsy done, but if there are no indications of foul play, the family has to give permission."
The owner of the brothel where two of the deaths occurred dismissed the notion that they were due to use of erectile stimulants purchased at his establishment, and said that people tended to speculate wildly in the absence of proof.
He added that, while he had heard the allegations and while he did retail authentic Viagra, one of the male clients who had passed away in a room with an "exotic dancer" (prostitute) had been found with Cialis in his pocket. The brothel does not sell Cialis.
In the other case, the proprietor said he was in his club when the gentleman, weighing more than 300 pounds, walked in and went straight to a room with an exotic dancer. He succumbed shortly after. The owner said the gentleman did not purchase any pill before going into the room. "Whatever he had and whatever he drank was not purchased at my club."
The mother of the man who died in the latter case told this reporter that her son, had suffered two cardiac arrests in the same calendar year, and the cause of his death was registered as a heart attack. However, she noted that several persons had told her that her son had succumbed after consuming "something."
The brothel owner said he was aware that Viagra is a prescription-only drug and should be used under a doctor's supervision, adding that no one was forced to purchase the stimulant at his club. He said too that male enhancers could be easily obtained outside of his establishment and even via the Internet.
Growing fad
The manager of another brothel said that, while he did not sell the pill, many patrons would walk in and openly request it. "They come in and ask for 'the pill' or the 'Chinese pill' or 'the thing.'" Men were embarrassed to ask for an erectile stimulant in the past, he said, because most people believed it was only for "old men," but today, the use of Viagra and other erectile stimulants seemed to be a growing fad and was seen as "something cool."
Against that backdrop, the easy access to prescription-only erectile stimulants on the streets is a major concern for medical practitioners and other officials interviewed for this series.
Pfizer Central America and Caribbean (Viagra producers) Corporate Affairs Director Alejandra Castro told The Daily Herald from Chile, where she is based, that while her company hadn't received information from local health authorities about the cases referred to in this article, buying medicines in adult clubs seemed risky, and should alert the consumer to the possibility that the product might not be the original or authentic item, and could pose a threat to health and even life. She said too that there had been a spike in counterfeit medications in recent years (see part III).
"In St. Maarten we do not register medicines directly, as we work with Curacao's Bureau of Regulatory Affairs. However, we know that there is a strong will among St. Maarten's health authorities to develop their own regulatory procedures, but meanwhile we are working with Curacao's legal framework," Castro explained.
Vos alluded to the case of a woman younger than 40 who had suffered a stroke after using weight-loss pills she had bought in the streets of Curaçao. He said the woman's husband had shown doctors the pills that his wife had been using, and medical authorities concluded that the product sent up her blood pressure, resulting in the stroke. "This woman is paralysed on one side of her body."
In addition to the illegal peddling of medication, Paediatrician Dr. Pieter Offringa is also concerned about the sale of "trespacitos" rat poison by roadside vendors. Offringa said he's seen children with traces of this dangerous drug in their systems, and its sale should be curtailed, and or at the very least, its use in homes with small children should be more closely monitored.
Curbing practice
While health and pharmaceutical officials interviewed for this series agreed that the sale of medication under the counter should be curbed, they also acknowledged that completely closing the black market would be virtually impossible, particularly with the proliferation of Internet pharmacies.
"It will always be a challenge," Inspector General Rob Sardeman at the Inspectorate of Health, Social Affairs and Labour VSA said.
"It is not something that authorities will be able stop completely," added Luttekes.
However, some comfort in battling this scourge comes from United Haitian Community President Castin Ironce and Dominican Republic Consul General Doris Elsa Vasquez Martinez, who both say they are willing to help educate their respective immigrant communities against supporting the black market, in an effort to reduce the prevalence of the trade.
However, Vasquez Martinez stressed that it was up to the relevant authorities to clamp down on illegal importation of medication by controlling ports of entry. "It is out of my hands to control what is supposed to be controlled by Customs and Government," she said.
"I am willing to do whatever needs to be done to help, but the authorities have to notify me first, and together we can go out and see what the problems are. I can also notify the authorities in the Dominican Republic of the problem."
Ironce said he had always been cooperating with authorities and would continue to do so to help curb this practice. He is willing to use his Creole language radio programme to enlighten Haitian nationals about the risks. He said too that authorities could use his radio programme to give information, which he would translate into Creole.
But while some advocate education as one of the solutions, Luttekes questions the judgement of educating immigrant groups against using medication that they are familiar with.
"We are a multicultural society, and I don't think we should try to teach people from the Dominican Republic and Haiti that what they are doing is wrong, because there may be truths. The medication could be effective, even if we are not familiar with it," he said. "What we can do is advise them not to take something, but who are we to judge if they do according the beliefs taught by professionals in their country?"
Luttekes believes the best solution to reduce the real risks of buying medication on the black market is to provide universal access to health insurance, an issue the Island Government is addressing in its health insurance policy, as St. Maarten prepares to assume her new status as Country within the Kingdom of the Netherlands.
Sickness insurance
The current insurance system has some glaring flaws. While a system is in place guaranteeing medical insurance for all undocumented immigrants with a job, many still don't have access to it because their employers refuse to sign them up. There is also a growing concern that even immigrant workers with access to medical insurance delay and postpone treating their medical conditions because of fears of jeopardising their employment.
"The best way to settle this issue is for people to ask a professional about the use of medication, which is why it's important for people to have access to sickness insurance that covers their consultation with a physician," Luttekes said.
Sardeman and Inspector of Pharmaceuticals Ashanti van Heyningen said that, based on a risk analysis, the Inspectorate had prioritised combating the sale of prescription-only medication on the streets, and supervising imports of all medicinal drugs – legal and illegal.
Until the Inspectorate assumes the inspectorate functions from the Central Government, the responsibility for inspections lies with the Inspectorate in Curaçao, which occasionally sends down small teams to control businesses that illegally peddle medications.
"One of the problems is that it is a free haven, and we don't know what is being imported," Sardeman said, adding that a combination of measures, such as controls and education, would be needed to combat the black market for medicines.
Gynaecologist Dr. Randall Friday said education about not patronising the black market and about the risks of doing so was badly needed, and such a programme should be started in our schools.
Vos said whenever the inspectorate discovered medicines on the black market it issued press releases warning the public against using them, and educating them about the risks. "We try to inform the public that these items should only be used under the guidance of a physician, and we've tried to alert Customs to confiscate them. This issue is a concern and we are trying hard to stop the importation."
In the meantime, the black market network continues to thrive, and all aware of the risks hope that it won't take more deaths clearly linked to the market to stimulate firmer and more decisive action to address the issues involved.
Parts I, II and III of this series can be read in this week's Tuesday, Wednesday and Thursday issues, respectively. Send feedback to:
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