Americans rush to Tijuana's 1000+ farmacias

Biggest sellers – Retin-A, Ventolin, Viagra, Nicorette gum, Xenical

Time was when a tourist driving through Tijuana might have thought this a metropolis of auto-upholstery shops. To a visitor on foot, the ubiquity of curio stores suggested the city was about purses and blankets.

Now, a tourist takes home a new impression: drugstores. They’re everywhere.

The Tijuana phone directory lists over 700 drugstores, but the Asociación de Boticas y Farmacias de Tijuana (Tijuana Association of Pharmacies) says there are about 1000. (Drugstores in the colonias may not have phones or be listed in the book.) If Tijuana’s estimated population of 1.3 million is correct, there is 1 pharmacy for every 1300 residents. By contrast, the city of San Diego has around 125 drugstores, and the county has an equal number. That’s 1 per 10,800 residents.

Mexicans go to the drugstore more than Americans since Mexicans traditionally consult pharmacists instead of doctors about minor health problems. But the fuel propelling the pharmacy trade in T.J. is the American rush to the border to buy their drugs of choice.

It’s price that drives Americans southward. In the United States, according to the pharmaceutical industry, the costs of research, development, and testing add to the price of drugs. Soaring prices have become national political fodder, and because of media reports, it is no longer a secret that prescription medicines are cheaper in Canada and Mexico. A bill pending before Congress — fiercely opposed by the pharmaceutical industry — would legalize the importation of medicines. At the moment, bringing drugs across the border from Mexico for distribution is illegal by federal law.

A few dozen paces past the pedestrian gates into Tijuana, across from the large cab stand, is Plaza Viva Tijuana, a shopping mall for gringos. Compressed into the main courtyard is a kind of quintessential downtown Tijuana tourist district, conveniently relocated to the border. Pushcarts and sidewalk vendors sit just outside the plaza, and inside are curio shops, bars, restaurants, even a massage parlor. And, at last count, 33 drugstores.

Although downtown on Avenida Revolución, hustlers in doorways of shops and bars have shown restraint in recent years, that famous old “take a look” aggressiveness is alive and well at Viva Tijuana. In the open area of the mall, where a mechanical bull hooks tourist bucks, clusters of white-shirted young men hawk their employers’ wares. “Need a Cuban cigar?” “Cold beer?” “Nice blanket?” “Painkiller?” “Viagra?” This shifting line has prompted one nearby shop owner to post a sign warning hustlers to keep a distance from his business.

On any weather-friendly weekend Americans by the hundreds, or thousands, stroll the square, lunch at outdoor cafés, and mosey from one drugstore, or farmacia, to another like bees poking around a flower bed. After alighting to make a purchase they emerge toting small telltale black or gray plastic bags.

One day last spring I watched as a young male trio, planted in a pharmacy for almost half an hour, engage in strenuous negotiations with the clerk. They don’t want to tell me where they’re from, but they appear no strangers to pumping iron. “I come over once a month,” says one well-developed guy, early 20s. “Mostly just to party, but while I’m here I’ll buy some antibiotics.”

Antibiotics? OK. Several pharmacy clerks tell me that bodybuilders come to Tijuana to buy muscle-padding steroids, but they come in fewer numbers now than in years past.

Probably more typical is an American resident of Rosarito who says she stopped at Viva Tijuana while crossing on foot to the United States. “I bought something called Feldene. It’s pretty new, I think. I checked it out first. You rub it all over your fingers and hands, for arthritis. It works fine for me.”

The pharmacies in this plaza pitch directly to Americans, with names in English such as Pharmacy Dixie, Drug’s [sic] 4 Less, Stop Drug Store (featuring a large red stop sign). There are “D apostrophe” stores like D’Garcia and D’Susy, which I’m told are all owned by the same family. D’Susy favors shotgun marketing: window signs offer “Herbal Medicines” and “Original Cuban Cigars.”

Toward the back of the square, next to a shop selling purses and ponchos, is the Payless Drug Store (capitalizing, of course, on the name of the now-defunct American chain). The store was built in the mid-’90s; its current owner, Armando Estrella, purchased it last year, sinking in his life savings of $180,000. (In Tijuana’s colonias, a similar drugstore may sell for a quarter of that price.) His clientele is 99 percent American; 60 percent are regulars. “The average customer,” he says, “spends $200 or $300.” The biggest sale? “Someone bought $2300 worth, mostly diet pills and drugs for hypertension.”

While we talk, an early-30s blond man enters, sporting a generous spare tire. He quickly makes his purchase and leaves. Miguel, the manager, who waited on him, says he purchased Xenical, a “fat blocker.”

“Some places in the plaza,” Miguel states, “don’t explain what the medications are or how to take them. Some don’t even speak good English. And we don’t put pressure on anyone. Some places here say to customers, ‘If you want it, OK. If not, go.’ ” Despite the crush of pharmacies already in the plaza he thinks more will open, with no lessening of profits for his shop.

Serving customers in the Mexican pharmacies is strictly on-the-job training. “My ex-boss made us keep little notebooks,” Miguel says. “We had to investigate on our own, using the PDR [the Physicians’ Desk Reference, the standard pharmaceutical guidebook, published in both English and Spanish editions], what each drug is, for what purpose, what kind of help it gives, what bad reactions to it can happen. That’s the way we learned, by ourselves.” He admits he doesn’t possess the qualifications of a university-trained American pharmacist, but says because he doesn’t have to separate pills out into “little bottles” as American pharmacists do, he doesn’t have to be well trained. “Here, everything is in boxes already counted out.”

Fifty percent of his American customers, Miguel estimates, come from San Diego, and 30 percent from Los Angeles and Orange Counties. “It’s worth it to a lot of people to drive down to save $300 on their medications.” Ordinary tourists from other parts of the United States also buy pharmaceuticals in T.J. “It may be something they don’t need right now but know from experience they may need later, like antibiotics.”

Miguel says the most asked for drugs in his store, in rough order, are first, Retin-A, the acne medicine now widely used as a wrinkle remover, which sells for about $8 a tube. Then, Ventolin, for asthma, and Viagra, the famous impotency medicine. Fourth is Nicorette gum — “No prescription needed and it’s a lot cheaper here than on the other side.” And the fifth is Xenical, the weight-loss drug.

A redheaded American, about 30, walks into Payless. His obviously abashed girlfriend trails along, attempting to maintain a discreet distance. “How much for Viagra?” asks the American, not modulating his voice. Miguel quotes a price of $13 for one tablet of 100 milligrams. The gringo replies that another store offered it for $10. “Then,” Miguel says, “that’s where you should probably get it.” The American, somewhat belligerently, says that’s where he’s headed.

Miguel sees a lot of younger men buying Viagra. “Everyone wants to try Viagra. Everyone wants to know what it feels like. And it doesn’t matter if you’re only 20. It works.”

American-developed drugs still being tested for approval are often available in Mexico. “It’s because Salubridad [the Mexican department of health] goes by European studies of a drug, and there the approval is usually faster than in the U.S.”

Like most of the pharmacies in Viva Tijuana, Payless does not sell psychotropics, drugs such as Valium and Prozac. These mood-altering medicines are “controlled” in Mexico and usually available only at older, more established stores, whose license requires that a pharmaceutical chemist oversee the sales, although he does not have to be on the premises.

According to Miguel, recently issued licenses to sell controlled drugs require that a chemist or doctor be at the store. Even if a pharmacy is owned by a doctor, and there are several such at Viva Tijuana, the physician must be present when the controlled drug is sold.

Addicts and recreational drug users, he says, come down “all the time,” seeking tranquilizers like Valium or heavy painkillers like Vicodin, which is not produced in Mexico nor sold in the pharmacies. (Nor is the popular American pain medicine hydrocodone.) “Mexico isn’t a good place to get painkillers. Most Mexicans don’t use them. But they will go to a pharmacy a lot for influenza medicine or antibiotics for colds.” He chuckles, adding, “Mexicans get a lot of colds.” Milder anti-pain medications, such as Darvon or Tylenol with codeine, are available at the pharmacies.

In Mexico, Miguel explains, drugs are grouped into six classifications, or schedules. Schedule 1 consists of hospital-use drugs, such as morphine; these are not available in any pharmacy. Schedule 2 comprises drugs that have high potential to become habit-forming, such as Valium. The third category are painkillers, such as Darvon, and medications that have a lower potential to be addictive or that may become addictive when combined with other drugs. Schedule 4 includes Retin-A, antibiotics, diabetes, and ulcer and hypertension drugs. Schedule 5 includes milder medicines, such as prescription-strength Motrin. The sixth schedule is over-the-counter items such as Tums or Maalox.

Payless sells mostly from Schedule 4. According to Miguel, Salubridad technically requires that purchasers of Schedule 4 drugs show a doctor’s prescription, but the store is not required to record it. “To me, that’s kind of stupid, because anyone can grab a prescription from another person and show it when they go to buy. But even so, anybody [in fact] can just go into any drugstore and buy it without a prescription. They go in and say, ‘Hey, give me that antibiotic, I have a bad cold and I need it.’ Everybody in Mexico does that. It’s been that way for years and years.”

Avenida Revolución is bloated with tourist-oriented drugstores, and the streets that finger off hold many more. Pasted on pharmacy windows or on sandwich signs in doorways are prices of popular drugs and promises of deep discounts. ZANTAC $14.25 — IBUPROFEN $7.95 — WE HAVE THE NEW DIET PILL — PRESCRIPTIONS REFILLED HERE — BEST PRICES GUARANTEED — FABULOUS PRICES. Inside, though, they all seem cloned: solicitous young clerks whose white or light blue smocks impart an air of professionalism, mirrors that create illusions of space, and wraparound shelves that display shiny white boxes with lettering in green, yellow, gray, and purple. Some stores post notices outside advertising Viagra. To satisfy health authorities that they are complying with regulations, the signs state the drug is sold “with prescription only.” Gringos are not likely to be discouraged by this since the signs are written in Spanish.

Americans bringing pharmacy drugs back from Tijuana are legally required to have a prescription from a Mexican doctor. One from an American physician won’t do, since a drug that is approved and available in the United States may not be brought into the country. The rules are set by the Food and Drug Administration and enforced by U.S. Customs. There appears to be a mile-wide breach in the regulations, though, because importing a drug is permitted, says Laura Bradbard, a spokeswoman for the Food and Drug Administration, if “you get sick in, say, Mexico, and get a prescription from a Mexican doctor and you need to continue to take the drug. You would have to have bought the drug in a Mexican pharmacy. That’s OK. We just don’t want people to go over and get a lot of boxes of something and then sell these to someone else.” And if a person brings a pharmacy drug over without a prescription? “As it’s written,” she states, “it’s not allowed. But because there’s more than one agency involved [her agency and Customs], I’m sure there is discretionary room, if it’s just a few boxes someone is bringing in to treat themselves.”

However, a spokesman for Customs at the San Ysidro crossing says that there are daily seizures of pharmaceuticals, small quantities, being brought in illegally by individuals for personal use.

Drugs can be brought across the border legally if they are unavailable in the United States. The purchaser must affirm in writing that they are for personal use and must furnish the name and address of the American doctor who is providing treatment. Only a three-month supply is permitted. An exception to the above requirements is if the drug is a continuation of a medical treatment begun in another country. “We don’t want to prevent someone from trying a treatment they feel they need, if it’s not available here,” says Bradbard.

It’s unlikely that many Americans have prescriptions for drugs they buy in T.J. Dot, one of two gray-haired women emerging from a pharmacy near Sixth Street, shows me a white-and-purple box of Tafil, made by Upjohn of Mexico. Dot says she lives in Chicago but comes to Tijuana every year when she visits her brother and sister-in-law in San Diego. “Sometimes I have trouble sleeping, so I just cut one of these in half. It’s all I need,” she says. Tafil is the Mexican name for Xanax, a popular American tranquilizer. In her purse Dot has several boxes of Retin-A, which she is taking back to friends in Chicago. Informed that she needs a prescription from a Mexican doctor for the Tafil and is not allowed to bring in the Retin-A for anyone but herself, she says, “I won’t tell if you don’t.” (Ironically, the Food and Drug Administration spokeswoman had noted, “No one is going to stop your grandmother for having a little Xanax in her purse.”)

A few blocks away a gentleman of ripe years from San Diego says he comes to Tijuana “mostly for antibiotics. I have insurance, and small co-payments, so it’s cheap enough for me in the U.S., but if I need something I’m not taking regularly and I don’t feel like hassling around going to the doctor, I’ll come down here.” He adds that he has seen in an American Association of Retired Persons (aarp) magazine that drug companies earn as much as 40 percent profit on their sales. “Everywhere else — in Canada, Europe, Mexico — the drugs are cheaper than they are in the U.S. The pharmaceutical industry is definitely taking advantage, and you won’t believe the costs the government adds to the price.”

Sipping a soda while betting on a basketball game at the jai alai sports book is Lawrence Trimble, 57, a resident of Tijuana who works in San Diego. Trimble, a legal researcher, spent a decade in Europe. He says that a few months ago when he had an upper respiratory infection he did what he used to do overseas, “went to the pharmacy, told them my symptoms, and let them choose. I didn’t want to pay a $70 office visit to talk to the American medical priesthood. The pharmacy probably knows the best antibiotic for this year’s bug. They sold me an antibiotic manufactured under license for a German pharmaceutical company, and it cost six bucks. I saved at least $100. And I’m now taking penicillin for a toothache until I can get to see a dentist.”

It’s not the casual, individual purchaser that worries Lori Senini of the San Diego County Department of Health Services, although she thinks it foolish and potentially dangerous to use a prescription drug without a prescription from a physician. Senini is the county’s coordinator to the California Office of Binational Border Health, one of the agencies concerning itself with the farmacia boom.

“The big problem,” Senini says, “is the illegal sales of huge amounts.” Pharmacy drugs transported in voluminous quantities from Mexico to Southern California or beyond have become a concern of local, state, and federal agencies. “It’s a big issue,” Senini states.

The federal agencies “are really the ones who were picking it up. It’s really their issue. We can work to educate the communities, but they have the enforcement side.” Nonpyschotropic pharmaceuticals smuggled from Mexico usually end up in Hispanic communities, mainly in counties to our north. “Los Angeles and Orange have been pushing San Diego to do something, because we don’t have any programs as aggressive as theirs.”

In L.A., the smuggled prescription drugs are sold in mom-and-pop groceries, at swap meets, and at farmer’s markets. According to Senini, unlicensed doctors and dentists operate behind shower curtains at swap meets and farmer’s markets, dispensing services and pharmaceuticals.

To crack down on the sale of the illicit drugs, Los Angeles has formed an enforcement group called the Health Authority Law Enforcement Task Force. The task force employs a full-time pharmacist, who says that the lack of the standard controls required in U.S. pharmacies and the prevalence of untrained personnel vending the drugs have created a public health problem. Last year in Orange County, a child died after being treated by an underground pharmaceutical vendor.

The head of the task force says that since its founding two years ago, the task force has made 150 arrests and this has pushed the problem underground. Where the drugs were once sold openly, they now are kept out in the car or in the back room.

Senini does not know if the problem of illegal pharmaceutical sales is as exacerbated in San Diego as in L.A. and Orange Counties, since for San Diegans it’s a short trip across the border. County officials, she says, won’t commit resources to conduct even an educational campaign unless they are convinced we have a problem. To help convince them, last February enforcement personnel from the Los Angeles task force visited five swap meets and farmer’s markets in San Diego. They found Mexican pharmaceuticals for sale at three.

The task force was in town to attend a meeting between American agencies — the Food and Drug Administration, the Drug Enforcement Administration, U.S. Customs, the California Department of Health Services, and the San Diego Department of Health Services — and the Tijuana Association of Pharmacies. This first-ever meeting by American health authorities with a nongovernmental Mexican group was initiated by the National City–based Institute for Health Advocacy. The purpose of the meeting, at least from the American perspective, was to assess the level of training received by pharmacy personnel in Tijuana and to request that T.J. pharmacies stop selling the so-called date-rape drug Rohypnol and stop selling large quantities of any drugs to individuals or groups.

“We found out,” says Senini, “that there was no set credentialing system” for Mexican pharmacies. The Tijuana association seemed mostly interested in obtaining some kind of American recognition of “legitimate” pharmacies — pharmacies belonging to the association — and help in getting rid of the bad ones. The association agreed to a second meeting with the U.S. groups, but after canvassing its members decided to cancel it. Senini doubts that the Mexican government has much interest in stronger regulations for pharmacies. “This is probably not a big concern of theirs. But the whole thing is giving the Mexican pharmacies a bad name.”

Jack Veinbergs, a Mexican citizen who lives in San Diego and works in a downtown T.J. pharmacy, concurs. “The Tijuana pharmacies have suffered a bad image because of some unscrupulous business people.”

Veinbergs tells me he’s the manager of the Medicine Store, on Avenida Revolución between Third and Fourth, across a narrow arcade from the Maxim perfume store and boutique, which has kept current by installing its own pharmacy next door. The Medicine Store — not part of a chain, says Veinbergs — is one of the newer pharmacies and is not licensed to sell controlled drugs. His customers are almost all American tourists. “Unfortunately,” he quips, “tourists like to bargain. The maximum price is set by the Mexican government. But we can discount. The discount depends on whether the medicine is imported [into Mexico] and the volume, the size of the purchase. But there is a bottom price. I don’t think anyone in his right mind is going to sell something at a loss.

“The Tijuana pharmacies are a good option for people who have no health insurance or are on Medicare, which pays for the doctors but not necessarily for the medicines. Even if a drug is not approved by the fda it is allowed into the United States for humanitarian purposes. Recently, a customer came here and asked for thalidomide, a drug that years ago had children being born deformed. Now it’s come back, and some doctors prescribe it for lupus or cancer.”

Veinbergs believes that adults should have the right to choose their medications, at least those not controlled. “And the medicines made here are one and the same as those available in the United States. A lot of people may say because there is no fda here, there is a difference in the medicines. I’d venture to say there is no difference. Why would Pfizer make a different Viagra for the United States than for Mexico?”

Pfizer, like most major American pharmaceutical companies, has offices and factories in Mexico. Sometimes the Mexican-made product bears the same name as in the United States, sometimes not. But the ingredients are always the same.

But Viagra, Veinbergs notes, is as expensive in Mexico as it is north of the border. The bargains he names are fertility drugs like Pergonal — less than a third of the price in the United States — and antibiotics and diabetes medications. Veinbergs claims that sending pharmaceuticals to the United States is not always illegal. “We export medicines from this store. If somebody sends me an original prescription from the United States, we can export the medication. Most Americans don’t know what their rights are. You have a personal exemption. If you get sick in another country and seek medical advice, U.S. Customs won’t disallow you to take medicines with you, if it’s a treatment from a Mexican doctor. [But] these Mexican doctor prescriptions are not valid in the United States, just as American prescriptions are not valid in Mexico. There’s no reciprocity; it’s not in the Free Trade Agreement.

“If a customer calls from the United States, and the price I give him is cheaper than in the United States, he’s allowed to import, provided he has a prescription [from an American doctor] and the doctor’s protocol. He is allowed to import to the United States.” Veinbergs says that American physicians can import drugs from Mexico “in any quantity they want. I don’t send it myself. I send it to the lab that processes it, and they send it.” He declined to offer more details, for fear of revealing secrets to competitors.

According to the Food and Drug Administration, a doctor may import drugs from another country only if they are not yet available in the United States and the doctor is conducting federally approved clinical trials on groups of patients to determine the drug’s efficacy. Drugs cannot be imported to treat just one patient.

But there seem to be few secrets among the people who work in the downtown drugstore trade. A block away from the Medicine Store, two young clerks in another pharmacy — after moving out of earshot of a suspicious security guard — are quick to point up the foibles of competitors. One knows Jack Veinbergs and says he is a principal in a chain that owns about ten stores downtown and at the border. Stores in that chain are distinguished by the bold-lettered, marquee-type overhang at the entrance. “Different names, same owners,” he says. “They sell a lot of drugs because they have a lot of salesmen. Just sell, whatever the customer’s problem.”

The other clerk explains that he works on a 5 percent commission plus a minimum salary. “We can discount up to 20 percent. Any less than that and I can’t make my commission.” He reaches for a box of antibiotics that lists for $22. “I can go as low as $17, that’s it.” He’s worked in the pharmacy for a bit more than a year. He says he makes an effort to be conscientious, to consult the pdr and provide information about the drug. “I wish,” he says, “it could be more professional, more like on the other side.”

The clerks say pharmacists will not talk truthfully to any journalist, “because they want to keep the information here in Tijuana.” Of the pharmacies that sell controlled drugs, “around 20 percent of them will sell without a prescription, and most of the rest will recommend a doctor who will give you the prescription.” The going rate for a prescription, they say, is $20 or $30. Later I visit a doctor’s office a few blocks off Revolución. The doctor agrees immediately to give me, for $30, a prescription for Valium.

As to the profusion of pharmacies in the downtown area, the first clerk says, “It really sucks. There’s a law here that there’s not supposed to be a pharmacy within around 100 meters [110 yards] of another. But I guess there’s been some money passed around.”

A former owner of pharmacies in Tijuana and in several other Baja cities, who requests anonymity, confirms the clerks’ observation. Three or four years ago, he says, when the always-profitable drugstore business heated up, a host of new players moved in, people with no experience in the business. “Some were owners of curio shops that were losing money. Some of the people had very strong local political connections. Sometimes the pharmacies went up right on the site of the old curio stores.”

Because drugstores are now the hot enterprise in Tijuana, those seeking the most desired locations — either a few yards from the border crossing or on Avenida Revolución — will usually be required to pay a hefty up-front fee to the building owner or lease holder. “Here, it’s called el guante — the glove. It’s been as much as $40,000 or $50,000, although I heard it’s been dropping a little lately. That’s not including the monthly rent, which for a place on Revolución could be $3000 or $4000 a month, sometimes more.” According to this former drugstore owner, the local police also stop by each month for their mordida.

A good clerk, he says, can do fairly well, earning $150 a week, which includes the base salary of $40. But paying commissions to pharmacy help is illegal and is done “por debajo del agua,” or under the water, under the table. “No drugstore will admit to paying commissions, because the government would want the store to then pay taxes and social security on the total amount.

“And the commissions are paid only on the generic drugs, not the brand names. A pharmacy may earn only 10 or 15 percent profit on a brand name but a lot more on a generic. It’s to the advantage of the store and the clerk to sell the generic.” However, he, like several others I talk to, believes that the Mexican government plans to encourage the production of generics in Mexico — most generics currently come from the United States — and that the government will then control the price of generics. If that should happen, “There’s going to be less profits for the pharmacies. Once the government gets a monopoly, they’ll raise the price. All the drugstores here believe that.”

A pharmaceutical wholesaler in San Diego later tells me that the most likely reason American-produced generics are cheaper in Mexico is because “the American drugstore is marking down a bit from the [price of] the brand name, so the generic will be a bit cheaper, but not that much. In Mexico they mark up from the actual cost of the drug. Again, in the United States the pharmacy will often get reimbursed by a government-support program, so they don’t want the price of generics to be that much cheaper than the brand names. The cash customers get the short end of that.” The wholesaler also says that recently major pharmaceutical companies have been buying up smaller producers of generics and that this trend will ultimately result in higher wholesale and retail prices for generic drugs.

In the mid-1990s, the former drugstore owner says, the San Diego pharmaceutical wholesalers, under pressure from the Food and Drug Administration, stopped selling directly to Tijuana drugstores. Now, they sell to Mexican wholesalers. Still, he claims, a few pharmacies have found a way to buy from U.S. wholesalers and smuggle the drugs into Mexico, bypassing the Mexican wholesalers. He confirms that smuggling goes on in the other direction too, that some pharmacies bring their products to the United States for resale to American buyers. He knows of one drugstore in Rosarito, another in Ensenada, and several near the border that smuggle drugs northward.

Eliminating the smuggling and limiting the number of pharmacy licenses are high on the list of the Tijuana Association of Pharmacies, according to Efrén Rodríguez and Ignacio Romo, current and past presidents of the association. Both own drugstores some blocks west of the main downtown area, where few tourists stray. The men attended the February conference with American health authorities, a meeting they describe as inconclusive.

“There are more pharmacies in Tijuana than the population can support,” says Romo. “We have to limit the licensing, but it’s out of our hands. That’s all controlled by the local office of Salubridad.” There are around 300 members of the association, which means, says Romo, “300 are regulated [by the rules of the association] and 700 are not regulated.” He pulls out a copy of an article from a February issue of the Mexico City financial paper El Financiero, which refers to some Tijuana drugstores as “narcofarmacias,” meaning they sell the so-called controlled drugs with very few controls.

Romo does not wish to say if any of his members own stores in the downtown or border tourist areas, but Rodríguez pointedly explains that since all association members are bound to obey laws relating to the sale of pharmaceuticals, it wouldn’t be possible for their members to own drugstores that cater mainly to tourists. As to why so many pharmacies have sprung up in Tijuana in recent years, both men say, “Ask Salubridad.”

Salubridad has an office in Tijuana. When I call the office, a spokeswoman says that inasmuch as there is an ongoing investigation into the sales of controlled drugs by the Tijuana pharmacies, no one can speak to the media until the completion of the investigation. She can’t say when that will be.

A U.S. federal agent familiar with the Tijuana pharmacy trade displays a cynical view of regulatory controls in Mexico. “When they want to show they’re doing something, they go out and arrest an American who bought some pharmacy drugs. The government won’t challenge the store, though.” Two years ago a man visiting from Wisconsin was held in the La Mesa penitentiary for six months after being caught buying controlled medicines without a prescription, but the drugstore at which he made the purchase went unpunished. An employee at a downtown pharmacy says that was because the store was able to show a prescription — prefabricated, one of many filled out by a cooperative doctor and kept at the pharmacy. This, though, did not help the man from Wisconsin.

The agent, who asks not to be identified, says that from what he’s heard about the meeting between U.S. agencies and the Tijuana pharmacy association, not much came of it. “It seemed they wanted us to certify them as the good guys, the responsible ones, and we can’t do that.”

Scores, or hundreds, of Internet sites supply information about buying drugs in Mexico. The majority appear to sell names and phone numbers of farmacias in Mexican border cities, information probably obtained from phone books. One site advertises itself as “the first on-line Mexican pharmacy,” but it, too, seems to sell only information. However, drugs from Mexico have been smuggled into the United States and then mailed to purchasers all over the country.

Smuggling of pharmaceuticals, the agent says, is a problem that’s been receiving more attention from the federal government in recent months. “It’s so easy to go down there and buy drugs and smuggle them up here. You can get a phone number [from the Internet], call that and talk to José, and say, ‘I want Rohypnol,’ or ‘I want Percodan.’ That’s a drug a lot of addicts use. And they’ll say, ‘OK, send 250 bucks to our P.O. box [in San Diego].’ Then they smuggle it across and mail order it to you — to Michigan, to Georgia, or wherever. And you get your drug.”

In early July the 50-year-old owner of a Tijuana drugstore, along with two of her children, was arrested for smuggling Rohypnol and steroids into the United States. During the three years they operated their mail-order pharmaceutical business, according to American officials, they sent about 2000 shipments to U.S. addresses. A similar case occurred in 1997, when a Chula Vista pharmacist and his son were convicted of selling quantities of Rohypnol, after smuggling it in from their family’s drugstore in Tijuana. In these cases, the smuggled pharmaceuticals were illegal or difficult to obtain in the United States. In other cases, smuggled drugs are available but more expensive in American pharmacies. Contraband such as antibiotics usually winds up in the markets and small shops of Mexican-American neighborhoods, but not always. There was a case involving pharmacists from Salt Lake City who regularly traveled to Tijuana to, says the agent, “buy hundreds of thousands of dollars of various prescription pharmaceuticals. While in Mexico, they’d take the drugs out of their blister packs and put them in plastic bags, in the trunk of their cars. The dogs can’t sniff out pharmaceuticals as well as they can illicit narcotics.” Once in Salt Lake City the druggists repackaged the medications in their own labeled bottles. Ultimately, they were caught after being sent to the secondary inspection for a routine search.

The federal agent says he understands that many people, seniors included, head south to save money and that the issue is politically charged. It’s very unlikely, he admits, that anyone caught bringing over more than the legally permitted 90-day supply would be detained. “It would have to be a large amount, and repetitive. Being caught three or four times. And it depends on the drug. Rohypnol would be a definite arrest. If it’s mom and pop with their arthritis medicine, we’re probably not going to put them in jail. The fda is trying to compromise with pressure groups like the aarp.”

The agent, though, warns of another danger. Some Tijuana pharmacies, he says, sell low-quality counterfeits. These are drugs that don’t meet the manufacturer’s standard. In a 1997 raid of a South Bay warehouse, U.S. Customs seized over $30 million worth of pharmaceuticals that were manufactured in India but labeled as produced in either England or the British Virgin Islands. “These were heading for the pharmacies in Tijuana, to be sold to consumers. You don’t know what you’re getting down there, because there’s no regulatory agency that will check.” The current ad campaign to defeat the legislation that would allow pharmaceutical imports from Mexico emphasizes the same point.

Lucy Sánchez, owner of three pharmacies in downtown Tijuana, strongly disagrees that counterfeit drugs are a problem. “The government watches out for those kind of things. With so many tourists coming to buy medicines, bringing in money, they’d be foolish not to. I’ve been in this business a long time. I know what to look for. I wouldn’t let bad medicine in any of my stores.” She says she empathizes with her customers because, despite being only 36, she has suffered debilitating illnesses.

Two of Sánchez’s pharmacies are called — unabashedly — American Pharmacy. One is on Fifth, just around the corner from Revolución, the other is on Seventh, midblock between Revolución and Constitución. The third, United Pharmacy, is on Revolución, just inside the arcade that serves as a terminal point for the Mexicoach tour buses. United is the first drugstore American tourists see when alighting from the bus. (Another American Pharmacy, on the hot corner of Revolución and Fifth, is owned by Lucy’s younger sister.)

United and the pharmacy on Seventh draw about 90 percent American customers, and several clerks at those stores speak English. The store on Fifth, with only 65 percent American business, may have only one English-speaker behind the counter. That place, though, the first one Lucy opened, is the only one of the three licensed to sell controlled drugs. There she must by law keep in a locked drawer records of all controlled prescription drugs sold. Inspectors from Salubridad come by two or three times a year. “They want to be sure the controlled drugs aren’t out on the counter. And they check the prescription book to be sure the doctor’s name and the name of the buyers is listed, stuff like that.”

The government also requires that she have a chemist on call for the Fifth Street store, although the choice of the chemist is hers. She tells me she pays him around $350 every six months, but he has never been called in the 11 years of the store’s existence. Lucy can’t conceive of ever calling him. “If we need him, we’ll call him. But we don’t need a chemist here.” (The chemist is actually a woman. Her name appears on a sign in the store window, a legal requirement ignored by some pharmacies that sell controlled drugs. She was hired by Lucy’s husband, and Lucy has never met her.)

Lucy employs only clerks with prior drugstore experience. When she is not at a store, cameras keep watch for her. She is not a pharmacist, she says, but a technician. While working years ago at Le Drug Store, a pharmacy inside the Avenida Revolución and Fourth Street building of the same name, the owner paid a physician to instruct Lucy on prescribing medications. “We’d spend about three months on geriatrics, prescribing for older people. Another three months would be all about family planning, birth control, injections.” The doctor issued diplomas for each course of study completed, each specialty, and Lucy earned three diplomas. But she does not think that even this basic pharmaceutical education is any longer available in Tijuana.

“In the U.S. the pharmacist fills the prescription. In Mexico, everyone who works in the store fills the prescription. Mostly, Americans come in and they have their lists ready. They check it off, they compare prices. A lot of Americans come to Tijuana to buy drugs because they have a prescription from an American doctor, but that prescription may only be valid for a few days or a few weeks. Instead of spending the money to replace the prescription with the doctor they come to Tijuana. If the doctor charges them $50 for the visit, that may just be enough to refill the prescription here, for one or two months. You know, even some American doctors understand this, for their customers without insurance. I have customers whose doctors send them to Tijuana to buy their medications because it’s cheaper.” The drugs most requested at the American Pharmacies are Retin-A, Lopid (for cholesterol control), Glucophage (diabetes), and various antibiotics. Although most popular prescription drugs are much cheaper in Tijuana, the price difference for a few is negligible; Zoloft actually costs less at Longs in San Diego than at American Pharmacy, but that doesn’t include the cost of the doctor visit.

Where generics are available in Tijuana the savings can be significant. Although the American industry trade group phrma states in a handout that in “in 1991, Mexico implemented a world-class patent law,” in fact, generic versions of drugs still under patent protection are sold in Tijuana, drugs such as Prozac and Prilosec.

Some low-income Mexicans also patronize Lucy’s stores, especially the one on Fifth. “With Mexican customers, if they look OK and we’re sure of what it is that’s wrong, we’ll prescribe. That’s customary down here. But only for things like colds, headaches, arthritis. And the elderly, we always send them to the doctor.”

Lucy, her husband, and their three children, aged 4, 9, and 16, live a few miles away in a quiet hillside neighborhood overlooking the city, the home middle-class by U.S. standards. They also own a ranch near Rosarito, where they raise ostriches and breed fighting cocks. Her husband tends to the ranch; Lucy oversees the drugstores.

The farmacia gold rush is recent, but drugstores in Tijuana’s tourist areas have always been profitable. Lucy learned the business from her father, Santiago Sánchez, who in the early ’60s worked without papers in a Los Angeles tortilla factory. There he met Lucy’s mother, and they returned to Tijuana to marry. Shortly after, Sr. Sánchez started working in Botica Sherr, a downtown pharmacy that was the city’s only 24-hour drugstore. He worked there until around 1978, when the family, now numbering six, crossed the border illegally and went to work in several East Los Angeles drugstores. Lucy worked for about a year in such a store, when she was 16.

The Sánchez family returned to Tijuana in 1981, after an old friend of Lucy’s father, a physician, purchased Le Drug Store, in the heart of central Tijuana. Sr. Sánchez managed the place, and Lucy, her two younger sisters, and a brother (now deceased) served as clerks. Working in the store helped Lucy improve her English, and she discovered that she was able to connect on a personal level with many of the American customers.

After running this store for four years Sr. Sánchez met a businessman who made him an offer: the man would put up the money to buy a downtown drugstore, Lucy’s father would manage it, and profits would be split equally. The family opened the store in 1985, on Third Street just off Revolución. The owner of Le Drug Store insisted they not use the words “drug store” as any part of their name. “We had a business that would be 99 percent American, because that’s where the money is. We sat around trying to choose a name, and we came up with American Pharmacy. It made sense. We were actually the first Tijuana pharmacy to use the word pharmacy, with the English spelling. Now, a lot of stores do it. And we were the first pharmacy where everyone spoke English, not just one person, and not just a few words.”

The big red, white, and blue “American Pharmacy” sign they put up pulled in the gringos. Sr. Sánchez was making more money than he ever had before. Lucy, who received 10 percent commission on her sales, was earning about $300 a week. A few years before, when she was 18, she had married a man 8 years older, a fellow she’d met at her grandmother’s house when she was 11. He often crossed the border without documents to work in the landscaping business and was often apprehended and returned to Mexico. When that occurred he would lodge at the home of Lucy’s grandmother. They courted when he was in the United States, corresponding by letter to save money, and by mail he had proposed.

Lucy’s father was finding uses for his newfound prosperity, engaging in a number of extramarital romances. He purchased three other pharmacies but soon sold them because of the financial need incurred by supporting several women. One place, however, he signed over to his two younger daughters, the American Pharmacy on Fifth and Revolución. (One sister later sold out to the other.) Lucy was not included in the gift, as unlike her sisters she was married and she and her husband were earning a good income. “We saved our money, and when we’d saved around $10,000 we opened the place on Fifth.” That store actually cost about $60,000 to open, but they were allowed to pay off the cost of construction and of the initial stock over time. Two years later she opened the store on Seventh and five years after that the United Pharmacy in the bus depot. She was doing so well that she lent her father money to pay off his partner in the flagship drugstore on Third, receiving from him a house as security. When he defaulted on the loan, she and her family moved in. (The drugstore is now called New Mexico Pharmacy. Sr. Sánchez died last year, and his new wife changed the name.)

Lucy’s health problems began in the early ’90s. “I started losing my memory. It went on for a long time. Six years ago I finally went to the doctors. They found an atrophy of a part of the brain. I took all their medications, but I wasn’t improving. I was also losing my hair. Then my pancreas stopped working. I went down to Guadalajara, to the best doctors there. I got a lot of medicines from them too. When I came back to Tijuana I was in bed, sick, all the time.”

One day her aunt brought two people to her sickroom, a husband and wife. These three, all Christians (as Mexican Protestants usually call themselves, rather than by their specific denominations), prayed over the bedridden Lucy, a nominal Catholic. Lucy recalls she felt markedly better ten minutes into the praying. “I felt restored. I felt well again. Before that I never let anyone talk to me about religion, but I decided then and there to serve God. Look, I couldn’t even drive for two years, but the very next day, after the prayers, I was driving again. I couldn’t drink milk, no dairy at all. Now, I eat anything. All the symptoms disappeared, and I never went back to the doctors, except for my pregnancies. I believe God cured me.” Several times a week, she attends an Evangelical church in the Otay area.

Many owners of downtown pharmacies, Lucy says, own two or three stores. They almost have to, to be able to buy in volume to compete with the chain drugstores, such as El Fénix, the big, national chain, and Vida and Roma, Baja California chains. “The big stores, the chains, have their own warehouses. The price they can sell retail is sometimes the price we have to pay at the warehouse.” Small stores in the remote colonias, she says, generally must sell at full retail.

Lucy relies on long-term, regular customers, some of whom were cultivated when she worked as a clerk years ago at Le Drug Store. “Some customers we see two or three times a year, sometimes more often. From all over, mostly California, but we have people coming in from Oklahoma and Florida, all over. We’re still in business because of our regular customers. It’s not good enough just to be there. We try to always keep up with the latest drugs, to know what they are and what they do. All my pharmacies have the latest pdr, in both English and Spanish. Customers say to us all the time, ‘Oh, you know what you’re talking about.’ ” A woman comes into the store while we talk to purchase medicine for a severe spinal condition. She tells me she and her husband fly here from Florida several times a year to buy from Lucy. “She makes me feel like I’m more than just a customer,” says the Floridian.

Other year-in-and-year-out buyers include American transsexuals, who Lucy says account for 1 or 2 percent of her business. “They come down for the female hormones. Now it’s mostly Orientals. Vietnamese, I think. I don’t know why.” They take, according to Lucy, Perlutal, an injectable birth control drug, and also Premarin and Progesterol, which are widely used by menopausal women as estrogen and hormone replacement therapy. “Perlutal changes their voice and helps stop the growth of facial hair. And, you know, gives them hips, a butt, and boobs. They make, like, a cocktail, combining the Perlutal with either Premarin or Progesterol, but I don’t know exactly how. They don’t say, and I don’t ask. I think they give themselves the injections, or to each other.” Viagra sales also give her steady revenue, but less than when the drug first hit the market. A sizable percentage of Viagra buyers are not older men. “A lot of young men seem to be having problems with erections,” she says. At another pharmacy, a customer tells me that kids take it after a debilitating night of drugs and booze.

Lucy closes her stores at 8:00 p.m. “After that time all anyone wants to buy are condoms and speed.” By “speed” she means diet pills, muscle relaxers, and tranquilizers. (There is a store downtown called Speed Pharmacy.)

She doubts she’ll encourage her children to continue the pharmacy business, and in fact she’s considering selling out and getting into another type of retail. When she opened her first pharmacy, there was only one other drugstore on the block between Revolución and Constitución. Now there are six, including the one just inside the lobby of the old Hotel Caesar.

“I don’t think it’s going to be a good business when they grow up. It’s much tougher to make a living now than ten years ago. There’s the competition, of course, and now it may be that soon the American companies with factories here won’t be able to import the ingredients to make the drugs.”

Still, she knows of people who have made small fortunes in the business, even in the past few years. “They have big boats in the marina and expensive homes in San Diego. But I don’t want to operate like that. I don’t want to sell tranquilizers to someone who doesn’t really need them. I wouldn’t feel good about that. Because I’m a Christian I don’t want to lie.

“I’d rather do the right thing and make my hundreds [of dollars] a week, rather than thousands, like some of the pharmacies do. I feel better for myself and for my family. The hundreds I do make, I feel it’s blessed. If I did it the other way, and made thousands, it wouldn’t be.”

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