According to a recent survey in California, 25 percent of U.S. residents who enter Mexico as tourists buy pharmaceuticals, and 31 percent of the Los Angeles residents polled said they know where to buy prescription strength medications without a prescription in places like meat markets, party stores and produce markets.
Since 1999, a unit known as HALT, short for Health Authority Law Enforcement Task Force, has made hundreds of arrests and seized $20 million worth of illegal and potentially dangerous pharmaceuticals. The team responds to complaints and confiscates medications and counterfeit drugs.
On one recent morning, three police officers, a Los Angeles County health inspector and a pharmacist gathered for a HALT team briefing on the scheduled locations for the day's operation plan.
"Since I made the undercover buys, we are going to have the Health Department go in and conduct an inspection of the locations," said a police officer, "and if they do find anything else, they are going to come out of the stores and tell [the police officers] that they found more pharmaceuticals, so that we can go recover the pharmaceuticals and either arrest or cite the person for the violation."
The police officers waited in unmarked police cars on the street of the first inspection. The pharmacist and a deputy health official in forest green jackets with PUBLIC HEALTH written in big letters on the back went into a small variety store that sells clothes, suitcases, toys and candy.
When they found the illegal medications behind the counter, they called in the police officers for a follow up investigation. The fine could run as high as $5,000 for the first offense. A second violation closes down the business.
The middle-aged Spanish speaking shopkeeper was questioned by the police, but doesn't seem unnecessarily bothered that he got caught. He stepped away from the police officers and told me when I asked, that, yes, he knows that it is against the law to sell the drugs, but he said, "I don't specialize in this kind of trade, and so I didn't figure there was much of a risk, since it was mostly for my personal use." As to why he sells the drugs to the public, he answered simply, "because customers come and ask for them."
The same inspection was repeated at a second party supply store on the same block, where the manager had sold an antibiotic cream to the undercover HALT team detective.
"She had a bag full of a lot of creams that I noticed when I bought from her," said the undercover officer, "and when she opened the bag I saw a lot of antibiotic creams." He had no problems making the purchase, and no questions were asked.
Meanwhile HALT pharmacist Daniel Hancz methodically sorted through jars and tubes and some pills wrapped in foil like candies.
"We are finding actually a lot of syringes, injectable medications," he said. "It appears that the owner of the store was giving people injections of various substances. We found some controlled substances, some anabolic steroids, a lot of antibiotics, some non-steroidal products, products to treat eye infections, to treat vertigo.
"This is like a pharmacy that is operating without a license," he continued," pointing to a supply of injectable antibiotics. Does he think the people know what they're doing is illegal? "I think they are aware," said Mr. Hancz. "The products were not on display. They were hidden away in drawers and cabinets and in an area that was not visible to people that walk into the store."
Does the pharmacist consider what was found a lot of pharmaceuticals? "I would say this is a considerable amount of drugs that could be used to treat a wide variety of conditions," he said.
Later in the day back at the Los Angeles Department of Health Services, pharmacist Daniel Hancz logged the pharmaceuticals seized as evidence for legal charges. He and health inspector Erick Aguilar said they were finding fewer illegal pharmaceuticals in certain areas. They credit the increased HALT vigilance, although they have reports that the medications are moving elsewhere in the state.
HALT inspections generally do not cross Los Angeles County borders, but the team is hopeful that other jurisdictions will introduce the same tactics to protect public health.
This is part five of VOA's five-part series on Curbing Abuse of Antibiotics.