Black market drugs offer risky relief for uninsured, low-income Californians

LOS ANGELES - In "the alleys" around MacArthur Park near downtown Los Angeles, it’s easy to find alternatives to prescription drugs.

Customers there can’t afford drugs at pharmacies due to the high prices or because they lack health insurance.

On the street, they can buy painkillers, anti-inflammatory medication, and natural medicines and vitamins, among other remedies. But doing so can be dangerous, even lethal.

Dr. Anjali Mahoney, a family practice doctor at the AltaMed clinic in Orange County, says it’s never a good idea to self-medicate, let alone buy medicine on the street.

“(Consumers) don't know what’s in that medication, and even worse, if they get it on the street, they can’t tell if it’s expired or what’s in it,” Mahoney said. “They may get something harmful to their kidneys or liver, and if a doctor isn’t prescribing it, it’s even worse because there’s no (patient) background.”

Samuel, a street vendor who declined to share his last name, points out that self-medicating can be more expensive, since the cure buyers are seeking for their disease doesn’t always work.

“I tell them, ‘You’d better go and see a doctor,’ and if they come with minors, I tell them to see a pediatrician because they know more,” said Samuel, who sells Advil and muscle pain creams along with other merchandise. “For example, I don’t sell antibiotics because those are sensitive items that could cause allergies.”

However, Samuel said he knows firsthand how expensive a doctor’s visit can be.

“One day, a dog bit my finger and I went to the doctor,” he said. “I had to wait for an hour (in the waiting room) and three hours in a small cubicle. Then they gave me three pills, one for the pain and the other two for the infection.” A few days later, he added, he received an enormous bill.

Samuel said he fortunately was able to apply for Medi-Cal, the state’s Medicaid program for low-income residents, which covered the expense retroactively. Otherwise, the charges would have been devastating.

Despair without measure

In some cases, the need for self-medication goes beyond curing an illness or alleviating pain. Such is the case of transgender people who, despite the risk, often take hormones they acquire on their own to help with their gender transition.

Africa Avila left her native Morelos, Mexico, for the United States almost two years ago to get away from relatives and acquaintances who rejected her for being “different.”

Once she was in Los Angeles, Avila found a far more welcoming environment for transgender women.

“I started making friends and some of them were transgender and they gave me advice,” Avila said. “They told me, ‘Here you can get hormones, here you can do your surgeries. Here you can do whatever you want without getting hurt.’ That’s when I started my transition.”

However, her lack of health insurance forced her to buy hormones on the black market and use them without medical advice.

“About five months after arriving (in Los Angeles), I started getting hormones from El Salvador. I went with a friend, who had another friend who got the hormones for her,” said Avila.

She soon learned that hormones were sold illegally in the alleys and other areas around MacArthur Park.

“You look for people and get a name, although sometimes it’s hard to get information because it’s dangerous. They want to make sure you’re really looking for (hormones),” said Avila.

“Each shot is $17, but you need about two shots a month. That’s a good price, since a shot can cost up to $40 each” elsewhere or at a pharmacy?, she added.

Khloe Perez Rios, coordinator of transgender programs at the Bienestar clinic in Long Beach, said prescribed hormones could cost as much as $150 to $200. Some clinics are authorized to sell hormones, but they won’t accept any medical plan.

Rios added that Avila was fortunate that she didn't suffer side effects from self-medication. At Bienestar, Rios has come across people who developed health problems as a result of buying or taking illegal medication.

“Many people have suffered a stroke or a heart attack due to taking so much hormones without medical supervision,” Rios explained. “We've talked to people who suffered kidney damage from administering ‘cuerpo amarillo’ (progesterone), a very strong female hormone. When people are not under treatment or medical supervision, they don’t administer the right dose, and this may damage their kidneys.”

Rios said many transgender people first go through gender dysphoria, which means they identify with the opposite sex and feel discomfort with the sex they are assigned at birth.

Because gender transition treatments can be expensive, some people choose other alternatives.

“Taking hormones, administering industrial silicone or oil shots and undergoing cosmetic surgery are all ways that transgender people opt for to decrease (gender dysphoria),” Rios said.

However, when those procedures are unsupervised, transgender people may suffer serious side effects.

“People can die from industrial silicone shots, and even if the consequences aren’t immediately fatal, the skin damage caused may later develop into fibrosis, a muscle condition that can later turn into something worse,” Rios said.

Removing clandestine drugs

Erick Aguilar, an agent at the Los Angeles County-run Health Authority Law Enforcement Task Force (HALT), said it’s impossible to verify the authenticity and origins of medication sold on the streets.

HALT’s main goal is to investigate unlicensed dental operations and physicians, as well as the sale of illegal drugs in Los Angeles County.

Aguilar said that in the first half of this year, HALT agents reported 35 cases involving the sale of illegal drugs in the county.

“There are currently 11 cases related to medication coming from Latin America targeted at people with health issues,” Aguilar said. “Of these 11 cases, eight are individuals who sell drugs on the street or at their homes, and only three are businesses” operating otherwise legally.

No illegal drugs targeted for the transgender community have been seized so far this year, Aguilar added.

“But I believe we’ve seized some in the past. We also accept any report (even anonymous) related to this type of medication,” Aguilar said.

Despite the danger and warnings, a street vendor in the MacArthur Park area who wished to remain anonymous argued that he and other vendors were just helping low-income, uninsured Latinos who can’t afford doctor’s visits.

“We sell vitamins that are dietary supplements and everyone (in the area) thinks that a vitamin will help,” the vendor explained. “They think that (with self-medication) they’ll be cured. They don’t have enough time or money to buy medication, or they don’t have Medi-Cal.”

Physicians warn that such supplements can be dangerous if used incorrectly.

Unlimited search

A transgender hormone vendor who identified himself only as Angel, said he doesn’t regret selling black market remedies. He hadn’t planned on entering this business, but has been selling hormones for about 10 years now.

"It started as a favor and then it became a source of income,” he said. “Plus, you acquire a good reputation when you’re able to get what they need, so that brings more business.”

Angel said it’s easier to get different types of medication in Mexico, but crossing the border is a challenge. He usually tells border agents that his medication is for personal use.

“That’s why I have a small-scale operation — if you work with large quantities, you get caught,” he said.

“I feel my work is beneficial to my friends, since we all have limited resources and the cost of hormones can be very expensive, especially for those without health insurance,” Angel said.

Avila said U.S. prescription drugs tend to undergo “more stringent controls” than drugs from Mexico or Central America. A few months ago, she found out about Bienestar, which has given her guidance on how to continue with her gender transition in a safe manner.

“Many ask if I’m not afraid of the risks involved in buying street medicine, such as catching diseases,” Avila said. “But my desire to become a woman is too great, so I overlook the consequences.”

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