<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%> Medications and the Medical System in Mexico
Little Log

MEXICAN MEDICINE AND THE MEXICAN
MEDICAL SYSTEM -- A GUIDE FOR RVERS

By David Eidell (10/09)

[ED NOTE: The following article provides detailed guidance to RVers who wish to purchase prescription medications in Mexico. However, the information should be of interest and value as well to anyone contemplating the purchase of medications in Mexico. Please note the author's disclaimers that the information is not to be construed as either medical or legal advice.]

READ THIS FIRST: Your personal physician is your first and last authority on determining your medical condition and prescribing medications to treat your medical problems. This article was created for and intended to educate readers about the Mexican medical system and its medicines on a primary or basic level. The article, its author or hosting website specifically does not recommend or advocate purchase or consumption of Mexican controlled or uncontrolled medications without obtaining prior explicit consent of your US physician.

WHAT AT FIRST APPEARS TO BE SYNTAX ERRORS; AND POINTS OF INFORMATION THAT HAVE BEEN REPEATED, ARE INTENTIONAL. SUCH EMPHASIS AND REPETITION IS INTENDED TO AID READER ASSIMILATION OF VITAL GOALS AND ISSUES:

Millions of Americans cross the Mexican border every year in order to purchase reasonably priced prescription medicines. Thousands more expatriate Americans buy their medicines in the country. Mexico is a stable highly regulated republic and one hundred twenty million consumers rely on the Mexican pharmaceutical manufacturing sector to provide products that meet international standards for efficacy and purity. Medicines that are not considered controlled* by the US Drug Enforcement Agency are sold over-the-counter in Mexico without a prescription. The American medical society, pharmaceutical manufacturing and retail pharmacy community has from time-to-time issued vague yet scary sounding warnings about buying Mexican medications. My hunch is that the scare tactics are intended to reduce the number of cross-border purchases of medications that can cost as little as ten percent of their USA counterparts. I know of one blood sugar control medication widely used in the USA that is manufactured in Puerto Rico. The same exact medicine, also made in Puerto Rico is sold in Mexico at half the price of its US cost. A major pharmaceutical manufacturer recently warned it would quit selling medicines in Mexico if “something isn’t done to reduce the number of people buying their products in Mexico”. The company Glaxo-Smith-Kline did not act on its threat. Tens of billions of dollars are at stake in the US pharmaceutical industry – always keep that in mind when dealing with consumer information or news issues that could potentially affect their bottom line. Historically American news agencies have had many a field day with scandalized substandard made-in-USA drugs and you can bank on the fact that the slightest hint of a similar scandal from Mexico would similarly make headlines. It is inevitable that sooner or later a Mexican medicine is going to be discovered that is found to be below minimum FDA accepted standards. But you can bank on the fact that industrial spies have already been sent to Mexico to retrieve samples of medication and present them to US testing laboratories hoping to uncover a sensational fault – I haven’t read of such a sensational occurrence being reported; have you? Again, I feel confident that any revelation of a substandard drug by our fourth estate be it from the United States, Canada, or Mexico will make enough noise to wake the dead.

* Refer To Drug Enforcement Agency Controlled Drug Categories Below

WHAT IS MISSING IN MUCH OF THE CURRENTLY AVAILABLE INFORMATION ABOUT PURCHASING MEDICINES IN MEXICO

FOURTEEN COMPONENTS WHICH ADDRESS ISSUES ITEM BY ITEM

Pre Trip Preparations

1. Make an appointment with your doctor or doctors and get a checkup. Explain your plans to visit Mexico and your need to obtain enough medicines to last your trip. If your doctor throws a hissy-fit because you have life-threatening medical conditions then you’re going to have to sleep on making a decision to go or to stay. Some doctors mistakenly believe Mexico to be as medically backward as Somalia. If needed a second opinion wouldn’t hurt. And, refer to the EVAC OPTION section below.
2. You should ask your doctor to create a letter on his letterhead, with DEA registration number detailing your medical issues, a list of all your prescription medicines and the dosage of each. Have him/her list all routine lab work requirements and sign the document. Make sure he specifies and categorizes all controlled medicines in your personal formulary according to DEA standards.
3. Ask your health care system to have your doctor’s letter translated into Spanish. The translation MUST be done by a translator familiar with Mexican (not just Spanish) medical terminology. Translation of this information is CRUCIAL to locating and purchasing controlled medicines in Mexico so please have it done! Having an official translation of your health issues can save your life should a medical emergency occur. Be sure to have your doctor specify any allergies to prescription medication.
4. Sign medical history release forms that will allow your medical provider to immediately send your records to any medical facility in the United States. If you return to the USA ill for some reason you may end up choosing to go to the first medical center that you encounter. They will need your medical records fast!
5. Visit your pharmacist, fill your doctor’s prescriptions, and ask him/her for a piece of paper actually a reference piece referred to as a PACKAGE INSERT for each of your medicines. Package Inserts are tightly folded brochures that contain EXACTLY THE SAME INFORMATION as listed for the medication in the Physician’s Desk Reference. Have your pharmacist make photocopies or official hand written receipts for all your doctor’s written medicine prescriptions.
6. Ask your pharmacist for a check off of every medication that you take that is “time release formulated” and ask him to specify legibly the brand name or other labeling difference that differentiates the time release medicine from the non time release form of the same medicine. If an alternate action medication exists, ask for the PACKAGE INSERT for the other medicine and then before you go any further mark it with something like ALTERNATIVE MEDICATION across the top so you don’t confuse it with your correct medicine.
7. Take all of the paperwork to a copy shop; make LASER COLOR copies of your doctor’s letters, the Mexican translation, and your pharmacist’s official Rx receipts. Next place back-to-back your doctor’s letter and the Mexican translation and have the copy shop seal it in plastic. Buy a top-quality transparent document pouch and stuff everything inside. If you wish have the copy shop make ENALRGEMENTS of each of the PACKAGE inserts that your druggist provided and also stuff them in the document pouch.
8. Patients being treated for hypertension or cardiac issues should strongly consider purchasing a quality electronic blood pressure monitor. Desirable models have an irregular heartbeat detector as well as pulse, blood pressures and perhaps storage of the last 100 readings. Highly recommended! Buy extra batteries.
9. Diabetics should stock up on supplies and not hold back on the number of test strips, lancets and testing liquid they obtain for the trip. A smart move would be to get a spare blood test machine and two or three extra batteries especially if the device uses a coin cell battery.
10. Make it a practice to put all medical stuff including paperwork aboard your rig before you start your regular loading and outfitting. Leaving it all behind is a good way to sour a trip.

Download And Print Out Specific Drug Information

1. The object of this exercise is to obtain the critically important first page data sheet for each of your drugs as printed in the PDR. The first page contains the drug’s molecular (chemical) structure.
2. Go to this website: http://www.rxlist.com
3. In the search bar type in the brand name or generic name of the medication
4. A list of medicine names will appear, select the appropriate drug ( Beware: some have multiple active ingredients or are long-acting preparations) and click
5. The critical 1st page of the PDR will appear, copy the page, print it out and then make sure you can CLEARLY make out the hexagon formula including numbers and letters. If hazy try resetting your printer to “Fine Quality” resolution.
6. Repeat the above for all of your medicines.
7. Staple the pages and then stuff them into your medical record document pouch.
8. Your pharmacist’s PACKAGE INSERTS have very tiny print and should be relied upon as a better-than-nothing backup to full size downloaded and printed online pages.
9. Your pharmacist will help you understand what chemical molecular symbols mean if you fail to grasp the concept after seeing actual examples (below) extracted from the PDR.

Aircraft Medical Evacuation (EVAC) Service

Several US companies operate aircraft medical evacuation services that can pick up a patient in Mexico and then fly them back to the United States. The aircraft is staffed with medical personnel, basic medical equipment, and communications. Some better quality services can send an airborne electrocardiogram by FAX to your medical facility of choice.

1. http://www.google.com Enter MEDICAL AIR EVACUATION SERVICES
2. Ask whatever service chosen to send a sales package that specifically depicts their air coverage in Mexico.
3. Read and understand the procedure protocol guarantee for pickup and delivery
4. Will EVAC aircraft land solely at major international airports in the USA and Mexico or at minor ones as well?
5. Does the service allow transport of the patient to a destination of your choice?
6. Get a written guarantee of how many hours evacuation will take.
7. Check the history of the EVAC service with the Better Business Bureau for the number of complaints that a company may have accrued.
8. Realize that the ill person will not be transported until such time as a Mexican medical facility “stabilizes” the patient’s condition. Discuss this with the EVAC service, and with your personal physician to make sure you understand why stabilization is so important for patient safety.
9. Return to number 3 and re-read the brochures, before plopping down your credit card.
10. To and from delivery can take more than twelve hours – clearly understand that point going in. Some evacuees later complained about the amount of time that it took to clear US Customs, but such complaints must be balanced with the advantage of returning to US medical care and umbrella insurance coverage in hours rather than days. Other reports heaped praise on aircraft crew and on-board medical assistance.
11. Someone is going to need to replace an RV driver if they are evacuated. Most major Mexican campground residents usually have someone in mind and can be a great help in resolving such an issue. Motorhomes with a 10-year permit can legally remain in Mexico and the permit can buy enough time to allow resolution without resorting to hiring a substitute driver. A spouse, parent or sibling with the same last name as the person listed on the Temporary Vehicle Import Permit must accompany the vehicle all the way back to the border according to Mexican law. Make sure that your Mexican Insurance policy would cover the vehicle if using an emergency driver.

US Drug Enforcement Agency DEA (4) Controlled Drug Categories

Mexico’s Sector Salud uses a very similar system to categorize their controlled medicines. Later on in this article you are going to encounter excerpts taken from US government official documents that discuss points of regulation for these medications. In specific note what category (1) medications means.

(1) Outright banned narcotics such as heroin, cocaine, LSD, marijuana, hashish, methamphetamine, peyote, hallucinogenic mushrooms, and designer poisons such as ecstasy. Some other formerly legal medications like Rohypnol are now banned outright in the USA.
(2) Drugs with a high potential for abuse such as morphine, Demerol, synthetic opiates, some dextro-amphetamines, anabolic steroids, etc.
(3) Codeine, Vicodin, etc. When combined with acetaminophen these preparations are degraded from schedule (2) to schedule (3)
(4) Benzodiazepines like Librium, Valium, and Tranxene. Barbiturates, Ritalin and other psychotropic medications also fall into this classification. Your USA pharmacist is your best bet to tell you the DEA classification of your medications.

The Mexican Prescription Drug Laws Enforcement Community And How It Works

Mexico has a combined the equivalent of our DEA, FDA, and AMA organizations into a single, massive bureaucracy called SECTOR SALUD (hereafter referred to as “SSA”). SSA deals with the Mexican part of registering, and code enforcement of Mexican health care providers and medications. Consumer criminal violations are dealt with by local, state and federal police. SSA itself does not have the power to arrest offenders within the Mexican health care system but it works closely with Mexico’s federal Attorney General’s office (PGR) and various Mexican state Attorney General’s offices (PGE).

Mexico’s SSA is a powerful entity – it licenses and provides prescription registration numbers to doctors and pharmacies (just like our own DEA). Violators may have their license yanked or even be jailed for major or repeat SSA violations. Doctors and Pharmacists have a healthy respect for this agency and its rules and regulations. Every container of Mexican medication has an SSA registration number plus an inclusion of a DEA type drug classification number. Again, the systems are highly similar to one another with regard to drug rankings.

The SSA also oversees operation and regulation of health care organizations like the IMSS and ISSSTE, plus various state-operated community health clinics.

1. Controlled medicines II, III, IV, and V cannot be obtained or sold in Mexico without the buyer presenting a valid prescription from a recognized federally registered local Mexican doctor. Pharmacies that handle controlled medicines always have a recommended local doctor on file. The doctor is located within a block or two.
2. Prescriptions from US doctors are as worthless in Mexico as a Mexican prescription would be in the United States. The purpose of bringing your US bilingual document that your US doctor and translator provided, is two-fold. The first is to show the Mexican doctor that a US doctor thinks a particular medication is appropriate for you; the second is compelling evidence to show Mexican law enforcement (not at all likely to happen) that you are a legitimate shopper and not a gringo addict or drug pusher. This is why having your US doctor list your DOSAGE is so important – it is again compelling evidence that your need for a controlled medication may require a purchase of a larger than “normal” quantity of medicines.
3. All medications sold in Mexico are handed to the purchaser in their original bottle or container. They are not repackaged into prescription bottles with official regulatory labels that show your name or an “Rx Number”. Controlled medicines are legally touchy in the Mexican Justice System. You will ask the farmacia for a copy of the Mexican doctor’s prescription (by law they keep the original); receive a legitimate sales receipt and your medications. DO NOT MISPLACE either the photocopy of the doctor’s prescription or the sales receipt. DO NOT remove any medications from their factory packaging. They are your SOLE proof to Mexican Law Enforcement and to US Customs that you obtained the medicine legally and the medicine is what the package states it is.
4. Many Mexican physicians are wary of writing a prescription for category II, III or IV controlled medications in excess of a minimum normally prescribed quantity. It is up to you and your letters from your US doctor (in Spanish) to try and convince the doctor otherwise. Have photocopies of your translated documents made and at hand so you can offer one to the doctor and he can retain it as “proof”. Also be prepared to pay a premium over the doctor’s normal price for a visit – after all you’re asking him to stick his neck out.
5. Many controlled medicines are uncommon in Mexico so BEFORE YOU PAY the doctor for creating a prescription have him telephone the farmacia and VERIFY that they have a sufficient quantity of the medication on hand. To lessen the chance of being audited by the SSA some doctors will write multiple prescriptions and then tell you to use different pharmacies.
6. Having a single pharmacy sell you an extremely large quantity of a controlled medicine calls for extreme caution even when using a legitimate legal prescription. If the farmacia is a large one it’s probably OK. Beware of hole-in-the-wall farmacias as they are infamous for selling enormous quantities of controlled medicines to tourists with no prescription. They sell the medicine at a hugely inflated price, collect the money and then call in police cohorts who shake down the unsuspecting buyer, and then return the medicine to the crooked pharmacist and collect part of the loot. THIS IS AN INCREDIBLY UNLIKELY SCENARIO IF YOU GO ABOUT OBTAINING CONTROLLED MEDICINES LEGALLY AND HAVE ON HAND PROPER DOCUMENTATION AND RECEIPTS.
7. Just to clear the air; the use, possession, sale, or attempt to purchase category (1) drugs is a felony in Mexico and the laws are vigorously enforced by local, state, federal cops, plus the army and marines.

The Physician’s Desk Reference (PDR) And its Mexican Counterpart, Diccicionario de Especialdades Farmaceuticas (DEF).

Danger! Will Robinson! If you have the slightest bit of doubt about your ability to access, and copy technical data from the physician’s desk reference either from the book or online CORRECTLY then DON’T DO IT! Forget this part and count on showing your downloaded info or your pharmacist’s PACKAGE INSERT INSTEAD to a Mexican doctor or pharmacist! Don’t guess at this stuff. Have your personal physician or pharmacist review it, and straighten you out as to which medicine brand names fit which generic moniker in your personal Rx formulary.

Having said that, I believe many visitors to Mexico would be comfortable with making their own analysis. The following are examples of two entirely different medications that have similar sounding names.

CARDIZEM and CARDURA are two absolutely different (but similar sounding) medications used for different ailments. They are not in competition with one another as far as substitution of one for another.

The PDR and or your pharmacist's package insert contains on the first page a critically important diagram depicting the molecular chemical structure of the medication that was prescribed for you. Cardizem and Cardura have two extremely different chemical molecular diagrams that are impossible to confuse.

Some medicines like Glyburide are unknown in Mexico at least as far as the name glyburide goes. I made a search through the Mexican edition of the PDR (DEF) using the molecular structure of my dwnloaded PDR document. Viola! Searching through a pharmacists copy of his DEF I found a perfect match! Glibenclamida is the name for glyburide in Mexico. The molecular chemical diagrams were one and the same. The same process discovered PARACETAMOL is the same medicine as Tylenol or acetaminophen.

Yes, the subject requires a bit more than casual acknowlegement but the rewards are of making ABSOLUTELY SURE an offered medication placed on the counter of a farmacia that has an unfamiliar generic name can be run to ground on-the-spot and determined if it is one and the same as your doctor's Rx. The process also helps to identify if there are any other active ingredients.

Controlled Mexican Medicines, Medicinas Controlados, And How To Obtain And Possess Them Legally in Mexico.

Possession or attempts to purchase class I narcotics (See DEA Controlled Drug Schedule Above) are a felony in Mexico. Violators are arrested and promptly sent to state prison for a year or longer. Bribery is now as impossible with Mexican cops as it is in the USA so forget it. Medical marijuana exemption from prosecution and state statutes from USA legal authority are ignored and the Mexican arrest and adjudication are treated as a schedule I narcotics violation.

US prescription medicines come repackaged with labels that clearly indicate Rx numbers, your name, the doctor’s and pharmacist’s name and will have a DEA registration control number as well. Mexican law enforcement and the military have been instructed to acknowledge the permissibility and legality of USA medications that are properly labeled even if you seem to have enough controlled medicines on board to fill a piñata. But label or no, the possession of an official letter signed by your US doctor is your guarantee that no Mexican law enforcement personnel will so much as utter anything other than a “muchas gracias” as they step out of your rig. No one has EVER experienced a problem when they were armed with their doctor’s letter. In fact even being questioned at all about US medications in original prescription containers would be outrageous – I’ve never heard of it happening.

Compared to the United States most of Mexico has a very limited selection of narcotic pain killers, tranquilizers, and other controlled drugs. Warehouse pharmacies in the states may sell 100 tablets of diazepam for thirteen dollars, but 90 tablets of trademarked Valium are going to cost more than eighty-dollars – legally in Mexico. An RVer's wife ran out of Vicodin and was shocked to learn that run-of-the-mill 5-grain codeine plus acetaminophen tablets cost more than a dollar twenty cents each and the physician was quite unwilling to write prescriptions for more than twenty tablets. Mexico is definitely not the land of unlimited discounted controlled medicines. Smart RVers will carefully arrange to bring enough medication to last them their entire length of stay. In a pinch pharmacies in cities of more than a half-million may (or may not) have a greater selection of controlled medicines than what is indicated above.

1. Schedule II, III, IV and V medications can be purchased with a valid prescription from a federally registered Mexican doctor only. Attempts to merely inquire about controlled medicines are frequently thwarted by farmacia personnel until you have a valid prescription written by a registered Mexican physician in your hand.
2. Schedule 5 medications are unique and have no USA counterpart. The medications are usually sicotropic anti-depressants like ELAVIL (Amitriptylene) and the farmacia does NOT retain Class V prescriptions, at least not right away like they do for other schedules of controlled medicines. You are allowed with that one prescription to purchase three refills of that medication in a 90 day period. Each time at refill the farmacia will imprint a rubber stamp insignia and when the third purchase is completed the farmacia will then keep the prescription.
3. A relatively low percentage of Mexican farmacias carry controlled schedule II, II, IV, and V medicinas controlados as they are known and almost no discount chain farmacias have them. Most of the non stocking farmacias can recommend another that carries medicinas controlados.
4. Farmacias that stock medicinas controlados always have a list of one or more nearby doctors that can write legal prescriptions for medicinas controlados.
5. These doctors frequently keep Mexican Physician’s Hours and are not in office between the hours of 1:00 – 5:00PM. The best time to catch them would be from ten to eleven in the morning and after five in the afternoon.
6. When you are admitted to see the physician this is the time to produce your translated into Spanish medical history and prescription medicine requirements as prepared by your US physician and translation service. The presence of such written advocacy of your use of a controlled medication may carry great weight, especially when it comes to the quantity of doses the doctor will request on the prescription.
7. The doctor may shake his head no – the medicine may not be available locally or in Mexico at all. He may recommend a substitute.
8. If the medicine is not available or available in a different dosage that you normally take and or contains another active ingredient DO NOT SUBSTITUTE until you call your US physician or pharmacist and ask for advice.
9. Most physicians know enough English to go about asking “How Many or “How Much?” meaning how many doses you are requesting. You may want to write down the number and pass it to him.
10. If he shakes his head no. Hold your hands up in a classic “Now What?” gesture. It is well understood. The physician will write down the number of doses that he feels comfortable writing and you must abide by it. Don’t forget that many forms of controlled drugs are not available outside large cities.
11. He will then write a prescription. Ask him in pantomime fashion if necessary to call the farmacia and see if they have the medicine in stock. Pantomime dialing a phone, point to the newly minted prescription and give that classic now-what shrug. Believe me this will be understood. Rushing from a doctor’s office to find no medicine may mean rushing back to the doctor’s office to discover that he has departed for the day.
12. If you do not have a translated history or record of a US doctor’s written prescription the Mexican doctor is probably going to become wary that you are using the medication minus supervision. He may end up refusing to write a prescription or limit the total prescribed doses to a minimum. You’ll have to live with it. Individuals under fifty years of age are particularly renowned in the Mexican medical and pharmaceutical community to seek large quantities of controlled medicines to satisfy a drug habit.
13. DO NOT EVER ATTEMPT TO TAMPER WITH A SPECIFIED QUANTITY OF MEDICATION INDICATED ON A PRESCRIPTION IN ORDER TO INCREASE IT. Mexican pharmacists are hyper sensitive and almost infallible in detecting altered or forged documents and they may end up calling the cops. Many farmacias will reject a prescription if it is the least bit torn or dirty or more than 15-days old.

LEGAL ILLEGALITY IN MEXICO

Mexican law and law enforcement acknowledges and even has a litany of unkind jokes about the ability of law violators to obtain abnormal quantities of controlled medicines by various means including the visitation of multiple doctors and purchases in multiple farmacias. I would advise caution in this area and avoid trying to possess on your person 500 tablets of Valium using prescriptions for example from eight doctors and purchases in eight different pharmacies. Unless you are prepared to produce on-the-spot compelling evidence in Spanish from your US physician (Example Valium 4 X Day w/10 refills), and have on hand photocopies of all (8) written Mexican prescriptions and receipts from all (8) farmacias – you can end up in hot water real fast. Boiled down what this means is that you should return to your rig with each purchase, stow it and then pursue your next purchase. Cops in both countries understand that possessing a mass quantity of codeine, Ritalin, Valium, along with other controlled medicines is a clear sign of abuse or intention to resell which is illegal no matter how legal the purchases may have been. RV rigs are never strip-searched except rarely by US Customs.

14. The Mexican pharmacy will fill your prescription by selling you bottles or boxes of the prescribed medication. They will ask you for your written prescription and then retain it. Almost always the farmacia will provide a photocopy of the doctor’s prescription. DO NOT LOSE IT! If they don’t automatically make one, ask for it. Many times the farmacia will ask for photo ID and then meticulously copy down your name, the doctor’s name, the medication and god knows what else. Be patient. Your photocopy will be your sole proof to Mexican law enforcement and US Customs that you obtained the medicine legally.
15. BEFORE YOU TAKE POSSESSION OF THE MEDICATION review the box or label for an expiration date which in Mexico is referred to as FECHA de CADUCIDAD. Day/Month/Year, sometimes spelled out other times numerically.
16. If the farmacia cash register spits out a faded register receipt, ask to have someone hand draft a copy on an official farmacia sales receipt. The name and quantity of the drug must be legible. This is vital documentation for US Customs. Keep it and the photocopy of the doctor’s prescription clean and safe – I cannot emphasize the importance of retaining the entire chain-of-evidence-that-you-obtained-the-medicines-legally enough times.

Uncontrolled Mexican Medications, Some Tips On How To Locate Them And Get The Best Price.

IMPORTANT: In the USA Wal-Mart, Costco, and other large pharmacies offer substantial discounts on basic uncontrolled medications. Many times the author has discovered a drug’s price tag to be far below that of the same medicine in the cheapest Mexican farmacia. Of course like when buying any medication in the USA you will need your doctor’s written prescription. If you intend to purchase medicines in Mexico first check the price in USA pharmacies.

Big first-class Mexican farmacias that handle controlled medicines seem to stock a greater variety of medication classes of uncontrolled medicines. These farmacias ALWAYS have an up-to-date DEF prescription drugs manual handy and the education of counter personnel and supervisors is many times a lot more sophisticated than it is at most of the cut-rate farmacias. I always make a first-class farmacia stop FIRST ON MY ROUTE so that I can use the facility to accurately access the availability of medications, their Mexican brand name, and generic moniker and to help compare the molecular chemical structure diagrams in case there is no data present in the DEF on your medication. A list of things to carry into the first class pharmacy would be pen, pad, reading glasses, a magnifying glass, and your copies of the PDR pages with the medicine molecular chemical structure symbols.

Here is a perfect example: GLYBURIDE is the generic moniker given to an oral diabetic medicine in the USA. Every doctor and every pharmacist is extremely familiar with it. But if you go to Mexico and ask for GLYBURIDE, they won’t find it on the shelf or in the DEF. What gives? For whatever reason the molecular chemical structure of GLYBURIDE happens to match exactly the Mexican generic GLIBENCLAMIDA! Therefore the medicines are one in the same but if I hadn’t taken five minutes to compare molecules in diagrams I would still be in the dark. Non-prescription acetaminophen is not known by that name; rather Paracetamol.

The first-class farmacia may not have the lowest price around for uncontrolled medicines but I always patronize the farmacia with ten or twenty dollars worth of purchases to make their consultation time and trouble well worth the effort. I always make controlled medication purchases first and they will fairly well fall all over themselves trying to help with information about purchases for uncontrolled medications. Sometimes controlled medicine farmacia discounts reduce the price of uncontrolled medicine enough where shopping elsewhere would be a waste of time and effort.

UNCONTROLLED MEDICINES DO NOT NEED A PRESCRIPTION IN MEXICO

You can purchase unscheduled medicines from Penicillin to Celebrex. Keep in mind that if you show up at the US border with a large packing crate of uncontrolled medicines it may stir up a lot of curiosity as to why you apparently possess enough medicines to start your own pharmacy.

BRAND NAME MEDICINES COST MORE THAN GENERIC EQUIVALENTS JUST LIKE IN THE USA

1. Male erectile dysfunction medication may cost seven, ten, even fifteen dollars a dose and is not available as generic medication.
2. Some newer medications are not available as generic in the USA but Mexico has a shorter gestation time between the introduction of a new medication and an allowance of production of much lower priced generics. Few Mexican brand name medications cost as much as they do in the USA however. As a rough-hewn rule the reduction in price is around forty to fifty percent.
3. REJECT any and all medications that are manufactured in India, China, or Africa. Some of these imported medications are packaged impressively written in English with official USA emblems of FDA and USP but they are phony and I have personally purchased some of these medicines and discovered total dose count shortages, and once three DIFFERENT medicines in the same bottle. These medicines are to be avoided at all cost.
4. Brand name medication is the ONLY medicine in Mexico that observes a “Maximum Cost To The Public” regulation that is usually pressure imprinted on a flap on one end of a box or on the label of a bottle. The price will be in pesos.
5. Many first class farmacias offer a double-digit discount on all their medications EXCEPT FOR CONTROLLED MEDICINES. The discount is always taken at the register.
6. Uncontrolled medicines usually have a “Maximum Price To The Public” printed on a label or tab just like brand name medicine but it is no longer mandatory. The incredibly stiff competition between the tens of thousands of farmacias in Mexico is more demanding than any government price control regulation. Huge discounts bite into these suggested maximum prices.

CHASING DOWN HARD TO FIND UNCONTROLLED MEDICINES

1. Patience is a virtue. Go to a first class farmacia and copy down ALL the brand names from the DEF. Maybe the first farmacia has it in stock – who knows?
2. Try competing first class farmacias – some seem to stock an alternating list of hard to find medications. Others may promise to order it but don’t hold your breath. For my formulary I need to visit FIVE different farmacias!
3. Huge chain farmacias like Farmacias Similares, Farmacias Genericos, Farmacias Fenix, and Farmacias Guadalajara sometimes carry medications that their competitors don’t. All are worth a try.
4. Try Wal-Mart, Soriana, Commercial Mexicana, Bodega Aurrera, and Mega. I found the medication AMIODARONE only at the local Soriana hypermarket. Life is weird.
5. I hate “I-Told-You-So’s” but this is yet another example of why vacationers should bring a full supply of medication for their entire trip – chasing down hide and go seek meds rather than basking in the shade of a coconut palm can be a drag.
6. Mexico’s largest cities and the border tourist zone prescription Mecca’s are the best place to zero in on really difficult to find generic (or brand name) medicines. Going from farmacia to farmacia will best be accomplished using a taxi hired for a half-day or more.

"HECHO EN MEXICO POR" Means, “MADE IN MEXICO BY”. After the name and address of the manufacturer is printed you will find the Sector Salud registration number. Many times you’ll find further addressing for Latin American countries and their own version of drug classification and registration.

Tips To Reduce Errors When Purchasing Medications. Spend time beforehand with the online PDR familiarizing yourself with molecular chemical symbols and how to tell them apart. Some of your USA medications may be long-acting (time-release) and you must double-check that an intended purchase isn’t an incorrect non-time-release medication even though name and dosage may be the same. Time release Mexican medications are referred to as “Accion Prolongada”. Rely on your American physician, and pharmacist to enlighten you about your medications. Use a Mexican doctor to corroborate facts and in event of your falling ill for some reason. Treat helpful RV park neighbor’s suggestions as being suspect – especially if their information promotes the use of an unfamiliar medication. Check and re-check all purchases before you leave the farmacia that you are getting the correct medication in the correct dose with no added or subtracted other-medicines in the same pill. Check expiration dates and reject medications that will expire before you use them. If farmacia personnel or a flood of customers seem to be giving you the Bum’s Rush, go somewhere else or return later. Take your purchases back to your rig and review their ingredients and your PDR molecular structure page yet again. Until you gain proficiency with the interpretation of molecular chemical symbolism (I can compare, accept or reject in about ten seconds flat) use caution – you will instinctively know if you have an aptitude to absorb information and create an ability to become comfortable comparing symbols in a short period of time. Final Warning! A Mexican physician or senior staff person at a Mexican farmacia that handles controlled medicines can help you identify a particular chemical molecular structure, translate the information into identifying the generic name of the medicine and finally an assortment of brand names.

DON’T PLAY DOCTOR DOOLITTLE

At 63, I have aged similar to most other seniors in that the multitudes of medicines prescribed to me over the years has left me very sensitive to side-effects and bad reactions. Presently I have to be meticulous in taking correct medications in protocol in order to maintain some semblance of normal life. For now, I would rather see Chichen Itza again rather than the Pearly Gates. Adding a strange unapproved medication to a personal formulary without medical supervision can be likened to fitting another five bullets to a revolver and then playing Russian roulette.

MEXICAN DOCTORS AND CLINICS

There are as many bad doctors and outright quacks in Mexico as there are in the USA.

Your RV park neighbors are an excellent source of gossip and information about local doctors and clinics. If for some reason you need fast transportation to a hospital think about calling a taxi unless of course the patient needs immediate life-support attention by an ambulance crew. Mexican taxis regularly whip around speeding Code 3 ambulances like they are standing still.

Mexican federal law dictates that the medical profession must at no cost render triage to seriously ill or injured persons at no cost. Treatment is limited to stabilization of the patient’s affliction so that they can be transferred to pay care or another facility.

I am a cardiac patient and I no more trust a Mexican family physician to make important decisions about my health care than I would an American G.P. to do the same. Stomach aches, cuts, sprained ankles, diarrhea and the sniffles are the realm of general practitioners. Unless it is an emergency I will specifically seek out a cardiologist to tend to my heart’s needs, and an internal medicine specialist for the rest of my medical issues. The same rationale should be applied by anyone whose health issues potentially go beyond what a regular MD is able or qualified to handle. Mexico has everything from accredited brain surgeons down to interns and trainees and everything in-between. There is absolutely no need to feel that you have to settle for an inferior level of care. A surgeon is a surgeon; an internal medicine doctor is an internal medicine doctor. A suspected heart problem demands going directly to a facility that can properly treat the affliction.

HOW TO GO ABOUT FINDING A SPECIALIST

Mexican towns and cities of any size have at the very least a health clinic. Personnel can refer you to a large hospital and it is there you can inquire about seeking out one of their specialists who will frequently happen to have a practice on the side. Someone will be found who speaks English, if your need is an emergency the hospital will immediately tend to you to at least stabilize the problem. Larger cities have specialists dealing in oncology, heart-lung transplants, bone marrow transplants, dialysis, and the like. Ask any physician anywhere. Don’t panic and make a dash for an airport with someone who may have a life-threatening problem – they need to be stabilized first or risk expiring while ascending the steps to the airplane.

"Donde esta un hospital de salud?" What you are asking is Where Is The Nearest IMSS Hospital? The IMSS hospital system is vast with millions of members. I’ve walked into a strange IMSS hospital pointed to my heart and before I knew it I was hooked up to oxygen with an oximeter clamped onto my finger. The doctors stabilized me then recommended me seeing a local cardiologist who just happened to be their chief cardiologist who was moonlighting. This is a very reassuring way to make prompt important connections with a correct specialist. Even more amplification: The Mexican system operates exactly the same as ours – doctors know when to refer a patient to a specialist.

COMMUNITY CLINICS

The IMSS system is membership and rural IMSS clinics will often refer you to a state operated clinic. For run-of-the-mill issues, grit in your eye, a badly stubbed toe or even a bad cut a community clinic is well qualified to treat your affliction. Not long ago I walked into a local state operated clinic with a thumb tightly wrapped – it seems that I grabbed a falling can of peaches that had an opened lid and my thumb took the brunt of the slice. One look convinced the registration nurse that the cut wasn’t minor and I was led into a treatment room without delay. I had jumped ahead of a half dozen others waiting with issues of a less urgent nature. Treatment follow-ups and medicines ended up costing two dollars thirty one cents total.

US CONSULATE PERSONNEL

Consular agents always have on hand a comprehensive list of local medical facilities and personnel that can save lots of searching and headaches. Finding an English speaking physician sometimes is a necessity if for nothing else than to act as expert interpreter between yourself and a medical specialist. The United States embassy in Mexico City website lists the city, address, telephone number and name of every consular agent in the country and printing out such a list as part of your trip paperwork is wise.

Passing Through US Customs:

The last section of this article contains word-for-word (verbatim) excerpts of pertinent FDA, DEA and US Customs rules and regulations for the possession and importation of class II, III, IV and V medications into the United States. The Mexican SSA authority uses a very similar table or category of restrictions; the author has tried hard to insure accuracy of the text of this article but in all cases the authority contained in appropriate excerpts from US government agencies MUST ALWAYS TAKE PRECEDENCE.

The following discussion which is limited to anecdotes, opinions and prejudice deals solely with personal experience issues of entering the United States with medications. This section of the article does not have excerpts of US Customs regulations – that comes later; The following anecdotes may be a real eye-opener to some readers. It is a collection of sometimes very hard earned experiences, observations and off the cuff interviews with various agents:

Be prepared for anything from a wave-through to a down and out twenty minute wait while they go through your rig.

*A few years ago I had a senior agent ask the following question “Where are you coming from today?” I truthfully replied the name of a city a hundred miles distant. “How long were you in Mexico?” I truthfully answered Six-Months. “How far down did you go?” – he now had knitted his eyebrows “All the way to the Guatemala border” I replied. “Why didn’t you tell me that going into this conversation” he snarled -

“Sir, you specifically asked me where ‘I came from today’ – I supplied an accurate answer”. He gave forth a long sigh and admitted – “You’re absolutely right, I’m sorry”. He then waved me through.

Other Questions:

IT IS A US CUSTOMS PRIME DIRECTIVE TO NEVER SHOW THE SAME FACE TWICE

Some US Customs agents are polite, others are obnoxious, and many act like circling sharks quivering at a chance to get a whiff of “contraband blood”. Keep calm. These federal employees are paid to be suspicious and intense peer pressure is supposed to keen their senses to a knifelike edge. It takes just “one good bust” to advance in rank to Special Agent, and then they can “get back at all those miserable miscreant fellow employees” (the preceding quoted text is purely a product of my imagination but it serves me well in order to maintain my perspective and sanity when dealing with the occasional unpleasant agent).

HORROR STORY #1 ELDERLY MAN ARRESTED IN TIJUANA FOR POSSESSION OF PRESCRIPTION MEDICINES. FAMILY FRANTIC. EFFORTS TO FREE HIM UNSUCCESSFUL. The 80-year old man was discovered parked in a car parking lot in Mexico near the border. A police search discovered more than six hundred tablets of diazepam (valium) in the trunk of the car. He was asked if he had a prescription – he pulled a much expired prescription out of his pocket written by a US doctor. The police asked him if he had a prescription or photocopy of a valid prescription from a Mexican doctor. He had no prescription whatsoever. He was then asked for the sales purchase (farmacia) receipts for the six hundred doses of the controlled medication. He had no receipts.

HORROR STORY #2 YOUNG AMERICAN WOMAN ARRESTED BY ENSENADA POLICE FOR POSSESSION OF PRESCRIPTION MEDICINES, EFFORTS TO FREE HER BOG DOWN. Police discovered the woman walking on the side of a pitch-black highway at 2:00 AM. She bore a large backpack. A search revealed multiple controlled medicine packets containing a total of more than eight hundred doses. The medicines included valium, codeine based pain killers, tranquilizers, and Ritalin a powerful amphetamine-like drug used to treat youngsters with ADD disorder. She could produce no prescriptions from either side of the border, no sales receipts and no credible reason why a young woman would need all those uppers & downers. A popular website forum eventually listed information that posters had discovered that the woman had a long history of drug abuse in the USA.

Pressure from US private citizens and the government secured release of both of the accused within a few weeks. I always wonder if the same pressure could be exerted to afford their release from the clutches of the wheel of justice had a CALIFORNIA HIGHWAY PATROLMAN made the busts.

Homeland Security, FDA, DEA, and US Customs Rules & Regulations Excerpts

Since 1998 US Customs have enforced a DEA edict declaring that a maximum of 50 dosage units of controlled medicines schedules II, III, and IV will be allowed entry if the declarer does not possess a valid prescription written by a US doctor. Note especially that US Customs has an historically strict rule of imposing heavy fines for not declaring "Anything and everything acquired in Mexico when asked to do so". Possession of a valid prescription written by a US doctor does not exempt a declarer from the responsibility of declaring possession of controlled or uncontrolled medicines that were acquired outside the USA. I strongly urge readers follow the link that follows to pages that contains excerpts taken from official FDA, DEA and US Customs regulations. They, the regulations, are from the "Horse's Mouth" and are not overly ponderous to read and comprehend. Some may find the information fascinating.

IN CLOSING

© 2009-11 David Eidell, reprinted with permission.

[ED NOTE: Even though the author inserted a postscript regarding his inability to answer specific questions about medical health, medicines, finding medicines and prices, it should not be interpeted that general questions, opinions, and statements will be ignored. He can be reached at mexbungalows@gmail.com]

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