THAILAND: Misuse of Viagra, Fake Drugs Worry Experts

By IPS Correspondents Reprint | | Print |

Sonny Inbaraj

BANGKOK, Aug 19 2004 (IPS) - Fake drugs are big business in Asia and according to the World Health Organisation (WHO), one of the most counterfeited drugs today is Viagra. In Thailand, tourists may be unwittingly buying fake Viagra over the counter of numerous pharmacies in the capital and exposing themselves to serious health risks.

”No prescription needed. All kinds of pharmaceuticals sold here,” reads a sign in English outside a pharmacy in Bangkok’s red-light district of Nana.

A pack of Viagra, with four blue diamond-shaped pills – each with a 100- gramme potency – costs 2,500 baht (62.50 U.S. dollars). The drug is manufactured by the drug giant Pfizer.

”Don’t take it with alcohol. Just one small beer okay, but not more,” says the drug-seller.

According to Thailand’s tourist police, one of the killers of the 119 tourists who died last year was a volatile mixture of Viagra and alcohol.

But to an unsuspecting buyer using Viagra for ‘recreational’ purposes, there is no way of knowing whether the blister pack with four tablets is genuine or fake – and that is where the danger lies.

”Counterfeiting can apply to both branded and generic products and counterfeit medicines may include products with the correct ingredients but fake packaging, with the wrong ingredients, without active ingredients or with insufficient active ingredients,” says the WHO in a statement.

The United States Food and Drug Administration (USFDA) estimates that counterfeits make up more than 10 percent of the global medicines market and are present in both industrialised and developing countries. It is estimated that up to 25 percent of the medicines consumed in poor countries are counterfeit or substandard.

These figures place the annual earnings from the sales of counterfeit and substandard medicines at over 32 billion dollars globally.

The WHO says trade in these medicines is more prevalent in countries with weak drug regulation control and enforcement, scarcity, unregulated markets and unaffordable prices.

”However, one of the most counterfeited drugs today is Viagra, which is sold extensively (in both industrialised and developing countries),” adds the WHO.

Most fake Viagra contain a pharmaceutical that stimulates the body’s insulin production. High levels of insulin can cause a precipitous drop in blood glucose concentrations, starving the brain of energy. This syndrome is known as insulin shock, which is actually life-threatening.

A Thai Food and Drug Administration (FDA) officer tells IPS there is widespread smuggling of genuine and fake Viagra into the country because of misconceptions that it was an aphrodisiac but dismissed reports Thailand was a production centre for fake Viagra.

”The reports that Thailand is a centre for producing fake Viagra are not true. We have seized Viagra from the harbours and airports and found that it is shipped in from other countries,” he says.

But last year, an Egyptian man was arrested for attempting to smuggle 16,500 Viagra pills, believed to be fakes, out of Thailand when he was about to board a flight for Athens. According to Thai Customs the fake Viagra, if sold to unsuspecting buyers, could have fetched over 240,000 dollars.

Under Thailand’s drug rules, Viagra is not available in drug stores, but is sold only in hospital pharmacies with a prescription from a urologist, cardiologist, endocrinologist or psychiatrist for 400 baht (10 dollars) a dose.

Viagra, with sildenafil citrate as its active ingredient, was first created as a drug for high blood pressure. Then reports came in from men who were taking it that it had also cured their impotence. Researchers discovered that Viagra relaxes the smooth muscle cells that line the arteries of the penis, allowing more blood to flow into the penis when it is stimulated.

But according to the USFDA, over 500 deaths in the United States have been linked to Viagra, many from sudden heart attacks due to over-the-counter purchases without prescriptions. Medical doctors warn that Viagra is deadly for men who are taking nitrate drugs for angina – heart pain caused by partially blocked arteries.

Dr Boonriang Chuchaisaengrat, public health chief in Phuket province, said people could easily buy the drug from hospitals and drug stores. For tourists, he said, it could even be delivered right to their hotel room from the pharmacies.

Doctors specialising in urinary tract disorders should be the only ones prescribing the drug for erectile dysfunction in men, he said, and then only after a patient was given a proper check-up.

People taking the drug had to be careful against putting strain on their heart, he said.

”This is a serious concern. Demand from tourists has raised sales of the drug. Most consumers are middle-aged and old men who want to have sex but do not understand the safe use of the drug,” he told IPS.

But what’s more worrying is that the drug marketed to help erectile dysfunction in older men might be finding its way into the hands of a younger generation who are mixing it with other drugs to enhance their sexual performance.

The number of men between the ages of 18 and 45 taking Viagra has increased 312 percent since it was released in 1998, according to Express-Scripts, a U.S. trade group studying drug usage.

In Thailand, the current fad among young night-clubbers is mixing Viagra with the rave drug ecstasy or a combination of nitrate-based drugs such as poppers (amyl and butryl nitrate).

Rave drugs such as ecstasy impair male sexual function. It is known as the ‘hug drug’, since it increases the desire to touch and be touched, even though it reduces the libido. But used in combination with Viagra, it can increase sexual desire.

However, almost no studies have been done in Thailand on this lethal combination, which health experts say could be a ticking bomb for a deadly heart attack.

But Judith Aldridge, a researcher at Manchester University in Britain. has studied it, and says in an e-mail interview that Viagra, in combination with these drugs, may lead to dangerously low blood pressure levels.

Aldridge and two colleagues conducted a study with 2,000 participants on Viagra use in English clubs. ”Our biggest concern was that people were using it in combination with poppers,” she says.

”Since they both affect the circulatory system, this creates a big risk for heart attack and stroke,” adds Aldridge. ”I wouldn’t recommend anyone in Thailand to do such a thing.”