Most people see the doctor when they need a prescription. But some Boston residents are getting their medications another way.
They are visiting convenience stores that function as de facto pharmacies, dispensing medications without prescriptions.
The sale of antibiotics is especially common, and that has some doctors worried. WBUR's health and science reporter Allan Coukell has been investigating.
TEXT OF STORY
ALLAN COUKELL: It's a busy afternoon in at the Codman Square Community Health Center in Dorchester.
[SOUND OF CENTER]
COUKELL: Dr Ethan Brackett sees a steady stream of patients, many of them new immigrants. He recalls one who'd been diagnosing and treating her own infection.
ETHAN BRACKETT: She said that she'd had a strep throat and had gotten antibiotics for it. And so I asked her, 'oh, well, where'd you'd you get antibiotics?' And she was like, 'the store.' And I was like, 'Did you see a doctor?' And she was like, 'No, I just went to my neighborhood store and got antibiotics for my sore throat and now it's better.'
COUKELL: Brackett was struck by how routine that sounded. He started asking other patients and heard similar stories. Now, after more than two dozen interviews with patients, healthcare providers and store owners, WBUR can confirm that a wide variety of medications is for sale in local stores.
UNIDENTIFIED WOMAN #1: (In Spanish, with voiceover) It's mostly antibiotics. They also have cough syrup for kids, something for rash, and pain killers for sore teeth
COUKELL: Like many of the people interviewed for this story, this woman from the Dominican Republic asked not to be named. She was wary of speaking openly about these illicit sales.
UNIDENTIFIED WOMAN #1: (In Spanish, with voiceover) They use penicillin for infections and sores, or if they have a cavity or a tooth ache. It is available from any Hispanic store.UNIDENTIFIED WOMAN #2: They call it ampicillin. You use it for strep throat. You use it for some minor infection.
COUKELL: This woman buys antibiotics many times a year from local Haitian stores. She uses them not just for sore throat, but on a monthly basis, a so-called "cleansing" regimen that others also say is common.
UNIDENTIFIED WOMAN #2: If I got sick, I use it once or twice a year and after my period too. You, know, to clean yourself as a female.
COUKELL: Many prescription-only products in this country are available over-the-counter in much of the developing world. In this country, some people say they buy them to save money, but for many it's a cultural preference.
UNIDENTIFIED WOMAN #2: The thing is, sometimes it takes time to find an appointment. For example, you feel like you have strep throat, you go to the Emergency Room. If they find it is negative they do not give you anything. So you just go to the Haitian market, because you get used to it. It is something you used back home, so you don't feel any danger out of it.
COUKELL: But there may be danger, both to individuals and to the population as a whole. Again, from Codman Square, Dr Ethan Brackett:
BRACKETT: I am concerned about it. I think a lot of these medications are probably under the radar medications. So, are they actually what they claim to be? Are they expired? Could they have stuff in them that is going to hurt my patients? And then, because this is such a secretive practice and that people only bring it up if they've been asked directly about it, we are probably treating lots of people who are already taking things and who knows what is interacting with the medications that we are giving them?
COUKELL: There are only a few academic studies of medication use by US immigrant populations. One, in 2004, by Arch Mainous of the Medical University of South Carolina found that nearly half of Latino patients surveyed in that state had obtained antibiotics without a prescription.
ARCH MAINOUS III: Not only were they taking oral antibiotics, but many of them have a preference for injectable antibiotics. So they are injecting antibiotics as well.
COUKELL: And about one in five had obtained their antimicrobial drugs in a US store. Mainous says he can't prove a link to antibiotic resistance, but he believes it is possible.
MAINOUS: I think it actually could be quite massive. We know there would be millions of times this would happen just to treat things like colds. But on top of that, even when they get the antibiotics, they are not getting them in quantities that would be appropriate anyway. They make take two or three pills. I think we have to change these behaviors. Otherwise we are going to start seeing potentially a situation in the United States that is similar to Latin American countries, where we have a situation with much higher resistance rates.
COUKELL: A spokesman for the Boston Public Health Commission said staff there are not aware that antibiotics and other meds are available in stores in Boston. But WBUR's own informal survey shows that these meds are easy to get.
[EAST BOSTON LOCATION SOUND]
COUKELL (on location): I'm standing in East Boston. It is a bright, sunny morning and the American flag is fluttering in Maverick Square. Around me are many, many stores with the flags of many, many nations in the windows. In one, just across the street, I went in with my translator and we said 'what do you have for a sore throat?' 'Take this,' we were told, and we were given a capsule of cold medicine and two capsules of ampicillin, a type of penicillin. 'How many should we take?' we said, and he said, 'Take eight days.' But he was only selling us a couple of capsules. And a customer was standing by and she chimed in 'oh, this works very well.' And that's what we are finding: when we ask how many to take, people say 'oh, until you feel better,' which, of course, is not how you're supposed to take antibiotics.
COUKELL (in studio): We found antibiotics for sale in convenience stores East Boston, Chelsea, Jamaica Plain and Dorchester. The meds were usually kept out of sight, but were sometimes in plain view behind the counter.
Ampicillin was most often offered, but tetracycline was also widely available. Metronidazole, another antibiotic, was also sold. The usual price was a dollar per capsule.
That was also the price for amantadine, an antiviral drug that was sold in more than one store. Last year, the US Centers for Disease Control advised doctors to stop prescribing amantadine because so many flu strains had become resistant.
Other meds were also available. These included a high-potency prescription-only steroid cream — sold by a hair salon in Mattapan — and enalapril, which is used to treat high blood pressure and heart failure.
We also found two different brands of metamizole on display. This pain killer is widely available in South America, but has been banned in the United States since 1977, because of potentially fatal side effects.
[SOUND OF STREET TO STORE]
COUKELL: So how do these medications make their way to the United States?
FREDDY CABRAL: (A FEW WORDS IN SPANISH)
COUKELL (on location): Freddy.
FREDDY CABRAL: Hi.
COUKELL: Allan Coukell from WBUR radio station... [fade down on these last words]
COUKELL: In Jamaica Plain, I visited Freddy Cabral, owner of Freddy's Market Bodega. We'd noticed that all the stores seemed to carry the same brand of ampicillin: Feltrex, from the Dominican Republic.
COUKELL: Where does it come from?
FREDDY CABRAL: Those? They come in from Dominican. They
COUKELL: How does it get here?
CABRAL: They bring it to New York.
COUKELL: To New York? And then it is distributed from there?
FREDDY CABRAL: Yeah.
COUKELL: Do a lot of people use it?
FREDDY CABRAL: Dominicans use it.
COUKELL: For what sort of things?
FREDDY CABRAL: For infections. Sore throat infection.
COUKELL: And what else... I see you have chloramphenicol?...
[STORE SOUND DIPS UNDER]
COUKELL: The medicines shelf at Freddy's is a long clutter of brown bottles with various oils, vitamin products and, in amongst it all, a variety of prescription meds.
[STORE SOUND UP FOR BEAT]
COUKELL: What about these, the tetracycline, 500mg.
FREDDY CABRAL: This is coming from South America. It is for the same thing.
COUKELL: Same thing, antibiotic.
FREDDY CABRAL: Before I buy, sometimes, people from Guatemala, Salvador.
COUKELL: They bring it in?
COUKELL: Are there laws on selling this stuff?
FREDDY CABRAL: I don't know.
COUKELL: In fact, both federal and state laws apply. At the national level, Steve Silverman, in the Food and Drug Administration Office of Compliance, says such sales are illegal.
STEVE SILVERMAN: Civil penalties can include FDA coming and seizing these drugs that are being sold illegally. On the criminal side, penalties can range from misdemeanor — things like fines or imprisonment of less than a year — to felony charges for people who are repeat players or who are breaking the law intentionally.
COUKELL: But Silverman says that these sales are not a focus for the FDA.
In Massachusetts, the Department of Public Health, through the State Board of Pharmacy, oversees the sale of prescription only products. A DPH spokesperson says such sales would be referred to the Attorney General. However, neither DPH nor the AG's office were able to cite any case in which this had ever happened.
[RETURN TO CODMAN SQUARE CENTER SOUND]
NURSE: "she doesn't mind going to urgent care, as long as you'll help her with that...
COUKELL: A number of healthcare providers were reluctant to talk for this story — especially some who worked closely with particular immigrant communities. They expressed the fear that a crackdown on sales could hurt an already vulnerable population.
At Codman Square Health Center in Dorchester, medical director Chip Severin sees his patients doing their best to make themselves and their families healthier.
CHIP SEVERIN: I think the way we have some of our patients here. Many, most, if not all seeking medications from alternative sources is them trying to find a way to fill needs to do healthcare and is a reflection of what is going on in our healthcare system.
COUKELL: The system, he says, has to think not just about enforcement, but also about ways to serve the community better. For WBUR, I'm Allan Coukell.
This program aired on April 10, 2007. The audio for this program is not available.