The U.S. State Department issued a warning Friday for Americans to “exercise caution” when buying medications from drug stores in Mexico, posting the health alert a week after a letter from two lawmakers and an investigation by the Los Angeles Times.
“The U.S. Department of State is aware of recent media reports regarding counterfeit pharmaceuticals available at pharmacies in Mexico, including those tainted with fentanyl and methamphetamine,” the alert said. “Counterfeit pills are readily advertised on social media and can be purchased at small, non-chain pharmacies in Mexico along the border and in tourist areas.”
The new notice is stronger than previous language on the department’s website, which warned that counterfeit pills were common in the country. It did not specify that they could be purchased at legitimate pharmacies or that they might contain such potent and deadly substances.
“The State Department warning is a good and necessary step,” said Chelsea Shover, a University of California, Los Angeles researcher whose team documented the problem this year. “But there’s still a lot we don’t know about the scope of this issue, and I think finding that will be critical to issuing more precise warnings and taking action.”
The department did not answer a list of questions about the advisory, instead sending a statement.
On Friday, “the U.S. Embassy in Mexico City issued a Health Alert informing U.S. citizens of the danger of counterfeit pharmaceuticals available at pharmacies in Mexico, including those potentially tainted with fentanyl and methamphetamine,” the statement said.
Mexican agencies and officials did not respond to requests for comment. In recent weeks, President Andres Manuel Lopez Obrador has denied that his country is involved in the fentanyl trade, despite ample evidence.
The State Department’s warning comes one week after Sen. Edward J. Markey, D-Mass., and Rep. David Trone, D-Md., sent a letter asking the department to immediately “warn Americans traveling to Mexico of the danger they face when purchasing pills from Mexican pharmacies.”
The letter cited the Los Angeles Times’ investigation and the UCLA researchers’ findings, both of which documented dangerous counterfeit pills being sold over the counter at drug stores in northwestern Mexico.
“U.S. tourists who unwittingly purchase counterfeit pills from Mexican pharmacies — both with and without a prescription, according to the Los Angeles Times — face deadly risks from medications that have effectively been poisoned,” the lawmakers wrote.
Of the 17 pills Times reporters tested this year, 71% came up positive for more powerful drugs. In three cities, tablets sold as oxycodone or Percocet tested positive for fentanyl; in two cities, tablets sold as Adderall tested positive for methamphetamine.
Many pills were nearly indistinguishable from their legitimate counterparts, and all were purchased over-the-counter from small, independent pharmacies in northwestern Mexico.
The UCLA team found similar results when it tested 45 samples from four cities in the same region. Using infrared spectrometry, the researchers found heroin in three pills they purchased.
Although it was known that counterfeit medications had become increasingly common on black markets in Mexico and the U.S., it was not known that the powerful synthetic drugs had made their way into pharmacy supply chains. Drug market experts predicted that the contaminants would have fatal consequences.
“Whenever you have counterfeit products that contain fentanyl, you are going to have people use them and die,” Shover said at the time.
Five weeks later, The Times published an investigation detailing the final hours in the life of Brennan Harrell, a 29-year-old California man who died in 2019 after consuming fentanyl-tainted pills purchased at a pharmacy in Cabo San Lucas, Mexico.
His parents said they cooperated with the Drug Enforcement Administration, which conducts and assists with trafficking investigations in the U.S. and in Mexico. Agents looked into the matter, the Harrells said, but did not alert the public about the potential risk.
A DEA spokesperson declined to comment on the State Department‘s alert Friday, referring to an earlier DEA email.
“We do not regulate Mexican pharmacies, which is why we have recommended you reach out to authorities in Mexico,” the email said. “U.S. Department of State issues the travel warnings/resources for Americans traveling out of the country, so we refer you to them on information provided to American citizens visiting Mexico.”
Harrell’s parents fought more than three years for the State Department to issue a prominently placed warning about the dangers of Mexican pharmacies.
“This warning should have come almost in 2019, when I alerted the State Department,” Brennan’s mother, Mary, told The Times on Saturday.
Any other deaths, she said, “are on their hands, and how many deaths we will not know.”
In part, that’s because Mexican autopsies do not consistently include tests for fentanyl. Additionally, drug experts say the country’s mortality data vastly under count overdose deaths.
While more than 91,000 people died of overdoses in the U.S. in 2020, Mexico saw fewer than two dozen fatalities from opioids that year, according to the country’s official data. That same year, the U.S. recorded more than 68,000 opioid overdose deaths.
The State Department issues travel advisories for every country, rating the level of caution U.S. travelers should take. The lowest-level advisory — color-coded blue — suggests people should “exercise normal precautions” while abroad; the highest-level advisory, coded red, warns that Americans “should not travel” there due to life-threatening risks.
For specific — and often shorter-term — safety concerns in another country, the department puts out alerts about things such as demonstrations, crime trends and weather events.
On Monday, the State Department issued a broad “travel alert” for spring break that warned travelers about concerns in Mexico, including crime, drownings, medical emergencies and pharmaceuticals.
“Counterfeit medication is common and may prove to be ineffective, the wrong strength, or contain dangerous ingredients,” the alert said. “Medication should be purchased in consultation with a medical professional and from reputable establishments.”
That alert was largely a repetition of guidance on the site and did not include warnings that the lawmakers requested regarding counterfeit medications sold in drug stores.
On Friday, the State Department published the more detailed warning, “Health Alert: Counterfeit Pharmaceuticals,” offering more specifics about the concerns raised in recent reporting. However, the department did not answer a question about how long its alert would remain in place.
“Pharmaceuticals, both over the counter and requiring prescription in the United States,” the alert said, “are often readily available for purchase with little regulation.”
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