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The Other Drug War: Inside the World of Counterfeit Viagra

How the gaps in our health-care system are responsible for propping up a dangerous, global and billion-dollar industry

On December 29, 2015, 62-year-old South Korean national Nam Hyun Lee — better known as “Daniel Lee” — wrote an email to his contact in China asking about the best way to label a 50-pound container full of white powder known to help men attain rock-hard erections. A few months later, in March, they settled on labeling their first bulk shipment of Sildenafil — the active pharmaceutical ingredient in Viagra — “Granular Amino Molding Compound,” in order to pass through customs undetected. 

The shipment of unmarked containers arrived in Gardena, California the following November. That same month, two more 50-pound shipments of Sildenafil and Tadalafil (the active ingredient in Cialis) labeled as “Acrylic Paint,” along with two smaller containers labeled “Health Products,” arrived in Fullerton, California. And so would begin a nearly three-year venture selling counterfeit ED drugs marketed as herbal male sexual enhancement products in a scheme that earned Lee more than $3 million. In fact, between 2016 and 2018, if you were buying Rhino branded boner pills from a gas station in California or Texas, chances are you were buying Lee’s contraband.

Yet, in the world of counterfeit Viagra, Lee is a dime a dozen. Case in point: Around this same time — and approximately 2,500 miles away in Rome, Georgia — the husband-and-wife team of Irfanali and Shiba Momin (48 and 42 respectively) were involved in a similar scheme. Though they weren’t receiving powder, the Momins were working with a different unknown Chinese distributor who sent them boxes containing illegal pills of Sildenafil or Tadalafil labeled as beauty products, health products and health supplies. 

Moreover, in January, U.S. Customs and Border Protection agents seized three cargo containers from China only to discover that hidden amongst shoes, purses and other counterfeit goods, was more than one million fake Viagra pills estimated to be worth nearly $20 million. So far this year, in fact, they’ve confiscated over 1,000 packages stuffed with counterfeit Viagra. But even that amounts to only a tiny fraction of what’s out there. 

The other, far more lucrative side of the business takes place online. Per some estimates, nearly 80 percent of the Viagra sold online is counterfeit. A 2016 report from the Alliance for Safe Online Pharmacies claims that each month, 600 new illegal online pharmacies are launched to take advantage of the more than $11 billion global counterfeit pharmaceutical industry. Simply type “Viagra” and “no prescription” into a browser, and you’ll find a bevy of online pharmacies offering variations of the magic blue pill sans prescription. “Any website that claims that you don’t need a prescription for this product is an illicit online pharmacy,” Timothy Mackey, a professor of global health at the University of California, San Diego, tells me.

From a quality-control standpoint, the manufacturers of these products — all of whom use drop shipping to fulfill orders — run the gamut. According to Mackey, some labs are as sophisticated as a generic manufacturer in China or India. “The product could be very high quality and very controlled,” he says. In other cases, you may have a manufacturer who rents out lab space in a foreign country and works a night shift to develop the drug. “Who knows what the chemicals are or what the quality is, but at least it’s in a sterile environment,” Mackey reasons. Then there are people doing it completely DIY, without any active pharmaceutical ingredients, filling pill caps with chemicals and other fillers. “So it’s a huge range, and it’s really hard to tell the quality. Generally speaking, though, there’s not a lot of quality control around those types of products,” Mackey explains. 

Which, of course, gives way to complications. From a manufacturing standpoint, the thinking is: How can I find the line between saving on raw materials (mainly Sildenafil and Tadalafil) and overall efficacy? Because unlike counterfeit medications, which Mackey says may be nothing more than a pill filled with corn starch since “a lot of cancer patients have no idea if the treatment is effective or not,” a customer knows if and when a male sexual-enhancement drug works. 

In that way, developing counterfeit Viagra is similar to cutting fentanyl into opioid pills to save on costs. “Counterfeit Viagra is one of those drugs where it’s more likely that the counterfeit product contains too much active ingredient,” says Mackey. This, he adds, is usually on purpose — a way for counterfeiters to stand out on the market. “Over promise and give the customers more than they’re expecting,” he explains. (Unfortunately, in 2012, researchers who analyzed the contents of counterfeit Viagra found some other things consumers probably weren’t expecting — namely, traces of talcum powder, paint, ink, amphetamines and a variety of unrelated drugs.)

Another popular way to move counterfeit ED drugs is by simply copying the name of an already profitable product, which explains why there are so many variations of “Rhino”-branded male-enhancement drugs. “There’s essentially a family of rhino products,” says Thom Mrozek, the director of media relations at the U.S. Attorney’s Office in L.A. 

To his point, the FDA has a running list of over 300 different brands of “Tainted Sexual Enhancement Products.” Dating as far back as 2007, “Rhino” appears on the list more than 34 times. “Rhino became very popular,” says Mrozek. “We think it’s because people found that it was effective — that it did what they wanted it to do.” Why “Rhino” in the first place? According to Mrozek, in certain Asian countries, the rhino horn is viewed as an aphrodisiac. “We actually prosecuted people a number of years ago for trafficking in rhino horn powder,” he tells me.

And so, even after Lee was arrested and the Justice Department shut down his operation, other counterfeiters became the unofficial proprietors of the “Rhino” name. “Which is why you can — and likely always will — find Rhino-branded male sexual enhancement products floating out there in the world,” says Mrozek. 

The target demo for these products is seemingly seniors. “There’s this place in Florida, from what I understand, they have a large demand for such products, and sometimes it’s just easier to buy them online,” Mrozek explains, referring to The Villages, a retirement community in Sumter County where according to a 2014 BuzzFeed investigation, “There is reportedly a black market for Viagra.” 

Mackey, however, admits this evidence is mostly anecdotal. In fact, it’s more likely that the customers are more broadly men who are reluctant to discuss issues of erectile dysfunction with their doctors. As Hussein Kesvani reported for MEL in 2018, there’s still so much shame around ED that millions of men bypass the health-care system completely in favor of a Viagra street dealer, which allows them to remain anonymous. 

But even then, Mackey says, “It only scratches the surface.” Viagra and its competitors are what health-care providers refer to as “lifestyle drugs,” meaning “there’s low coverage from a prescription drug benefit standpoint.” Or more plainly: What keeps the counterfeit market humming is the gap between coverage and the price of Viagra ($70 per pill). “I do think there are solutions to hamper some of the illicit access points,” says Mackey. “There could be more content moderation. There could be more active takedowns of websites that are clearly selling illegally.” But most importantly, he adds, “You have to deal with the fact that people can’t afford these drugs.”

It could be argued that the rise of digital health companies like Roman and hims are attempts to remedy some of these problems. But Mackey still sees them as beholden to “private pay.” “It’s technology-based, so that’s great, because you’re lowering the cost to a certain extent,” he says. “But I don’t think it expands access to people.” For reference, while Roman offers generic Sildenafil for $31 a month for 12 doses of 20-milligram tablets, Mackey tells me that counterfeit Viagra can cost about half that. 

“People who can afford it will go to those places because it’s convenient, but people who still can’t afford it are forced to go to cheaper places,” he argues. “We have these two things that are running into each other — 1) how do we ensure equitable access to certain populations to make it easier to get drugs when they medically need it; and 2) how do we get rid of these bad actors that have filled that gap?” 

Or more aptly in terms of where this all began — prosecuting small-time crooks like Lee for exploiting the holes in our health-care system is the equivalent of putting a street dealer in prison for crimes carried out by the cartel. “It’s the tip of the iceberg,” says Mackey. “It doesn’t address the problem at all.”

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