Reg* is a forty three year old man, seemingly healthy in every other respect, complaining of alarming aches and pains, especially in his back, and headache severe enough to keep him off work. “At first I really didn’t know what was wrong with him – I was quite worried”, says Dr Leon Ehlers, a family doctor in Umhlanga who has a special interest in sexual health. “It wasn’t my first impulse to ask him about erection problems!” But, in hindsight, that’s exactly what I should have done!
With some gentle questioning though, the patient explained that he had taken medicine a friend had bought over the internet to boost his sexual performance. “He was lucky”, says Dr Ehlers, “we stopped the medicine immediately and he did recover. It could have been a much worse outcome!”
According to Dr Ehlers, there are different reasons why men might try non-prescription medicines for erectile dysfunction (ED) or to enhance sexual performance. Sometimes they feel too self-conscious or embarrassed to speak to their doctor. But often it’s because a friend or colleague has tried something and shares it with them. Some men may be seeking a solution to ED or sexual problems. Others might want something for recreational purposes or to ‘spice up their sex life’.
Regardless, there are several problems with this approach. “Firstly, we don’t know what the actual ingredients of these unregulated medicines are, and different men react differently to any drug or substance taken into the body”, he explains.
Many sites on the internet advertise inexpensive and easily accessible well known prescription medicines for ED, so it appears that the medicine might be legitimate, but most frequently these are actually counterfeit and unlicensed. Medicines for ED are an attractive product for drug counterfeiters, because they are associated with a condition that many men want to keep private, they are used in high numbers and they are worth a lot of money. Furthermore, selling drugs online is associated with minimal costs and a low risk of getting caught.1 Counterfeit medicines may be very difficult to distinguish from their genuine counterparts, but, in contrast to the real thing, may contain too much, too little, or no active ingredient at all. They may also contain toxic chemicals, such as other drugs, road paint, floor wax, chalk, talcum powder or shoe polish! Even printer ink has been used to colour the tablets blue! Not surprisingly, using counterfeit drugs can seriously damage your health and even cause death.1,2
“Recent reports of coma caused by massive drops in blood glucose and brain damage associated with these products concern me deeply”, says Dr Ehlers. “Moreover, some of the drugs that have been found in these products include amphetamines, which can be addictive, and others that can be toxic and fatal in overdose, or when taken with alcohol.2, 3 Even herbal or dietary products marketed for sexual dysfunction, that men may believe to be harmless, frequently contain drugs and other substances”, he explains. “They can be very dangerous.”2
The scale of the illicit ED drug market is difficult to determine, but appears to be increasing.2 A survey of 100 000 online sites selling prescription medicines found that 97% were operating illegally or not following pharmacy laws and standards.4 The scope of the wider problem is enormous. According to the World Health Organisation, counterfeit drugs are responsible for around 100 000 deaths a year in Africa alone! They estimate that, in some parts of Africa, up to 30% of drugs in circulation are fake.5
“The second reason why buying illicit medicines can have serious consequences for men with ED”, explains Dr Ehlers, “is that underlying causes of ED go undiagnosed and ignored. High blood pressure, arterial disease, heart disease and diabetes are common in men with ED, and ED itself may be the first sign of these serious, but manageable conditions. In comparison to men of comparable age without ED, men with ED are 20 times more likely to have type 2 diabetes and about 1 out of every 10 men will go on to have a heart attack within 5 years of developing ED! 6, 7 We might have been able to prevent that if we had seen the man when the ED first started”, he says.
So what can you do to protect your health?
“Buy your medicines from a reputable pharmacy”, advises Dr Ehlers. “It can be very difficult to distinguish between counterfeit products and the real medicine. However, when purchasing medicines, you should carefully check that the packaging is intact, properly sealed and clearly labelled with dosing, the holder of the certificate of registration, batch number and expiry date. All medicines should be provided with a package insert that clearly describes the characteristics of the medicine, how to take it and the details of the holder of the certificate of registration. Speak to your pharmacist or doctor if you are not sure and tell them about any problems you experience after taking a medicine or supplement, or if the results that you get from you medicine are not what you expect. For example, it may take longer than usual to work, may not work at all, or may cause unexpected discomfort or side effects. If necessary, take the medicine with you to show them.
Most importantly, see your doctor sooner than later if you have a health problem, and especially something like ED. It might take a little courage if you feel self-conscious, but it’s not necessary to suffer and it could prevent some serious consequences in the future. Remember that things will also get a lot worse if you unintentionally poison yourself on top of that!”
*Name has been changed
- European Alliance for Access to Safe Medicines (2008). The Counterfeiting Superhighway. Medicom Group Ltd, Surrey, UK. Available at:http://asop.eu/cache/downloads/dqqt3sge9hwssgcgcos440g40/CS%20for%20ASOP%20website.pdf. Accessed 2 December 2014.
- Jackson G, Arver S, Banks I, Stecher VJ. Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks. In t J Clin Pract2010;64(4):497-504.
- Health Sciences Authority, Singapore, 2008-2009. Available at http://www.fridae.com/newsfeatures/2009/09/18/8965.counterfeit-sex-drugs-11-deaths-and-24-coma-cases. Accessed 28 March 2015.
- National Association of Boards of Pharmacy (NABP). Internet Drug Outlet Identification Program
Progress Report for State and Federal Regulators: July 2013. Available at: https://awarerx.s3.amazonaws.com/system/redactor_assets/documents/237/NABP_Internet_Drug_Outlet_Report_July2013.pdf. Accessed 2 December 2014.
- Sambira J. Counterfeit drugs raise Africa’s temperature. Africa Renewal, May 2013 (United Nations Africa Division). Available at http://www.un.org/africarenewal/magazine/may-2013/counterfeit-drugs-raiseafrica’s-temperature. Accessed 28 March 2015.
- Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, Mannucci E, Maggi M. Prevalence of endocrine and metabolic disorders in subjects with erectile dysfunction: A comparative study. J Sex Med2015. DOI: 10.1111/jsm.12832.
- Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294(23):2996-3002.