Hacker News Reader

Comment by pizzaparty2 | Hacker News Reader

Prescription drugs? Because I need some and it takes months and time off work and repeated Dr and specialist and procedure trips just to get an antibiotic called Rifaximin that can cure certain types of IBS. Last time it took six months, a thousand dollars, four or five days off work, and a colonoscopy before I could get a prescription. But they don't prescribe enough to actually cure it. Is there a black market for this? I'm asking for a friend.

View on HN

For antibiotics specifically, many manufacturers will sell them "for fish use". This will have an identical manufacturing process, but won't follow the guidelines for packaging, storing, and shipping antibiotics. So a bit more risk, but no prescription needed and significantly cheaper.

Alternatively, Indian mail-order pharmacies will successfully ship most things to the US in a plain brown envelope. It's technically illegal, but there's approximately zero enforcement action against it, the most they'll do is seize the shipment. Painkillers, opioids, amphetamines, and other pharmaceuticals with abuse risk are probably not going to be available this way (or advisable), but everything without a significant abuse risk has pretty much zero arrests.

Katherine Bean's Bottle of Lies documents how the same companies will produce drugs to lower safety standards when producing for countries with lower safety regulations.

"for fish use" - everything in me is screaming "NO!"

Antibiotic resistance is going to be so horrendous. Watching children die. Sooner, because "For fish use". I feel sick.

Alibaba...

A few years back, I was prescribed a anti cancer, prescription drug that costs $4k per box. (5mg per day, 28day day supply).

I went on Ali, and ordered 5lbs of the drug for $100 usd including shipping.

Honest question, how do you know you're actually getting the correct drug and that it isn't contaminated or cut with something else?

You could send it to a chemist and ask them to do an NMR and have a pretty good idea (provided it’s just one molecule)

You can test it yourself, but many times the same manufacturer in the USA is the same abroad.

I would say India for Drugs is not a bad idea - if you're worried it's "from" China.

I have not the remotest idea how I would test a cancer drug for myself to see if it was pure. I suppose I could hire a chemical laboratory, if I could figure out what kind of one would do that kind of work...

> if I could figure out what kind of one would do that kind of work

Open up the phone book. I'm sure you can find one within a day.

Chemists like money. Especially when it's not even a controlled drug.

> I have not the remotest idea how I would test a cancer drug for myself

As someone with only a high school level of chemistry training I would check the melting temperature.

Although seriously get it professionally tested. The delta between USA prices and India/China prices is so high a lab test will barely change the margins.

The first thing to do would be look up the Scientific Discussion or Monograph as filed with the FDA for the brand name product. With the details obtained from there, you'd know what to test for.

The first steps would be assay and impurity tests for the active pharmaceutical ingredients (API). If you bought tablets you'd probably want to do dissolution as well.

If everything looked fine after that, I'd still be concerned about uniformity. If you just performed dissolution on half a dozen tablets, how do you know all the tablets are the same from the whole supply?

Next question is then stability. What happens to the API over an extended time period? Does it deteriorate due to climate or poor storage conditions?

The main issue is quality control. Even an approved generic has to file with the FDA (or equivalent of wherever you are) concerning processes, batch sizes, critical quality attributes etc.

"You can test it yourself" : If you die, just make sure to leave a bad review on Alibaba. Do your bit to prevent survivor bias.

I meant by a reagent test. Not consumption.

> I would say India for Drugs is not a bad idea - if you're worried it's "from" China.

Then again:

https://peterattiamd.com/katherineeban/

> The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45]

Good link. On his podcast, Peter has also talked about generics vs. name brand differences. He had a chemist on who started a pharmacy selling generics where some statistically significant amount of each batch of drugs is tested for chemical verification.

Probably the best way is to use a mass-spectrometer.

I'm guessing the people who can afford a mass spectrometer can already afford the drug (or at least better insurance)

Heh, well if the drug is $4k a month and you can get the equivalent 5 year supply for $100 that leaves quite a bit of money left over for testing.

There are lab services that will run samples through a mass spec and report the results.

Hopefully they don't send you an inactive enantiomer!

Or an insoluble polymorph.

Realistically, a lot of cancer drugs are injectables, ramping up the risk of something going awry when you inject the powder you will have to handle.

Interesting. They now have a policy that prohibits the sale of medication. I wonder if there are other less scrupulous competitors of Alibaba...

I can still find stuff like amoxicilline, ketoconazole or paracetamol on Alibaba. Maybe the ban is only on some specific chemicals?

> ordered 5lbs of the drug for $100 usd including shipping.

Nothing like the sensation of dying with placebos knowing that you saved $4k dollars and you are smarter than the other guys. Can be done even cheaper: you could have obtained lots of carrot juice for $50 also. Did not worked for Jobs but maybe in your case could be different, why risk not trying?.

Seriously, don't do this. Even legit chemoterapy can dissolve you from inside and I'm not talking metaphorically. There are reported cases of unexpected and massive organ destruction. Chemoterapy is poison, can kill you faster than cancer if you have a secondary hidden condition.

And what was the name of this drug?

Did you need to handle the customs paperwork? I find it hard to believe the customs would just ignore a bunch of strange powder coming through the mail...

And even if they did believe you it was not cocaine, I would still assume they would not be happy about someone importing a prescription drug.

AFAIK Drugs are not available anymore on Alibaba.

You should not buy such important drugs from a dubious source.

Drugs from an official Chinese Pharmacy are probably very safe. If someone sells sugar instead of antibiotics be assured that he might face the death penalty.

Most raw materials are produces in China anyway, even if the medication is obtained from a western company.

BTW, was the cancer medication for injection?

Not a black market, but here you go - https://www.inhousepharmacy.vu/p-1614-rifakem-400.aspx

First rule of inhousepharmacy...

Meh, I have no way to DM this person

Had the same problem getting the same antibiotic. Going locally resulted in unnecessary tests as you describe without luck. With me it started with a positive hydrogen breathe test at a naturalpath. Based on those results I went the telemedicine route and said my np recommended an antibiotic. I got lucky and got it filled twice but had to repeatly try but the provider I used didn't charge unless you accepted the prescription.

At the end I still needed more but gave up. Going starch free helped more.

Did you notice a difference at all? Do you think you'll ever be "cured"?

I did notice a difference but the bacteria comes back if something is affecting mobility.
After the second time. I did three things that really helped.
- Ate chicken/carrot for lunch. Fish/seafood/bacon/pork/beef roast with one or all of squash, zucchini, spinage. In between I made a loaf of banana bread with honey and most importantly carob and ate one a day. That digested earlier and didn't feed the overgrowth lower allowing me to put weight back on. The carob forced mototity
- I did pure cbd in very small amounts for 2 weeks. That seemed to help close intestinal valves.
- I stopped all starches. Potatoes, sweet potatoes, peas..
I'm 4 months off of the second round and feeling and looking much better.

Yeah, it sounds like we are going through a similar form of hell. How long have you been dealing with this?

Seeing as you are at the point that you are looking for black market antibiotics, have you tried Kratom? Did it help? If you havent heard of it before, I should however warn you about the addiction potential.

2 years November this November after taking cipro. But only took the antibiotic 5/6 months ago. I dropped from 240 to 142 in the time beforehand (75 pounds first 45 days) and after the antibiotic and the bread I'm back to 180 and feeling better each week.
How long have you had this?

Wow, good job on the weight loss though. I've had this for years too but it's gotten worse. Or I've also become somewhat lactose intolerant. I always feel great when fasting (which I do regularly for weight reasons) but within 30 minutes of breaker ng the fast I'm burping again. Even fasting for like a week didn't seem to starve them at all.
I saw an article somewhere bthat said xifaxan should be taken for six weeks! So I'll probably try that next.
Oh also, weed edibles basically stop all stomach grumbling for me but they make me drowsy. IDK if they help kill the ... overgrowth though.

> With me it started with a positive hydrogen breathe test at a naturalpath.
Naturopaths are quacks though. You shouldn't be able to get any prescriptions based on their recommendations.

They can't at least where I am. And my experience with was more about getting that appointment fee so treatment is spread over many appointments.
Still a better experience compared to doctors. Anything internal seems to be an area they don't understand yet. Perhaps in time things will get better.
After the experience I strongly believe anyone should be able to buy medicine without a prescription. There are good and bad things that could come from that but I believe freedom of choice should be more available in this area.

> I strongly believe anyone should be able to buy medicine without a prescription.
While I can’t disagree that doing so is mightily convenient, it’s a really terrible idea, due to antibiotic resistance.
Now, if people could be trusted to only purchase antibiotics when they actually need them, and to complete their courses of them, this would be fine - but you can’t trust people.
I’ve spent a fair bit of time in Russia over the years. Hangover? Antibiotics. Head cold? Antibiotics. Tired? Antibiotics. The myriad incredibly inappropriate things people use antibiotics for is phenomenal.
And you’re talking about how a witch doctor told you you had quantum demon breath and so you need antibiotics. I’m sorry, but this is absolutely part of the problem, and underscores why antibiotics must be regulated.

To blame the patient is a little bit shortsighted. In my experience, well established doctors do prescribe too much antibiotics as well. I used to have a doctor who basically gave me antibiotics for everything I went to see him. After a while, my general health started to deteriorate. Once I understood the pattern, I started to throw away his prescriptions and did also get better.

I spent quite a bit of time in Russia and my experience is opposite. Everyone ever talks about how careful you should be using antibiotics. Not too little. Not too much. The exact prescribed amount for prescribed duration.

I think the story of how we are becoming of how we are becoming resistance is a false narrative. Doctors giving antibiotics to freely is an issue but the fact that they are allowed to use antibiotics in our animal feed is probably more likely the cause why this problem exists and whole classes of antibiotics are not prescribed anymore. If this is your first time ever using antibiotics penicillin should work.. but they need to jump to amoxicillin.
I know why they add it in our animal feed and I see the benefits but it also creates these issues.

The problem with this is many developing countries overprescribe antibiotics or have them available without prescription. In developed countries you see antibiotics used en masse for livestock breeding. Both of these things dwarf any usage in people in developed countries. (You also see things like betablockers available OTC in places like India, and there was recently a research article on HN about how much this improves quality of life and quality of care.)
It is kind of a tragedy of the commons, but the real solution is not to let people in the US die from easily treatable diseases. After all, what is the point of effective antibiotics if you never use them anyway?
The real solution is probably to develop enough treatment options so that they can be cycled or used in conjunction.

My last M.D. was a quack, too. He made a wrong call (not griping, I understand differential diagnosis) on my stomach infection, wrote a prescription, then went on vacation. Meanwhile, I did not know this, nor did I know my labs came back with my pathogen identified. I went back to the office only to overhear all that through a closed exam room door. Oh, and they let me make that appointment same-day, knowing he was on vacation.
That doctor is so very fired, and I made sure every patient there knew what happened to me on the way out. I have never been so angry about mistreatment.

First, have you looked into medical tourism? That might be a solution to just take a week off and go to a medical tourism friendly country. Looks like it's 2$ a day in Colombia (based on the wiki entry) vs 62$ a day in the United States so if you're insurance isn't cover a good chunk of it, that savings should soften the travel cost some.
>Is there a black market for this?
Sorta? A lot of prepper types will keep various fish antibiotics, which you can buy freely and legally online (in the United States anyway) that just happen to conveniently come in gel caps in human dosages. Personally I always keep a bottle of amoxicillin, penicillin and cephalexin on hand and replace them every 18 months or so (I've never taken any of them, but I take comfort knowing they are sitting in a drawer if there's ever some crazy scenario where I need one of them and pharmacies are dry).
I've never seen rifaximin though (probably because it is new and fantastically expensive).
Examples:
- Fish Mox & Mox Forte (Amoxicillin)
- Fish Flex & Flex Forte (Cephalexin/Keflex)
- Fish Zole & Zole Forte (Metronidazole)
- Fish Flox & Flox Forte (Ciprofloxacin)
- Fish Pen & Pen Forte (Penicillin)
- Fish Cin (Clindamycin)
- Fish Sulfa Forte (Sulfameth/Trimethoprim)
- Fish Fungus (Ketoconazole)
- Fish Mycin (Erythromycin)
- Fish Doxy (Doxycycline)
- Fish Flucon (Fluconazole)
- Fish Min (Minocycline)
- Bird Biotic (Doxycycline)
- Bird Sulfa (Sulfamethoxazole/Trimethoprim)
- Bird Azithro (Azithromycin)

Honestly diet is the cure, not an antibiotic (screwing your flora is no long term strategy). They are just doing their job the right way.

if it isn't schedule i, you can usually get it online from india relatively easily

or schedule 2

you're right, i mixed up how the scheduling system works -- schedule 2 is significantly more legally risky and difficult to procure in grey markets, schedule 3 (basically anything that isn't a prescription version of a narcotic) is typically easily available.

Late reply, but theres also schedule 2(non narcotic)

Yes you can order on the clearnet from Indian pharmacies. I've ordered rifaximin this way. It's expensive, about 130$ for a 14 day supply. For my SIBO it, like all antibiotics, causes total symptom relief while I am on it and then the symptoms come right back once I go off. Good luck.

There is a black market for prescription drugs like everything else. Grey market really since it is a legal drug. I've used the grey market with success but ymmv.

And just like the black market for cocaine, what you get in that pill or powder could literally be anything, and there’s no guarantee of consistency between orders.
I believe this is more of the overall point being made in a lot of the comments here - that obviously decriminalization would allow for quality control.

What's interesting about the article is that they claim that the Dream Market was able to enforce a level of consistency, because buyers could rate sellers. An independent lab tested some of the merchandise, and what you were really buying was usually what you thought you were buying.

Just like Amazon the on site ratings were normally pretty useless. Outside info sources like forums and Reddit normally had better results but were still full of constant FUD.

At least the average TOR users doesn't leave reviews like: "The mailman left my package in the rain, one star".
Usually a bad review is very well-deserved.

Pressed pills in a sealed blister pack coming from a large pharma company in India is hardly "just like" the black market. All these companies are doing is taking advantage of geographic arbitrage and loopholes in different countries' laws to move stuff around. They're not making this stuff from scratch.

I love how often we hear companies are expected to hire slave labor in developing countries and we should all accept this race to the bottom will impact our own wages and benefits all because of the fact that we live in a global market, but the minute you want to buy drugs from other countries or even just play a DVD made for sale in another country it's illegal and immoral.

The price difference is not wage difference, India does not enforce patents in many cases, also things are sold cheaper in countries without US health monopoly pricing.

S/He wasnt really claiming that but yeah.

The patent thing is the real difference. With the amount of citizens India has, it's the perfect storm. Any company can make anything (but the output is monitored), and the amount of people and their low salary make most drugs fairly cheap.

Or alternatively: that most of us happily accept the lower costs of goods and services from developing countries, but some people get upset that this drags our earnings down because of the competition from their workforces.

the problem is that is doesn't lower the cost of goods and services. If we were all paying the same prices they pay in developing countries for drugs maybe you could argue that it's fair when we accept their wages and working conditions.
Instead companies use sweatshops and slave cheap labor to boost their own profits while charging us a premium and expect us to compete with those workers while refusing to compete with the prices offered in the "global economy". If they want to pay workers at the lowest prices on Earth every American should only be paying the lowest prices for products and services found on Earth. That means that the drug that costs $1,000 in the US should only cost us $4. The movie ticket for $13.69 today shouldn't cost us more than $3.51.

Didn’t we just read about dangerous drugs in simple generics made in India/China and being sold here in pharmacies?

It turns out that microscopic impurities within specifications can still be a problem if they're potent enough.
Same would've happened state-side if the production was still there too.

So you’re saying it wasn’t just the generics, but the name-brand drugs, too?

For ranitidine, yes.

>And just like the black market for cocaine, what you get in that pill or powder could literally be anything, and there’s no guarantee of consistency between orders.
The same applies in any market - my last two orders from Amazon for something as simple as shampoo were counterfeit.

Get it from India. You can buy any antibiotics without prescription in India. And get it posted anywhere.

Check meatheals.com for ibs and gutsense.org for an explanation

Reply on news.ycombinator.com