A few months ago, India’s Narcotics Control Bureau (NCB) raided a “clandestine and unregistered” call center in Bangalore, the capital of the southern state of Karnataka, that had been selling Indian Viagra, various stimulants, antidepressants and other prescription drugs online to the US, Australia, and European countries.
A large quantity of generic versions of Viagra or erectile dysfunction (ED) pills and psychotropic substances such as Alprazolam, Amphetamine and Diazepam, used to treat sleep and anxiety disorders, were seized by the NCB, the Indian equivalent of the US Drug Enforcement Agency.
The NCB is the nodal law-enforcement and intelligence agency of India under the Ministry of Home Affairs responsible for fighting drug trafficking and the abuse of illegal substances.
The drugs were worth US$500,000 in the Indian market but likely to fetch US$10 million to US$20 million in Western markets, NCB sleuths say. These illegal online traders allegedly circumvented the law by sending the drugs disguised as vitamins or food supplements by mail.
This was not the first such case. In the last three years, the agency has busted four such rackets and seized ED and antidepressant pills that were worth US$30 million in the US and European markets.
These raids exposed involvement of four pharmaceutical companies – two in Surat, one each in Vadodara and Mumbai – operating through online modes. Their businesses were facilitated through websites hosted in other countries or by common e-commerce firms, officials say.
Alarmed with these cases, the NCB in a report to the Indian Home Ministry has stated, “The emergence of illegal websites established in the USA, Europe etc offering unregulated trade in a range of prescription medicines over the Internet has taken firm root in India as a supplier.”
On average, two rackets are being busted in the country every year.
“So far, most cases are reported from Gujarat,” said Mutha Ashok Jain, deputy director general of the NCB for the southwest region. He said that the vastness of the Internet makes it extremely difficult to control such businesses, but that his bureau cautiously works on every tip coming from India or abroad.
The demand for ED pills, stimulants, tranquilizers and herbal slimming pills, especially cost-effective ones, is rising exponentially across the world. E-commerce platforms, illegal Web vendors and manufacturers of counterfeit drugs are driving the growth, say police officials.
While 25% of the world’s population faces mental disorders at some point in their lives, according to World Health Organization estimates, obesity is also very common, as is male impotency. It affects one in every five men above 40, say health experts.
“Men are not hesitant to take ED medication any more. Besides, men in their 50s and 60s are more sexually active these days. Since pills have wider acceptability, affordability and accessibility, demand has gone up. Pornography is also fueling its consumption,” said Tushar Jagtap, a senior doctor in Mumbai.
The illegal online pharmacy market is estimated to be worth US$400 billion and growing. Apart from patients, drug addicts are also using this channel, misusing painkillers and tranquilizers, experts say
A 2016 report by the US Center for Safe Internet Pharmacies said there were close to 35,000 online pharmacies worldwide, only 4% of which operated lawfully. The rest were either selling prescription drugs without prescription, providing illicit and unapproved drugs, or operating without a license.
Sourcing from India
Poor regulation, cost effectiveness and over-the-counter availability are three factors fueling the illegal trade from India, say experts.
For instance, while Pfizer’s flagship blue Viagra is priced at US$65 per pill, and its generic version costs half that, many Indian variants are available for 50 cents to US$1 per pill.
Medical treatment is very costly in the West compared with India. It is even costlier for those who are not part of a national health scheme. Getting medicine without a prescription is almost impossible even from online pharmacies because of strict regulation.
“Since medicines in [the] US and UK are available only on prescription and at much higher costs, generic Indian products make their way through illegal routes,” said Hari Om Gandhi, director of the NCB for the Gujarat zone.
Various tricks are being used to run this illicit business. The accused in the Bangalore call-center case had authentic-looking websites to trick potential customers outside India into believing that the drugs were procured locally. They would contact potential clients using VoIP (voice over Internet protocol) calls and dispatch the drugs via shoddy courier companies, police say.
Pharmaceutical companies involved in the rackets make fraudulent claims about the medicines and export them by mail or by popular e-commerce platforms, Gandhi said. A few are just vendors, for instance five men in Ahmedabad, Gujarat, who were arrested two years ago, Gandhi says.
Some foreign operatives have even set up clandestine laboratories in India, sources say. Telangana police last year busted one such illegal lab on the outskirts of Hyderabad. Officials say the sheer volume of international mail makes it impossible to screen every parcel, hence most illegal consignments pass by undetected.
UK, US battling the issue
Kamagra, a generic Indian product that supposedly contains the same active ingredient as Viagra, is now the most frequently seized ED drug in the UK after diet and antidepressant pills.
In 2016 alone, Britain’s Medicines and Healthcare Products Regulatory Agency (MHRA) seized unapproved medicines worth £17 million (more than US$22 million). ED pills constituted one-third of this seizure. The MHRA also shut down 4,760 websites last year for selling medicines without a license.
The UK is also seen as a transit and distribution hub to other countries. “Most medicines traded illegally online are unauthorized generic versions, sourced mainly from the Far East including India,”a MHRA spokesman said by e-mail. “However, the websites offering to supply them are not generally hosted in India.”
The spokesman added: “We are collaborating with India to stem the volume of unauthorized generic medicines being imported into [the] UK. We understand that some may be licensed for use in India” but have no marketing authorization in the European Union or European Economic Area.
The US, too, has taken action against more than 5,000 websites over the past two years.
“Many of these websites claim association with online pharmacies operating in Canada. Some sites claim affiliation with US pharmacy retailers. However, drugs purchased from these sites come from India and Singapore,” said a US Food and Drug Administration release.
A recent report by the Office of the US Trade Representative noted that 90% of all counterfeit pharmaceuticals including psychotropic drugs seized in fiscal year 2015 came from mainland China, Hong Kong, India and Singapore, though specific data on India is not available, said Lyndsay Meyer, an FDA press officer.