In borderland Texas, a widespread lack of health insurance goes along with poverty, and high rates of diseases like diabetes, obesity, high blood pressure.
Cheaper prescription drugs to treat these conditions are available across the border in Mexico. But physicians and law enforcement are tracking a relatively new trend -- the smuggling of medicine in bulk from Mexico to U.S. patients who no longer feel safe shopping for them over the border.
Pharmacist Jorge Sandoval says people who buy his medicines these days often buy for people they don’t even know.
"There's a trade in legal prescription medication," he says. "The trade is generated by people (in both countries) who want to buy medicine at a lower price. People are bringing in ice chests to fill with medicines that they sell to friends and relatives.”
About 33 percent of Texans have no medical insurance, the highest percentage of uninsured in the nation.
That’s one reason why, for years, people have crossed the border for cheaper medicine. The diabetes medicine Metformin is $35 a month here in the U.S., only $15 in Mexico. The blood thinner Coumadin is $60 a month here, $15 in Mexico.
But what’s new is a cottage industry of smugglers buying medicines in bulk to bring back to the U.S.
At emergency rooms on the border, physicians like Juan Nieto of Presidio, Texas say patients are at risk. He says they’re increasingly showing up with medications that don’t look right.
"These are medications that sometimes can’t identify. They appear to be black market, homemade," he says.
Nieto said patients are unapologetic about how they get medicine from Mexico, even if they don’t buy it themselves.
“Some of them say they have them bring it over for them, others say they just buy them here," Nieto says.
"Medications have made the scene in flea markets," he explains. "It’s a good avenue for people to be inconspicuous in obtaining their medicines, without seeming like they’re dealing with a drug dealer."
Branwyn Maxwell-Watts, a small business owner in West Texas, is hardly a dealer. She's a married mother of four, and engaged in her tight-knit rural community. But she crosses the border to buy medicine for friends and herself.
“Mainly diabetes, a ton of high blood pressure medicine. For me it’s migraine medicine, "she says. “It’s something that I was providing that they needed. I didn’t think about the consequences, I still don’t, because I still do it.”
A recent report by the British medical journal The Lancet says Maxwell’s case isn’t rare.
“There’s a lot of people, and even people that I know who’ve gone down there in the past, that won’t go down there now," Maxwell says. "Not even for their medicine. So they’re always asking, ‘Do you know anyone who is going that can pick this up for me?’.”
Medical professionals are sometimes asked the same question.
“I had a patient who had blood pressure, high cholesterol, congestive heart failure and diabetes," recalls physician’s assistant Don Culbertson, who has a license to prescribe prescription medicine.
Culbertson is talking about a patient who said he couldn’t afford to buy the medicine in the United States.
So he went to Mexico himself. Then Culbertson showed up at U.S. Customs, knowing it’s illegal to bring back medicine for anyone but yourself.
“The Customs officer asked me if I had anything to declare," he told Marketplace.
"And I declared, medications. And he asked me if they were from me for someone else. And I told him they were for someone else," Culbertson said.
"The Customs officer was a compassionate, reasonable person. And I know they have a job to do and laws to uphold. But they let me through that one time."
Back in Mexico, pharmacist Sandoval says "It’s being done in kilograms the same way it’s done with illegal drugs."
Sandoval is a passive participant in this trade. Nothing he does is illegal. He can't sell to anyone without a prescription. The days of walking into Mexican pharmacies and leaving with controlled drugs like the pain medication OxyContin are long gone.
But he acknowledges that obtaining prescriptions inside Mexico is easy.
In one raid alone last summer, authorities in Texas, seized 25,000 bottles of prescription medicine like antibiotics at a flea market across from Reynosa, Tamaulipas.
Nine people were charged with membership in a prescription drug organization that allegedly earned $5,000 a day.