(June 17, 2019)
When Andrea Miller, PharmD ‘19, completed her undergraduate studies in Yuma, AZ, she learned of medical tourism, the act of traveling internationally to receive medical care or purchase medications. Los Algodones, Mexico, is only a twenty-five minute drive from Yuma, and numerous patients crossed the border seeking the same name-brand medications at a fraction of the cost.
Under the guidance of Terri Warholak, PhD, RPh, Heidi Mansour, PhD, RPh, and the late Paul Myrdal, PhD, Andrea and a team of fellow fourth-year PharmD students including Nicole Woods, Rebecca Smith, and Ernest Vallorz, spent more than a year researching the efficacy of frequently purchased medications from Los Algodones, Mexico.
“On one occasion, a patient at the pharmacy where I worked was hospitalized from complications after consuming what appeared to be a counterfeit medication purchased in Mexico,” Andrea said. “I observed the need and wanted to know why this occurred and how often. Surprisingly, there is little data out there on this topic.”
The team surveyed travelers at the Yuma-Los Algodones, Mexico border crossing.
“Our main goal was to identify which medications were most commonly purchased from pharmacies in Los Algodones followed by completing a drug analysis to compare our survey results with actual, active ingredient data,” said Nicole.
Five medications most commonly cited were selected for analysis, including:
- Metformin, an oral diabetes medicine
- Sildenafil, used to treat erectile dysfuntion or pulmonary arterial hypertension
- Hydrochlorothiazide, a diuretic
- Apixaban, used to lower the risk of stroke
- Ibuprofen, a common pain medication
After obtaining multiple samples of each medication from pharmacies in Los Algodones, they examined weight variance, content uniformity, and dissolution, as compared to equivalent drugs purchased at Reed’s Compounding Pharmacy in Tucson. The drug analysis was completed in Dr. Mansour's pharmaceutics lab, where Dr. Mansour provided solvents and the United States Pharmacopeia (USP) dissolution apparatus, which measures dissolution. Of the 18 samples from Mexico, the team found that 12 fell outside USP content uniformity guidelines. Others were found to contain zero percent of the active drug compound.
“While the consequences of some counterfeit drugs may be negligible, others could lead to severe injury or death,” Nicole said. “Great caution should be taken when considering purchasing medication from Mexico. We hope to explore this topic more extensively in the future.”
The students are working to submit their research for publication soon.
About the Senior Research Project at the UA College of Pharmacy
This work was completed as part of a mandatory student research project in the students’ fourth year. For the assignment, students must identify a topic for investigation, plan their study based on a literature review, collect and analyze data, write a report and present a poster reporting the major findings. The project is managed by Marion Slack, PhD.
The topics must be related to health, however, a wide variety of projects can be pursued. In the past, students have studied rattlesnakes so the poison center would know how much anti-venom to administer, evaluated the medical content of popular TV shows (e.g. Dr. Oz and House), assessed the walkability of a community, and examined the use of antibiotic therapy in a hospital. Students have explored research opportunities among other schools, determining how many colleges of pharmacy have students doing research and identifying some of the outcomes from the projects. Students also do projects related to the UA College of Pharmacy curriculum to identify areas to improve or expand upon.
The senior research project has been a requirement since 1991. Between 50 and 55 projects are completed each year resulting in approximately 1,400 posters over the years. Students display their posters at the College of Pharmacy to the University community as well as at national professional meetings and conferences.