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ERECTILE DYSFUNCTION
Fuelling the BLACK MARKET for ED drugs
It is a well-known fact that South Africans are , globally , amongst the biggest consumers of male sexual enhancement pills . These counterfeit ED drugs are causing many to put their lives at risk .
It ’ s estimated that one in five South African men suffer from erectile dysfunction and only a fraction seek medical help . The globalisation of drug manufacturing and the anonymity and ubiquity of the internet are fuelling the traffic in male enhancement pills , and generating a market for the more questionable manufacturers .
A study , published in JAMA Internal Medicine , by Pieter Cohen , Assistant Professor of Medicine at Harvard Medical School and a colleague collected some of the lesser known facts about an industry that produces millions of pills - and likely generates tens of millions , if not billions in profits .
Male sexual enhancement pills are considered to be one of the most counterfeited drugs in the world , and South Africans are among the biggest consumers of black market ED drugs .
‘ Rock Hard ’ and similar so-called ‘ natural ’ supplements for men often contain potentially dangerous drugs - some of which have never been tested on animals , let alone humans .
Fatal drug interactions
When used in conjunction with nitrate containing medications , PDE5 inhibitors can cause excessive vasodilation and hypotension , which can result in death . The use of nitrate containing medication is a definite contraindication to prescribing PDE5 inhibitors . Nitrate-containing drugs are commonly used to treat diabetes , heart conditions , hypertension and hypercholesterolaemia .
The conditions these medications are used to treat are often widespread in men who have ED , suggesting that a significant proportion of men using counterfeit male sexual enhancement drugs , are putting their lives at risk . It is advised that clinicians emphasis and explain the dangers of black market drugs to patients and underline the critical aspects of proper treatment .
Background epidemiology of ED
ED is defined as the inability to have or sustain an erection adequate for satisfactory sexual activity . It is one of the most common chronic medical disorders in men over the age of 40 .
A global study of sexual attitudes and behaviours , targeting an adult population aged 40-80 years across 29 countries , identified early ejaculation and difficulty in achieving and maintaining an erection as the problems most commonly reported by men , affecting 24 % and 17 %, respectively .
The prevalence and severity of the disorder increases with age ; men in their 50s are three times more likely to experience ED than men in their twenties . It is estimated that moderate to complete ED affects 45 % of men in their mid- 60s , with a further increasing prevalence in older age groups .
Pathophysiology
Two-thirds of cases of ED are organic in origin and comorbid conditions should therefore be actively evaluated . Heart and vascular diseases ( especially those associated with hyperlipidemia , diabetes , and hypertension ) are associated with ED .
The combination of these conditions and aging increases ED risk in older men . Other hormonal and metabolic problems including primary and secondary hypogonadism , hypothyroidism ,
Here ’ s what they found :
• A product sold as ‘ Rock Hard for Men ’ in 2012 turned out to contain not only counterfeit Cialis ( tadalafil ) - but also a diabetes drug that can be deadly if used incorrectly . A similar combination killed more than a dozen men in Asia in 2009 .
• One Utah company alone produced more than a million pharmaceutically-tainted pills monthly , earning $ 2 million between 2007 and 2010 , according to an indictment issued in one of the few cases brought against such manufacturers .
• More than three-quarters of male enhancement supplements tested in one study in Singapore contained pharmaceuticals that were not disclosed - and half of them were present in higher doses than recommended .
• Over 45 different versions of drugs in the same class of Viagra have now been found in male sexual supplements . A Dutch study found that 75 % of the products sold in the Netherlands contained at least one analogue , or chemical variant that has the same effect as Viagra .
• A product called ‘ Mojo Nights ’ recently analysed by the Food and Drug Administration ( FDA ) included not just counterfeit Viagra , but also three different analogue drugs .
• The FDA identified three tainted supplements : ‘ Vicerex ’ and ‘ Bullet Proof ,’ which contain counterfeit Cialis and ‘ Lightning ROD ,’ which includes an analogue of Viagra .
28 | May 2017
The Specialist Forum | Vol . 17 No . 4