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Nuevo Laredo, Mexico — On a breezy afternoon in late January, 64-year-old Nancy Crofoot sat with several friends at an open-air cafe, sipping frozen margaritas and comparing pharmaceutical prices. A bottle of the acid reflux medicine Prilosec costs more than $125 in the United States. Ms. Crofoot found a generic version in this border town for $30.

The number of older Americans coming to Mexico for discount medications has fueled an industry that thrives off the ability of consumers to pass through United States Customs with little or no hassle, and has raised safety concerns on both sides of the border.

In Nuevo Laredo, Tijuana, Los Algodones and other communities, the number of pharmacies has doubled, sometimes tripled, in recent years. Tijuana has 1,500 pharmacies, up from 500 four years ago, according to the city's association of pharmacies.

Many of these have sprung up in a couple of days, medications filling the shelves before walls are completed. Mexican laws allow stores to open with just a business license and allow pharmacists to work with no training in dispensing drug prescriptions.

"The pharmacies near the border are not worried about the drugs helping people," said José Sánchez, the president of the Mexican Association of Pharmacists.

American officials lack data on the quantity or the quality of medications coming across the border, but they believe an increasing number of people are heading south to buy. About 293 million crossings into Mexico were made last year, 15 million more than in 1998.

Americans can legally transport medications for personal use with a prescription from a doctor in the United States. The drugs cannot be highly addictive narcotics or exceed 50 doses approved for use in the United States by the Food and Drug Administration, according to a revised pamphlet handed out by officials at border crossings.

The F.D.A.'s most recent survey, conducted in August, found that 46 percent of Americans returning with medication from Mexico were 51 or older and that they most commonly bought antibiotics, as well as drugs for diabetes, estrogen replacement, arthritis, impotence and pain. Survey workers interviewed 641 people at eight crossings.

F.D.A. officials say medications from Mexico are difficult to trace and may be manufactured improperly, stored incorrectly, mislabeled or contain an inaccurate amount of the active ingredient. The drugs are manufactured by Mexican pharmaceutical companies or American companies with plants in Mexico, or they come from as far away as India.

"When you buy these foreign drugs you could be getting anything from a counterfeit to a sugar pill," said William K. Hubbard, the senior associate commissioner for policy, planning and legislation for the F.D.A.

The Pharmaceutical Research and Manufacturers of America, which represents 100 of the largest pharmaceutical companies, said in September that chemical analysis found some Mexican drugs to be fake. Inspections of the drugs Fludac (an antidepressant), Omesol (an ulcer treatment) and Glipitrol XL (for Type 2 diabetes) discovered that they contained too much active ingredient or were impure.

American law enforcement officials said the amount of counterfeits and substandard medications could be as high as 25 percent.
"There is a lot of money to be made, and there are a lot of desperate people willing to buy the drugs," said Vince Rice, a spokesman for the Drug Enforcement Administration.

Nancy Crofoot does not consider herself desperate, just frugal. She travels annually to Texas with her husband, Jim, from Bay City, Mich., to enjoy the warm weather and to cross into Mexico to stock up on medicine and cigarettes.

"It's the reason everybody comes here," Mrs. Crofoot said, motioning her arm across the landscape.

Trash, mud and beggars line the cramped streets of Nuevo Laredo. A young Mexican girl carries straw dolls for sale, sharing space with well-dressed men in groups asking if people need medications. The men receive tips for taking tourists to the three or four farmacias on each block.
Congressional staff members recently visited crossings near Laredo, Tex., and San Diego to investigate how customs and Food and Drug Administration officials were handling the increase in border traffic and what quality checks were used. They found that officers at border crossings were too busy to inspect every person. When prescription drugs were declared, officials followed a hodgepodge of federal and state laws.

Sometimes they allowed 50 doses of a drug without a prescription and other times 90 doses. At some crossings, Mexican prescriptions were accepted; at others, only American prescriptions were allowed.

One recent day, customs officials, who are expected to uphold about 400 laws for 40 different agencies, spent more than 45 minutes inspecting one person, referring to manuals and the Internet to determine if a drug was approved for use in the United States.

"The rules are so inconsistent, it's meaningless," said Philip Anderson, the director of drug information service at the University of California-San Diego Medical Center.

F.D.A. and customs officials agree that there are inconsistencies.
"To some extent, people have to take responsibility for themselves," Mr. Hubbard said. "But they probably don't have an appreciation of what the risk is. I think the most the government can do is try to warn people and try to protect patients as much as possible from dangerous drugs."

The agency has been performing a balancing act as Congress tries to meet the public's demand for inexpensive medications and protect people from dangerous imports.

Congress approved a law in December allowing pharmacists and wholesalers to import prescription drugs at lower costs for consumers. Immediately after the law was approved, Donna E. Shalala, then the secretary of health and human services, said the program was severely flawed and refused to put it into effect. Ms. Shalala's action still stands, although several members of Congress have asked the new administration to reverse the decision.

"We're acutely aware of the fact that about one-third of the elderly in this country don't have access to reliable prescription drug coverage," said Representative James C. Greenwood, a Republican of Pennsylvania, who is on the House Commerce Committee. "In this day and age, if you don't have access to prescription drugs, you don't have adequate health care. Some people are in desperate straits."

In January 2000, a government committee found that the average prices for the top five drugs for the elderly were 83 percent higher in the United States than in Mexico. But those savings can be risky, pharmacists at American hospitals near the border said.

Elizabeth Kaczmarek, the director of clinical pharmacy at Mercy Regional Medical Center in Laredo, said that once or twice a month a nauseated patient would come to the emergency room as a result of bad pills or medications more potent than their American counterparts.
In one case, a 35-year-old woman taking a diet medicine bought in Mexico was taken to the hospital after suffering from multiple organ failure. She eventually died, Ms. Kaczmarek said.

The only published study that addressed the quality of medications being sold in Mexico was a pilot from May 1992 completed at Texas Tech University Health Sciences Center in El Paso. The researchers interviewed people who had brought prescription drugs back from Mexico.

"Although we have no data on hospital admissions in El Paso directly caused by complications from medications purchased in Mexico, our own experience suggests that serious medical problems do occur," the study said.

It concluded that side effects did occur from buying drugs in Mexico and that the effects might lead to hospital stays, but added that more research was needed. Dr. Paul Casner, a co-author of the study, said a follow-up was never conducted because of a lack of money and other priorities.
Monette Cuevas, a pharmacist for the Los Angeles County Department of Health Services, said that while a study on quality was necessary, education should begin immediately to protect American consumers.

"Whether you see somebody dying or a person getting an adverse reaction, we need prevention," she said. "One person dying is too much."
More than 25,000 people walk daily through the San Ysidro port, which has the busiest foot crossings along the border. At the border, officials sometimes take drugs from people if they do not meet regulations, including high numbers of Valium, Viagra and amoxicillin.

But perhaps more disturbing are the drugs that are not identified, said Joseph W. Misenhelter, a supervisory customs inspector at the port.
He pointed to a clear plastic bag containing some little blue pills with the Pfizer trademark stamp: Viagra. Then he showed another plastic bag, this one containing about 100 large white pills, and bearing no identification stamp.

"They could be anything," he said.
Ignacio Romo Calderón, president of the Mexican Association of Pharmacies in Tijuana, said Americans often got away with buying drugs without a prescription at many Mexican pharmacies. Only 5 percent of the country's pharmacies have university-trained pharmacists.

In Tijuana, where 35 pharmacies are crowded within about 500 yards of the United States border, Larry and Juliana Hoffer quickly found the once popular drug Propulsid, which was withdrawn from the market in the United States last year. Patients had complained of heart rhythm abnormalities when taking it.

The Hoffers traveled from their home in Mountainview in Northern California after Mrs. Hoffer's doctor recommended making the trip to Mexico for the drug.

Mrs. Hoffer, 42, suffers from diabetes and heart problems and has been taking the drug to ease digestion for 15 years.

She bought nine bottles of the drug's generic, cisapride, for $9 each at a shop in the tourist plaza. It was the first time she had bought the drug in Mexico.

"I had no alternative," she said. "I have to survive."