A man in his mid-40s goes to a makeshift table in Geylang. His eyes widen as the eclectic mix of colourful pills are laid out before him. The transaction is quick and mechanical. No further questions asked. He darts out with minimal eye contact, putting in no effort in concealing his anticipation. The newfound surge in energy swells to a climax as he feels the pill slide down his throat and thinks about his activity ahead.

10 hours and 3 heart palpitations later, he’s found dead in a nameless room.

This is the reality for some men that purchase illegal sex enhancement drugs, where neither the components nor the source of the drugs are known.

Despite the risk, there remains a market for such drugs – as evidenced by the convenience of buying such pills in Geylang, Currently, the only way to get legal sexual enhancement drugs such as Viagra in Singapore is by visiting a doctor as a prescription is needed before they can be purchased.

However, the recent crackdown involving S$700, 000 worth of illegal sexual enhancement drugs and the unaffected makeshift stalls in Geylang have raised the question on whether they should be made available over the counter to prevent the purchase of these illegal drugs.

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Should These Drugs Be Made More Accessible?

The United Kingdom could be the first to make them available over the counter, according to The Daily Mail earlier this year. The report stated that the UK’s National Pharmacy Association preferred its users to buy such drugs from a pharmacy than online, where there is a higher risk of misusing it and also because the “legitimacy of the supplier is harder to establish.”

Given that this illegal trade continues to exist despite authorities’ efforts to clamp down on it, why hasn’t Singapore followed in the UK’s footsteps?

The Health Sciences Authority (HSA) is less sure about that. According to Channel News Asia (CNA), HSA said that it would be keeping an eye on the developments in the UK.

It added that for a drug to be reclassified, various factors have to be taken into consideration – such as “whether the medicine can be safely used by consumers without a doctor’s supervision, whether the disease or condition can be self-diagnosed by the patient, as well as public interests and social implications.”

Similarly, when asked if sexual enhancement drugs should be made easily available, doctors in Singapore expressed their disapproval.

Dr Ho, medical director of Parkway Shenton, told the CNA that erectile dysfunction could be due to other diseases such as diabetes, obesity, and hypertension. He added that the lack of a doctor’s visit could also mean missing out on “diagnosing a potentially fatal heart condition”.

Convenience in attaining these pills may result in psychological reliance on the drug, and the lack of information on the deadly combination of heart disease medication called nitrates and such drugs could mean a loss of lives.

What Keeps The Business Going?

Undeniably, price is one factor. Dr Philip Koh, who runs a clinic in Tampines, told CNA that including consultation fees, it costs approximately S$80 for a box of four Viagra tablets from a general practitioner. In Geylang, a vial containing 10 Viagra-lookalike pills were on sale for S$25.

The social stigma attached to having erectile dysfunction (ED) plays a significant part as well, with many men refusing to seek professional help as a result. Instead, they turn to these cheap (albeit questionable) alternatives.

Perceived legitimacy is also increased when friends tell them that these cheaper drugs work without experiencing any side effects.

How Safe Are These Drugs?

With products having names like India Flirting Powder and Super Magic Man, one inevitably wonders whether these are safe to consume.

According to one of the sellers, “power and enjoyment” during sex are attained. According to CNA, another seller pointed to his chest and indicated that there would be no health complications while suggesting a pill called Golden Gun for S$10.

However, HSA has warned that such products could “potentially be counterfeits or adulterated with undeclared potent or banned ingredients. As they are manufactured under unknown conditions, they may not contain the correct ingredients, or the right dosages.”

In fact, 10 people died after using illegal products for sexual enhancement in 2008. It was later found that the pills were tampered with a medicine used to treat diabetes.

Pfizer, the producer of Viagra, also released an image of a counterfeit Viagra factory to warn against purchasing counterfeit pills.

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Matthew Bassiur, vice president of Pfizer Global Security, told the CNA that “samples of counterfeit Viagra tested by our labs have contained pesticides, wallboard, commercial paint and printer ink.”

What Is The Safer Option?

Given their dubious sources and content, the counterfeit sexual enhancement drugs could pose serious health risks.

Perhaps the HSA could consider a similar stance to the UK and make them available over the counter, and better prevent the misuse of drugs by providing the necessary health information to these users. Of course, a joint effort by Pfizer in making the cost of such pills lower would make it more affordable as well.

However what may be needed the most, are campaigns to eradicate the social stigma attached to ED.