FRONTLINE/World reporter Meghan Laslocky.

By Meghan Laslocky
October 5, 2004

Drug Running

An inch-wide black line runs diagonally across century-old wooden floorboards within the Haskell Free Library and Opera House, marking the 45th parallel and cleaving one small community -- Derby Line, Vermont, and Stanstead, Quebec -- into two countries: the United States and Canada.

If you step from the south across the black line, suddenly you enter a magical land where political campaigns last only six weeks, grocery stores offer free beer tastings and Lipitor is always on sale -- at least for Americans.

In Stanstead, the Goudreaus and Greniers have been neighbors with the Casses and the Curtises for generations. The population is evenly divided between Anglophones (some descended from Loyalists who emigrated after the American Revolution) and Francophones (Quebec was colonized by the French in the early 17th century). Stanstead is an old mill town whose bygone heydays revolved around granite, tools, whips, overalls and smuggling.

These days, Standstead's major attraction for Americans is the gleaming Pharmacie Diane Vaillancourt. When I pulled into its parking lot, an elderly couple in an equally elderly lemon-yellow Cadillac sporting green Vermont plates was just pulling out. According to Diane Vaillancourt, owner and mastermind of the new pharmacy, Americans such as the geriatric duo I'd just spotted tend to stock up on common drugs, like Metformin for diabetes, Lipitor for high cholesterol, Cardizem for high blood pressure and Methotrexate for cancer. The moment these American customers cross back into Vermont, they break the law: Technically, only drug manufacturers -- not little old men and ladies -- can legally import drugs into the United States.

Twenty percent of Diane Vaillancourt's pharmacy customers are elderly Americans. Prescription drugs cost approximately 40 percent less in Canada.

But aiding and abetting smugglers like the Cadillac couple is part of a routine that Vaillancourt says her staff goes through up to 20 times a day: An elderly American shows up and asks how much a prescription costs; pharmacy staff tell them, then send them up the hill to Dr. Gilles Bouchard, a retired Canadian doctor who will give them a quick evaluation and rewrite their prescriptions (Canadian pharmacies can't fill American prescriptions); they come back down the hill to the pharmacy with prescription in hand and get it filled. The whole process, including the visit with Bouchard, can take as little as half an hour -- and can save them 40 percent or more.

People come from as far away as New York and Connecticut to visit Bouchard and Vaillancourt, and several sources just over the border in Vermont told me that many local people -- both insured and uninsured -- consider Bouchard their primary care physician because he's more accessible than their doctors in the States. One man told me that Bouchard has a sign in his office that reads something like "just pay what you can afford," and $10 is customary. When I caught up with Bouchard as he was locking up his garden shed, he declined a formal interview, stating that too many American doctors were angry with him as it was. ("Everyone hates your guts for seeing their patients," he later told me when I pursued him a second time by phone, "until I wind up seeing their mothers.")

Dollar for dollar, prescription drugs are cheaper in Canada, and the exchange rate makes them even more affordable for Americans. At Vaillancourt's pharmacy, a month's supply of Lipitor is US$35, whereas at the nearest pharmacy in Vermont, it costs $65. The cancer treatment Methotrexate costs US$23 at Vaillancourt's pharmacy, but it's triple the price just five miles south.

From 2000 to 2003, prescription drug sales in Canada increased by a stunning 57 percent -- an increase that many say can't be attributed solely to Canada's aging population.

The U.S. Food and Drug Administration (FDA) contends that prescription drugs bought in Canada are "unsafe," but Vaillancourt said that the drugs she sells are identical to, if generic versions of, drugs sold in the United States, and, she pointed out, medicine doesn't recognize nationality. "If it's good for someone in Quebec, it's probably good for someone in the U.S.," she said.

Most prescription drugs, including those bought by Americans and Canadians, are manufactured in foreign countries, for example, Ireland, with minimal FDA oversight. And, as Time magazine reported in February 2004, a hard-pressed FDA official admitted in a 2003 congressional hearing that there is no evidence that anyone has ever died from using a prescription drug bought in Canada.

But price isn't only thing that sets Pharmacie Diane Vaillancourt apart from its American counterparts. Should customers have to wait for a prescription to be filled, they aren't condemned to pace aisles stocked with toothpaste and tampons for 30 minutes. Rather, a Welcome sign signals a waiting room, in which one can take a seat and watch LIVE with Regis and Kelly or catch up on the latest issues of Elle or Car and Driver; a sparkling tropical fish tank, the size of two massive refrigerators laid end to end, provides infinite diversion; and a cheery playroom stocked with books and toys keeps children entertained. The pharmacy also has private consultation rooms, with computers and doors that close, and a large conference room where Vaillancourt hopes to host community health education programs.

This poster for the morning after pill translates as: "The emergency contraceptive pill: 5 days to turn away unwelcome visitors." It was produced by Quebec's health and social services agency. In Canada, the morning after pill is available without a prescription.

These are the amenities that caused one Stanstead resident to call Pharmacie Diane Vaillancourt "the first pharmacy of the 21st century."

Twenty percent of Vaillancourt's customers are elderly Americans. Of the American healthcare system, which indirectly helped build her palace, Vaillancourt simply said, "I know there is no insurance for some kinds of people." But another Stanstead resident put it less delicately: "With such a big country, with so much to offer, the [American] medical system is not for elderly people? You have the money, you have the people, you have the qualifications. Why not have a system for everyone?"

As I left Vaillancourt's drug store, one lone poster hanging on the waiting room wall caught my eye. La Pilule Contraceptive D'Urgence: 5 jours pour repousser des visiteurs inattendus," it read, which translates literally as "The emergency contraceptive pill: 5 days to turn away unwelcome visitors." I looked closer to see which pharmaceutical company had sponsored the poster, only to discover that it was produced by Quebec's health and social services agency.

In this largely Catholic community, this poster struck me as quintessentially Canadian: tolerant, practical and, at least to this American, utterly unexpected.

Basking in the Glow

From the hot tub in Michelle Richards's backyard, you can make out a copper glow behind tall whispering spruce trees: the lights of the I-91 border crossing.

Richards, 46, owns Domaine Les Boisés Lee Farm, a rambling, early-19th-century bed and breakfast that stands just across the street from Pharmacie Diane Vaillancourt. Although Richards now leads a quiet rural life, she spent 27 years as a physician's assistant with the Canadian Medical Corps, including six months stationed in Israel -- time that she says informed her thoughts on the role of the United States in world politics.

Although the official language in Stanstead is French, it is a largely bilingual community. The border with the U.S. is often difficult for outsiders to detect, and this sign reminds visitors who might have inadvertently crossed it to check in with customs and immigration.

From Israel, Richards made weekly trips across the border to treat people in Syria, where, she said, malnutrition was common and begging was rampant -- both of which she regarded as tragic corollaries to U.S. sanctions against Syria.

The week I visited Stanstead, a George W. Bush campaign advertisement on American television had left Richards shocked and baffled by what she thought were below-the-belt tactics.

"I believe that you can do your own politics without putting someone down," she said, adding that in her opinion, political advertisements should focus on a candidate's accomplishments and not criticize the competition. American campaigns could learn a thing or two from Canadian campaigns, which are less entertaining but more respectful, she continued, and at least she didn't mind her children seeing Canadian political ads.

Despite the negative ads on American television, Richards said she will continue to follow the U.S. election and will probably watch the televised debates between Bush and Kerry. "I do like politics, and I like to be informed," she said. "And right now, the world needs to be informed because of the war."

Canada did send 4,500 troops to Kuwait for Operation Desert Storm in 1991 (the first time Canadians had participated in combat operations since the Korean War), but did not send any to Iraq. Prior to the war in Iraq, about two-thirds of Canadians were against the war, and according to a more recent poll, 71 percent of Canadians think that Iraq is turning into another Vietnam.

Richards said that while she initially supported Bush's war on terrorism overseas, she came to doubt the president's honesty.

"We're being lied to, all around the world, and that's what people are upset about," she said.

Moreover, U.S. foreign policy has tinged Richards's sense of safety, especially with the glow of the border so near. "We used to be a very safe continent, but not anymore," she said.

An American on Canadian Medicare

While the Canadian universal healthcare system has been evolving since the 1940s, all Canadian provinces have provided prepaid healthcare coverage, including doctors' services and in-hospital care, to all citizens and permanent residents since 1972. Collectively, the universal plan is called Medicare, and it is widely regarded as an icon in Canadian legislation and the poster child of Canadian values.

In Canada, prescription drugs are covered by a public plan if an individual doesn't have access to a private plan through their employer. In Quebec, someone on the public plan pays a monthly maximum of $71 (US$54) for prescription drugs, $16 (US$12) if they are elderly and have certain income restrictions. For people with "severe employment restraints," for children, and for single full-time students, prescriptions are free.

Jane Blais, 42, is an American citizen who has lived in Stanstead for 18 years, since she married her Canadian husband. After her marriage, given the choice between American health care, which she could have gotten through her job at a bank in Vermont, and Canadian Medicare, she chose the latter.

Now, she counts her blessings: A year ago, Blais's kidneys failed, and she discovered that she would need dialysis for the rest of her life. With the help of an excellent doctor, she recovered, and now every night she hooks herself up to a $13,000 home dialysis machine. She's never seen a medical bill for her treatment (nor one in all of her 18 years with Canadian healthcare), and she never even had to sign for her machine. Her health care is hassle-free. She said, "You go to the hospital, you give them [your I.D.] card, and that's the end of it."

Not so for her American co-workers. "I listen to the girls talk at work about how expensive medicines are, how expensive it is to go to the doctor, how long it takes to get an appointment in the Newport [Vermont] area, and I think it could have been the same for me," she said.

Blais's many prescriptions cost about $600 a month before insurance, but with coverage through her husband's employer, she pays only about $120. The same drugs could cost an uninsured person in the United States $1,000 or more.

But it would be unfair to say that the Canadian universal healthcare program is perfect or that public confidence in it is what it used to be. In a recent survey, 71 percent of Canadians said that healthcare is less affordable than it was five years ago, and an estimated 3.6 million Canadians -- about 15 percent of the total population -- do not have family practitioners because of a shortage of doctors. Many go to the emergency room for prescription refills or treatment for the common cold, which, of course, winds up costing the system more. Long waits for routine care, even for those with family doctors, and for non-urgent surgery, is a common complaint.

Some Stanstead residents I spoke with about healthcare griped about the long waits, uneven reimbursement rates among provincial plans and hospital bed sheets that aren't snowy white. But I didn't hear anyone in town who preferred the U.S. healthcare system, which leaves 45 million people -- about 15 percent of the total U.S. population -- with no insurance at all.

"The U.S. is the only developed country to not have a social security net," one man told me when we talked about the differences in our healthcare systems. "You are the exception. We are the rule."

Watching the Traffic Go By

Lawrence Tilton watched a modest red pickup truck hauling a tractor up Foundry Hill. "That little boy is trying to pull a bigger load than he can do," he said.

Lawrence Tilton, a Canadian resident and citizen who worked as a deputy sheriff in the United States.

Keeping abreast of traffic seems to be one of Tilton's favorite pastimes. As we sat in his yard abutting the border, Tilton, a former volunteer fireman for Stanstead and a retired Orleans County, United States, deputy sheriff, shared with me some of Stanstead's smuggling history: In past eras, cotton for the overalls factory, booze in the 1920s and cigarettes during World War II made Francophones and Anglophones in Stanstead and in neighboring towns wealthy.

But these days, "Quebec gold" -- marijuana -- is the southward-flowing contraband of choice. "This area is noted for pot. The quality and the quantity," Tilton told me, adding that he's witnessed more than a few deals go down in the "dark spots" of the border around Stanstead, including in his backyard.

In front of Parliament, a Canadian shows his support for legalizing marijuana. This past summer, Prime Minister Paul Martin reaffirmed his intention to decriminalize possession of small amounts of the drug. (Getty Images)

Just a few weeks after I visited, Canadian police seized more than 500 marijuana plants -- most likely destined for points south -- from an apartment not far from Laurence Tilton's home. Then, just a few days ago the Associated Press reported that Rose Chetrit Palmer, a veteran employee of Canadian customs and a resident of Stanstead, was charged along with eight others with conspiring to smuggle hundreds of pounds of marijuana into the United States.

But in Canada, not all pot or pot-related activities are illegal. In 2002, Canada legalized medicinal use of marijuana, and this fall, the government will launch a pilot project in which pharmacies in British Columbia can sell government-certified marijuana for medicinal purposes -- without a prescription (just like La Pilule Contraceptive D'Urgence, which is also available directly from the pharmacist). In classic Canadian fashion, the strongest objections to this latest plan came from medicinal marijuana users who charged that when it comes to pot quality control, the Canadian government could learn a few things from High Times.

This summer, Prime Minister Paul Martin reaffirmed his plan to decriminalize the possession of small amounts of marijuana, which means the penalty for a minor pot offense wouldn't be too different from a traffic ticket. The push for decriminalization of marijuana has the support of conservatives in Parliament.

Needless to say, American drug officials are quick to comment on the dangers of Canadian pot. David Murray, a policy analyst with the U.S. Office of National Drug Control Policy (ONDCP) told me that while Canada is a sovereign nation, and the U.S. can't "shake a finger" at Canada or interfere with Canadian decision-making, the multibillion dollar illegal Canadian marijuana industry is a "very striking and serious concern."

Murray pointed out that in the past few years, indoor hydroponic marijuana cultivation in Canada has been quickly spreading eastward from Vancouver and producing a frighteningly potent product. "This is not 1960s Woodstock marijuana," he said, adding that from a policy standpoint, the ONDCP is concerned that marijuana isn't just illegal, but also a public health threat. In the U. S., he said, trips to the emergency room caused by marijuana usage have skyrocketed, and Canadians should beware: "It could become an additional stress on [Canadian] healthcare to treat young people addicted to marijuana."

As for medicinal marijuana, Murray said the term is a "contradiction and an illusion" because there are no proven benefits to marijuana usage.

Proven benefits, or lack thereof, didn't seem to figure into Tilton's more libertarian thoughts on medicinal marijuana. "If you can prove to yourself that the medicinal purpose is okay, there's no harm in that," he said, adding that should marijuana be decriminalized or even legalized, additional resources would be needed to ensure that people use it only minimally and follow the rules.

"I don't think there's any solid answer [to the marijuana controversy]," he said. "Sometimes you just have to make a few experiments to see what's going to work."

As for the other kind of drug running that goes on in Stanstead -- the kind involving geriatric smugglers in Cadillacs -- Tilton said he figures their business also supports the handful of local restaurants. "So I guess it pays everybody." Of Diane Vaillancourt, whose pharmacy he does not patronize, he said, "I don't blame her for taking advantage of the situation. Not a bit."

Bush, a No Show?

An advertisement for Fahrenheit 9/11, playing in English at the Maison du Cinema 30 miles away, is one of the few references to life outside Stanstead in the local weekly, the Stanstead Journal. But the outside world, including American politics, is very much on the mind of Jean-Yves Durocher, president and owner of the Stanstead Journal.

As we talked, Durocher sat in his dimly lit office, with a jumble of English and French newspapers on his desk. He wasted no time in sharing that if he had a say in the U.S. election, he'd vote for Kerry. George W. Bush, he said, "is an absolute and complete mistake for anyone living outside the U.S."

Polls suggest that Durocher is among the majority of Canadians: only 22 percent would vote for Bush if they could cast a ballot on November 2, and eight out of 10 Canadians believe that Bush is no friend of Canada. (One pollster I spoke to speculated that mad cow disease has taken its toll on Bush. Support for Bush has dropped in areas where it was strongest, like Alberta, perhaps because he has not moved to relax cow import laws even though the mad cow disease scare has abated.)

But then, Canadians' distaste for Bush might also have something to with feeling dissed: Bush's much-hullabalooed first official international trip after he took office in 2001 was to Mexico. While he has twice quietly attended summits in Canada, neither visit was considered official.

The Language Factor

In Canada, language exerts a powerful influence in politics. When I was growing up in Vermont in the 1970s, Quebec's separatist movement, spearheaded by the Francophone Parti Québécois, was gaining momentum, and Francophone demands drifted south into Vermont's schools, where for a few years in the 1970s and 1980s, federal grants supported bilingual classrooms in Vermont border areas. Although separatist referendums have been defeated twice since 1970, French became Quebec's official language in 1974.

Durocher pointed out that trilingual John Kerry has done interviews in Spanish but has apparently turned down requests by Québécois newspapers to do interviews in French -- a wise move, Durocher said, speculating that Kerry speaking French would be more than the American public could take. "It's not the Swiss Assembly that removed 'French' from 'French fries' in [the U.S.] Capitol," he said wryly.

But from now on, Durocher predicted, the United States will have presidents who are bilingual. "The Spanish vote is too important. Like in Canada -- the French vote is too important."

Indeed, in Canada's June 28 election, Francophone voters turned 11 years of a government dominated by the Liberal Party upside down. Conservatives latched on to "the sponsorship scandal" -- the use of funds by the Liberal government to pay for an anti-separatist campaign -- and to public dissatisfaction with Medicare. Meanwhile, Liberals fussed that Conservatives were too eager to buddy up to Bush and contended that with the Conservative Party in power, Canada could all too easily join Britain as Bush's "lapdog."

Prime Minister Paul Martin of Canada, leader of the Liberal Party, squeaked out a victory in Canada's June 28, 2004 election. (Getty Images)

In the end, liberal Francophone voters -- including Michelle Richards, the bed and breakfast owner -- turned the tides by supporting the more fiscally conservative Bloc Québécois (a federal political party founded in 1990) to send a message to the Liberal Party, which then lost its absolute majority in Parliament, leaving the Liberal prime minister, Paul Martin, chastened.

Francophone Canadian voters like Durocher think the United States should take heed: Minority language speakers might wind up calling the political shots in future U.S. elections.

Durocher predicts that, as Francophones have done in Canada, within the next 25 years in the United States, Hispanic voters in states like Texas, California and New Mexico will unite, district by district, and ultimately dismantle the United States' two-party system. And like the Francophones who support the Bloc Québécois, Spanish-speaking voters might wind up casting the deciding votes in close elections.

One of Durocher's staff members poked her head in his office and spoke to him in rapid-fire French. The interview was coming to a close. But Durocher had one last thing to share: U.S. campaigns go on for a seeming eternity, distracting politicians from their work and costing too much. He said we might learn a thing or two from the Canadian system of short campaigns, which last a maximum of six weeks.

And as for the end of this year's chapter in the eternal campaign, Durocher said, "If Kerry wins, come January, the world will be able to breathe."

Meghan Laslocky is an associate producer for FRONTLINE/World and a student at U.C. Berkeley's Graduate School of Journalism.

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