On Charles Street, inside the Belvedere Galleria, a company run from a small office offers cash for people's leftover diabetes strips, the tiny tabs used to test glucose levels, which are crucial to managing the disease.
An Internet search for "sell diabetes strips" turns up numerous websites offering to buy the strips via mail.
The demand for more affordable strips — some brands cost $1 each and the typical testing regimen runs three times a day — has created what some call a "gray" market for reselling them. Buying and selling the strips is legal, but the practice has raised concerns from the U.S. Food and Drug Administration, the American Diabetes Association and some doctors who say it poses a public health risk and advise people to use extra caution when buying strips from resellers — or not buy them at all.
The companies say they provide diabetics with cheaper medical supplies, but health officials warn that there is no clear way to know if the people who previously owned the strips stored them correctly or never opened them. They also worry that diabetics strapped for cash will sell the strips when they should be using them to monitor their condition.
"There is no guarantee of the quality because these strips are sensitive to temperature and expiration," said Katherine Rogers, executive director of the American Diabetes Association's Maryland chapter. "We don't know if the person selling the strips didn't have them in the back of their car for two weeks overheating, which ruins their efficacy."
If the vials that hold the strips have been opened by a previous owner who has pricked a finger, they may have trace amounts of blood, which pose a risk of infection, according to the FDA.
"The bottom line is that we think this is a public health concern," said Courtney Lias, an official with the FDA's Center for Devices and Radiological Health.
The FDA can take enforcement action against companies if there is evidence that the test strips are misbranded, stored incorrectly or adulterated in some other way. It is illegal to resell expired test strips, for instance, and the FDA has initiated criminal proceedings for this practice.
Companies that resell packaged strips don't need to register with the FDA, but they do if they relabel or alter the packaging, Lias said.
The FDA has issued alerts and taken action against companies that have sold counterfeit strips or strips that weren't stored correctly. In 2011, the agency issued a warning to H&H Wholesales Services Inc. in Michigan for, among other things, using a broker that didn't properly store test strips. In 2006, the agency issued a warning about counterfeit strips sold under the name One Touch Basic and One Touch Ultra.
"The FDA takes these issues very seriously," Lias said. "If we hear of illegal activity in this area, we investigate, and if there is evidence of illegal activity, we will enforce our laws."
She recommended consumers use their judgment on whether they are buying test strips from a medical facility or pharmacy. Consumers should be cautious about online outlets, and purchasing strips out of a car, truck or home might be questionable, she added.
"People should be careful about where they are buying these test strips, and people should buy them from a reputable organization," Lias said.
The resale market is growing mostly on the Internet on websites such as quickcash4teststrips.com, traderjackproducts.com and sellyourteststrips.com. Many promise quick cash, and some even offer pick-up services.
Several resellers contacted by The Baltimore Sun declined to comment. It could not be determined if any were registered with the FDA or needed to be.
According to Susan Livingstone, who said she is the owner of sellyourteststrips.com, companies like hers unjustly get a bad name. She said she makes a good living reselling strips, while helping diabetics who can't afford to buy the strips at the regular price.
The strips come from people whose diabetic relatives died, leaving unused strips, or from people who don't need them anymore, such as a mother who had gestational diabetes while pregnant but whose condition improved after delivery, Livingstone said.
While acknowledging there is no way of knowing how people have stored strips, she said she takes as many precautions as possible. She doesn't resell strips that are expired or purchased by Medicaid or Medicare. She suggested buyers compare readings on the strips to make sure they are good.
"I do the best I can to get a decent quality," Livingstone said, adding that she offers refunds if there are problems with the product. "I do everything I can to make this an above-board process. I wouldn't do anything to cause anybody any harm or distress."
On streets around Baltimore — a city where about 13 percent of adults are living with the disease — bright yellow signs beckon people to sell their unwanted strips for cash. They're ads for a small operation run out a mostly vacant retail space in the Mount Vernon neighborhood. Dollarsforstrips.com operates out of a window where customers can bring their strips for resale.