Fake Drugs Return To Streets With A Vengeance

 

Fake drugs are not a recent development. Like anything counterfeit, they are almost as old as real medicine. All over the world, drug counterfeiting is a potentially deadly phenomenon, but the situation may be actually worse in Nigeria as we have a tendency to be reactive to problems instead of proactive.

  In Nigeria, fake drugs undermine every aspect of medical treatment and health care delivery and are a major cause of suffering and death. The problem of fake, counterfeit, spurious, unwholesome and adulterated drugs has rocked the Nigerian health care system for years on end. Drug counterfeiting contributed negatively to the wellbeing of the average Nigerian that former Director General of the National Agency for Food and Drug Administration and Control, NAFDAC, the late Prof. Dora Akunyili described it as an act equivalent to mass murder.

 

 From a health provider’s point of view, counterfeit drugs are bad news. They erode confidence of the patient in the health provider. They waste scarce and hard-earned resources, cause treatment to be ineffective, potentially harm the health of the patient. A doctor who declined giving his name shared that “I once had a patient during my horsemanship that needed to treat what is commonly known as toilet infection. She didn’t want the insertion drug, so I prescribed a dose of fluconazole.  

  Unfortunately the drugs she procured from a mobile chemist around Yaba did not work. So she went about telling her friends that I was a quack. She came back to me and said it was because I was not a woman that I cannot treat her issue. She showed me the rest of the drugs and we discovered they were fake and helped her get a new prescription and she took it and it worked. That was how I was vindicated.”

 

 Counterfeited drugs are dangerous not because of their counterfeit nature, but because of how they are created. A counterfeit drug, by definition, is one that has been made by someone other than the genuine manufacturer. It is done by either copying the formulation of the drug or imitating it without permission to do so.

  Many counterfeits don’t have the active ingredients that the packets claim they have. Some even have the wrong ingredients, while others have incorrect quantities of the correct ingredients. According to the World Health Organisation, WHO, counterfeit drugs are those “that have been deliberately or fraudulently mislabelled with respect to identity and/or source”. 

The products can include incorrect ingredients, wrongly stated amount of active ingredients, or can be manufactured under circumstances that lack quality control. It is known that more than 30 per cent of the counterfeit drugs that are available today don’t contain any active ingredients whatsoever.

  The problem, however, did not simply appear in Nigeria suddenly.

  On 12, April 2001, Prof. (Mrs.) Dora Nkem Akunyili was appointed the Director General of National Agency for Food and Drug Administration and Control (NAFDAC) of Nigeria. She was a pharmacist and governmental administrator who gained international recognition and won several awards for her work in pharmacology, public health and human rights. Following her appointment, Akunyili established as a top priority the eradication of counterfeit drugs and unsafe foods in Nigeria, something that was almost anathema in Nigeria.

  Before she took office, fake and substandard foods and drugs were sold in Nigeria without any form of regulation. She was recorded to have been disheartened by the inability of Nigerians to successfully fight killer diseases like malaria and tuberculosis due to the sale of drugs that were little more than sugar syrup and chalk tablets, cynically packaged to look like the real drugs.

  Though a difficult process, Akunyili led Nigerians down the road of freedom from fake drugs, and she almost won the fight. Under her administration, little went unnoticed and producers of food products and drugs began to work with prescribed standards.

  Well over a decade since she left office, Nigeria seems to be back at the point we started from. Fake antimalarial medication has been threatening efforts to control malaria in Africa. According to the World Health Organisation (WHO), Nigeria is Africa's largest drug market, and over 70% of its drugs are imported from India and China, considered a big source of fakes."

  In 2010, NAFDAC in Nigeria launched an SMS-based anticounterfeiting platform using technology from Sproxil. That system was also adopted by GlaxoSmithKline (GSK) in February 2011. In 2011, it was discovered that 64% of Nigeria's imported antimalarial drugs were fake.

  Looking into the issues of fake drugs, the acting Director General of NAFDAC, Mr. Ademola Mogbojuri said, “The public health implications of substandard and falsified medical products are dire. This includes treatment failures, loss of confidence in the healthcare provider and health system, high treatment cost, development of resistance and ultimately results in fatality and death. He raised an alarm that the problem has become a serious threat to the global public health and should be looked into by both the governmental and the non-governmental bodies.”

  A while back, the Pharmacists Council of Nigeria, PCN, sealed off 287 premises of persons operating illegal pharmacies in Kogi State. Stephen Esumobi, the PCN Deputy Director Enforcement said it took the council a five-day raid for the operation, which covered 373 pharmacies and patent shops. He further said that the sealing, which cut across the state, was made up of 27 illegal pharmacies and 260 patent medicine stores who contravened various offences. 

“The premises were sealed for operating without registration with PCN, failure to renew premises licence, dispensing ethical products without the supervision of pharmacist, poor storage and sanitary conditions among others. Findings of the PCN team showed that in Kogi State, many pharmaceutical premises commenced operations without fulfilling the minimum requirements for registration while others failed to renew their licenses.”

 

 Even though patients are advised to buy drugs only from a registered pharmacies with the green cross RX sign, some Nigerians due to ignorance, failing economy, scarcity or abject distrust of a structured system still buy from roadside sellers, self-acclaimed chemists and mobile chemists.

  Speaking with a pharmacist with a store in Omole area of Lagos, she said that some people see the store and immediately revert to a preconceived notion that whatever they sell there would be expensive. “A mechanic once came into my store having been sent to buy drugs by his boss. He took off his shoes outside before opening the sliding glass and coming in. When I asked him why, he told me that the place is neat and fine and he does not know if we would have let him in with his dirty shoes. 

When I asked how he buys his drugs whenever he needs them from a pharmacy, he just told me that he has never been into a pharmacy, that he buys his drugs at Ojuirin at Agege on his way home from the women who display it on their tables or make-shift stalls. He said he has a nurse that treats him in his compound and she simply tells him what to buy. I was shocked.”

  

 Counterfeiting is punishable by imprisonment for between 3 months to 5 years or alternatively a fine of N100, 000 is imposed. Such a weak and incongruous penalty is incapable of making any great impact in preventing this lucrative crime. NAFDAC has recommended life imprisonment and forfeiture of assets of the offender to compensate the victims, but the National Assembly is yet to pass this into law.

 

 Recent studies show that the quality of medicines on sale in Nigeria leaves much to be desired. Seizures of counterfeit drugs running into billions and shutting the unlicensed drug outlets have not solved the problem. Detection of counterfeits has become more difficult as counterfeiters have got more sophisticated, cloning holograms and other security features. Some of the counterfeiters are clever enough to add active ingredients that pass quality test controls but don’t provide user benefits.

  For Nigerians, malaria drugs and antibiotics are among the most popular drugs that have been counterfeited.    

  The case of the ‘My Pikin’ drug readily comes to mind. A toxic chemical mixed into a teething medicine for babies killed at least 84 children in Nigeria as of February 16, 2009. The children died after taking My Pikin Baby Teething Mixture, a syrup for teething pain, according to Nigeria’s Health Ministry. Health officials said that a batch of the medicine that went on in November contained diethylene glycol, a chemical that can cause damage to the heart, kidneys and nervous system when ingested; an industrial solvent and an ingredient in antifreeze and brake fluid.

  Abiodun Adeyemo and Ebele Austine Eromosele, who were employees of the company that made the toxic syrup, were found guilty by a court in Lagos, Nigeria. The company that produced the toxic syrup, Barewa Pharmaceutical Company Limited, was ordered shut by the court and all of its assets seized.

 NAFDAC reported that the first affected child was taken for treatment on November 19, 2008 and pulled more than 5,000 bottles of My Pikin from the market soon thereafter. On November 26, 2008, NAFDAC shut down Barewa Pharmaceuticals.

  Figures from the Nigerian Health Ministry estimated that three-quarters of children made sick by the medicine had died. As of February 6, 2009, 111 children were affected.

  The former Nigerian Health Minister, Professor Babatunde Oshotimehin said in a statement at the time “The death of any Nigerian child is a great loss to the nation. The Federal Ministry of Health sincerely regrets this painful incidence and sympathises with the nation and the families directly affected.”

  Speaking with Dr. Ayoola of Lagos, she told SATURDAY INDEPENDENT that “Fake drugs are bad apart from having the problem of not actually being effective for the disease that is actually treated. They can also have terrible side effects or they could be toxic or poisonous just like the case of the ‘My Pikin’ drug. It was a drug that was used for teething, but led to liver disease, liver damage and death of children. Please ensure your drugs are NAFDAC approved and registered before using them.

   “NAFDAC generally, these days have a pin identifier and the number which you send pin identifier is toll free, so it doesn’t cost you anything. Everybody has a mobile phone these days, and it doesn’t cost you anything to send that number to make sure that the drug you are using is actually original. 

 Also if you find out that the drug is not original, you can also report that pharmacy or chemist store to the appropriate authorities. Then the whole issue of fake drugs and poisonous drugs can be traced back to the source and this can be stopped.

 

  “Some people complain about the price of these original drugs. Well, you cannot put a price on safety and even some of the brands that are less popular are available at affordable prices and they also have pin number. NAFDAC is making it compulsory for any drug that passes through its system to have a pin number. If you are alive, you can enjoy your money but if you are dead from buying a cheap drug that comes out to be toxic to you… I mean, that is being penny-wise and pound-foolish.

  “Even if you are buying drugs from a chemist, make sure you read the pamphlet to know what the drug contains, there are search engines that are available to see what the drug contain. However, many of these drugs contain chemical that you cannot even account for, some of the things that are done make the drug look like the original drug.

  “Unfortunately, you might not know what effect the drug might have on your liver, your organs, your kidney; you don’t know the effect the poisonous drugs can have on body systems. Every drug has to pass through three stages of approval, the clinical trials, the trials on people, case control files and things like that. They have to get approval to make sure that the side effects are things that are minimal, that will not cause too much harm to your body. That’s the point of having a drug approved.

  “Quite frankly, fake drugs are unsafe. In Nigeria, we have a very bad drug control practice and generally buying drugs on the road… I don’t know why someone will do that. Drugs are dangerous chemical that needs to be prescribed, though there are over the counter drugs that you can buy without the prescriptions. Even the drugs that are approved for specific conditions are not appropriate in every situation, some people are allergic to some drugs, but we take those drugs without knowing the effect they will have.”

  INDEPENDENT also approached one such drug seller who turned out to be quite taciturn though she eventually said a few words.

   “Not that my medicine is fake, it is just that I have my customers. Some people, if they go supermarket, they go see small mark for the medicine cover, thy no go wan use am. My own people no dey complain, and e no dey expensive. My own medicine no be fake, e dey work. And I get different types.” She explained.

  When asked if some of the drugs could be expired, she said no. “If you fit taste am you go see say na the same. Medicine no dey expire like that. I no get expired medicine.”

  It is imperative that we intensify efforts in fake drug eradication. Although, drug counterfeiting is adjudged to be more dangerous but just as lucrative as the narcotics business, the penalty is less severe. In Nigeria, a counterfeiter is allowed to pay a fine option of N100,000. Some people say that the appropriate penalty for counterfeiting could be an effective deterrent; sadly, the penalty for manufacturing or distributing counterfeit drugs is rather lenient.

  In all, the best defence against unhealing medications is to know your medication. That knowledge in itself doesn’t have to be inherent, it could be outsourced by any means necessary, all to protect.