Slow poison: The world of fake drugs

In different parts of the country fake drugs are sold not only in chemists and pharmacies but also in the open market like every other common item. TADE MAKINDE examines the influx of fake drugs and the aactions taken by regulatory agencies to control the menace.

FOR long, fake drugs have been in circulation in the country, and drug monitoring agencies have been doing their best to curtail the influx of the products into the markets. But recently, the has become so alarming that consumers now worry about the source of every drug, be it vitamin C or valium, before they buy it. While some stakeholders blame the rising case on the harsh economy, others blame it on the falling naira against foreign currencies since Nigeria is majorly an import-dependent country.

Several weeks ago, a mother took her ill daughter to a hospital somewhere at Apata area of Ibadan. She was told her daughter needed to buy some drugs immediately as her temperature had risen beyond the average.  Sunday Tribune learnt that the young girl lost her sight after taking the drugs. “She has been taken to Ilesha for spiritual treatment,” she said.

The young lady, should count herself lucky when her lot is compared to that of a prominent medical practitioner in Lagos who eventually lost his life, despite having the financial capacity for oversea treatment. The physician had been on medication for cancer for years. Within two years, he had taken 10 out of the 15 doses of the recommended injection, but nothing changed. Worried, he travelled to England for further check up. It was there that it was discovered that what he had been injecting in his body for years werefake products. He died.

Before a prominent lawyer passed on about a decade ago, his last words were curses, rained upon fake drug producers and the ineffective regulatory agencies in the country. The man had been buying his drugs at a popular chemist to control his blood pressure. After several months, his eyes began to trouble him. On the advice of his wife, the man agreed to travel to the United States for an eye test. It was there that he was diagnosed as suffering from chronic liver problem.

Further tests revealed that he had also been using certain drugs, which were tested and confirmed to be fake. The drugs were made from limestone (chalk). He died two months after he got back to the country.

The above listed are not the only unfortunate Nigerians who have suffered fatally from using fake drugs over time. Many still do without knowing it.

A medical practitioner, Dr Victor Adeyefa in an interview with Sunday Tribune said most of the drugs sold on the counters in the country are under license, while the rest are imported.

“We just assemble the powder and other components of the drugs, like we assemble cars, and then bottle or pack. Most of the drug companies in Nigeria are licensed by foreign companies. The components of these various drugs are mostly imported, so, foreign exchange is involved,” he said alluding to the reason some of them are very expensive.

Mrs Esther Lawal, the Head of Administration, ALGON Comprehensive Health Center, Molete, Ibadan while speaking with Sunday Tribune, blamed the increase in drug counterfeiting on the devaluation of the naira.

“Most of these drugs are produced overseas, so the intricacies of exchange rates should be considered as a major factor that has negatively affected drug prices in Nigeria.

Mrs Lawal also told Sunday Tribune that drug prices have increased more than 50 per cent within three months, which has become a matter of concern among health practitioners.

A popular malaria fever drug, which sold at N550 around October last year, now sells for N1,200. The frightening increment has got many patients resorting to home treatment, invariably complicating matters as many misdiagnose, or visits local herb practitioners. A popular anagelsic that was once sold for N20 is now N50. Syringe, which used to sell for N10 now sells for N100, while bills that usually hover around N15,000 and N20,000 are now between N35,000 and N50,000 at private hospitals.

Doubts

Unfortunately the influx of fake drugs into the country is not about to end soon. The Standards Organisation of Nigeria (SON) has even admitted that it may continue because the agency has not been adequately positioned to stop it.

Mr Bola Fashina, Head of Public Relations of the organisation, said in Abuja that the SON had been disadvantaged by its relocation out of the ports since 2011, hence the inability to stop the importation of substandard products at the entry points.

“In spite of the off-Shore Conformity Assessment Programme (SONCAP), unpatriotic importers still circumvent the process to make excessive profits. The programme was aimed at ensuring that quality products were imported from their countries of origin into the country.

“SONCAP is a pre-shipment verification of conformity to standard process used to verify products to be imported into Nigeria. The agency was only able to examine consignments on arrival only when invited, while the invitations were normally far between,” he said.

Mr Lekan Asuni, the Chief Executive officer, Lafas Pharmaceuticals, Lagos in his own contribution commended regulatory bodies’ effort at controlling influx of fake drugs, which he termed an illicit business, He said influx of fake drugs will only stop when its perpetrators are made to face very stiff penalties.

“The current penalty is a mere slap on their wrists; we need very stringent penalties. It should be made a criminal offence. They should be made to forfeit all their properties and gains from this business to the government. Sometimes, they should be committed to death,” he said.

He therefore recommends a restructuring of the drug distribution chain in Nigeria to ensure that drugs can be tracked till they get to the patient that needs them. According to him, the new drug distribution policy that is yet to be fully implemented is a challenge to preventing the circulation of fake and substandard medicines in the country.

The pharmacist stated that recognising a fake and substandard drug is difficulty except one is trained, adding “most companies have found a way to identify their products that are vulnerable to adulteration and put in place measures that enable them to protect these drugs from adulteration.

“The measures are both overt and covert. Overt are things that are put on the pack or products that you can see through physical examination to tell if the product is genuine. “The covert ones are things that are not visible to the eyes but through their own training, they know exactly what to look out for. But the only way to confirm whether a product is fake or genuine is by forensic examination, and that the lay public cannot do.”

“Manufacturers of most fake medicines do not take time over the nitty gritty of what goes on the pack. There is usually one error somewhere, either a letter is missing in the name; the colour of the pack is a bit lighter and so on.”

Mr Asuni, however, suggested that in avoiding fake medicines, individuals are better off patronising registered pharmacy stores, adding “such stores have a lot at stake. If they are caught to be selling fake products and reported to the Pharmacists Council of Nigeria, it can affect their licensing.”

Dr Lolu Ojo, former, National President, Nigerian Association of Industrial Pharmacists of Nigeria and CEO, Merit Healthcare Limited Pharamceuticals, Lagos, also corroborated the position that increased influx of fake medicines into Nigeria should be expected given the high cost of importation of medicines and dearth of forex to even do so.

Dr Ojo refused to blame either NAFDAC or SON for the influx of fake drugs into the country. According to him, “it is government that we must blame,” but added that “NAFDAC must ensure that the drugs we are given are safe; they must not relent in safeguarding the health of Nigerians.”

Solution

A Lagos-based medical practitioner, Dr Richard Akande, while creating awareness on how to spot fake drugs said, a patient only needs to wait few days to notice some bewildering changes that will have taken place.

“The pack will have changed colour from blue to violet within three days if not used, and later to either green or yellow,” he said.

Gboyega Bolade, whose mother’s liver had failed due to fake drug usage, said fake drugs are usually cheap, but not necessarily. “Fake drug makers know that the lowly paid are those who will patronise them because they can’t afford the costly prices of some drugs. In the market, when you tell them so and so drug costs N200, they will tell you that a nameless drug sells for N100 at Mr or Mrs  so and so’s shop.

“This ‘expensive drugs’ have come directly from the makers in Lagos, and we all know how much it costs from the source. Sadly, retailers who don’t buy from the real makers later flood the market with their fake drugs,” he said.

For Dr Adeyefa, fake drugs could not be so easily identified. “Only a laboratory can detect if a drug is fake or real. If anybody tells you that they can without tests, it’s a lie. Unfortunately, we don’t have enough laboratories in the country. NAFDAC has one at Oshodi. You can’t determine by merely looking at a drug and conclude that it is fake. You have to test it at a laboratory,” he said.

Dr Abubakar Jimoh of NAFDAC however differs. He told Sunday Tribune that fakers had perfected their printing technology such that differentiating a drug by merely looking at it or trusting its labeling was no longer possible.

“When you place an original drug beside a counterfeit, it will be exactly the same and you will not be able to distinguish which is genuine. This is because they have perfected their game. The way now is to go to the laboratory and even this will take between two to three weeks.

“For an average consumer, it is not easy to distinguish. That is why technology is the answer. We are still working on smoothening the rough edges. Nonetheless, NAFDAC number is very sacrosanct and consumers should look out for it because it was borne out of scientific processes and the product given a clean bill of health.

“Even these numbers are sometimes faked. They have been faking our numbers, but how many people can differentiate genuine NAFDAC number from a fake?  We are the only ones that know our style of numbering.

“The challenge, however, is that we don’t have the staff strength that could visit all the shops in Nigeria, populated by 180 million and also the pharmaceutical establishments that are in the country. This was why NAFDAC decided to put the power to differentiate a counterfeit drug in the hands of the consumer through the mobile authentication scheme that when a consumer enters a pharmacy shop, scratch the panel on the medicine pack to access a pin number to confirm if a drug is real or fake.

— Additional report by SADE OGUNTOLA