Drugs have brought significant
benefits to our life, offering reduction in
morbidity and mortality. The improving
health status of increasing number of
the population can be attributed to the
use of drugs. Drugs , are any products,
substances or a mixture of substances
that is used or intended to be used for
the prevention, diagnosis or treatment
of disease or its symptoms or for the
modification or explore physiological
function or pathological states for the
benefits of the recipients. Equitable
access to quality drugs however remains
a challenge in developing and transition
counties like ours. Strong and functional
health system ensures that the right
good quality drugs are delivered in the
right quality and quantity, in the right
condition to the right place at the right
time and at the right cost under the
management of the right personnel.
Large segment of the population tends
to lose confidence in the ability of the
health care system to provide needed
health care services due to uncontrolled
circulation of fake drugs in the system.
A reliable, good-quality drug supply
is essential for health, but it is often
missing in many developing countries
with weak health care and regulatory
systems like ours
Drugs quality is categorized into four
main groups: quality assured drugs,
falsified (counterfeit) drugs, substandard
drugs and degraded drugs.
Quality assured drugs are those that
contained the recommended amount
of active pharmaceutical ingredients
(API) and at the same time meet other
requirements; falsified drugs don’t
contain the acceptable amount of API
and most cases carry false representation
of their sources of identity, sub-standard
drugs are those that are produced
without proper attention to good
manufacturing practice (GMP). Substandard
drugs may contain API or
disintegrating or dissolution times that
are not within the acceptable limits
and this could be the result of negligence,
human error, and insufficient human and
financial resources. Degraded drugs could
be as a result of exposure of good quality
drug to humidity, heat and light resulting
from bad storage condotions. In essence
fake drugs include falsified (counterfeit)
drugs, sub-standard drugs and degraded
drugs. The circulation of fake drugs in
Nigeria by unscrupulous people has
untold public health consequences on the
population. The result of the use of these
fake drugs could be poisoning, treatment
failure, untreated disease and death. We
should not be quick to forget the incidence
of “my pickin” a teething syrup episode of
2009 that took the life of about 84 children
in Nigeria. It is a fact that many tablets and
capsules used in this country have been
discovered to contain benign ingredients
like flour, chalks etc as API and in some
cases other substances are added to the
fake drugs to mask the illness. For example
paracetamol could be added to fake antimalaria
drugs to give that ant-pyretic effect
making the patients to feel and believe that
the drugs are working.
The essence of providing health care
services including drugs is to relieve the
patients of the symptoms of the disease or
slow down the progression of the illness.
In an event however, that the patients do
not respond to treatment as expected,
there should be good reason to suspect
any or all of the following: drug resistance,
misdiagnosis, inadequate dosing of the
drugs or fake drugs. It is sometimes difficult
to identify these fake drugs because
patients taking these medications could
die of natural causes therefore making
it extremely difficult to trace the cause of
the death to the drugs used. This situation
calls for continuous monitoring of drugs by
regulatory authorities to fish out these fake
drugs in circulation. If we could remember,
Dora Akwunyili of blessed memory once
told us that her sister, a diabetic patient
died from fake insulin. The management
of chronic disease like high blood pressure
and diabetes type-2 depend entirely on
maintenance medications and monitoring
their levels. One could imagine what will
happen if the drugs for these diseases are

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faked and the person taking them may not
have made out time to monitor the level
of their blood pressure or the blood sugar
level because as far as he or she is concern,
he or she is on medications and expects the
blood pressure or the blood sugar level to
remain within the normal range. In this
kind of situation where the drugs taken are
fake, the blood or sugar level can skyrocket
without the sufferer knowing it because
he or she taking the medication believes
the drugs would work. Poor-quality (fake)
drugs tend to compromise the treatment
of chronic and infectious diseases, causing
disease progression, drug resistance,
morbidity and mortality. The current wave
of increase in chronic diseases in lowand
middle-income countries including
Nigeria calls for availability of reliable and
good quality medicines. Substandard and
falsified drugs promote drug resistance;
threaten the weak and fragile health care
system and the health of populations now
and in the future.
There are many factors contributing to the
importation, manufacture, distribution and
sales of fake (substandard, spurious, falsely
labeled, falsified, and counterfeit drugs) in
Nigeria. Let us take a look at those things
that encourage/influence the importers,
manufacturers, distributors and retailers to
engage in production, distribution and sales
of fake drugs knowing full well the public
health consequences. Poverty and decrease
in household income: The inability of
people to afford the cost of some drugs for
their health needs in the phase of economic
recession could cause shifts in their drug
demand, utilization and expenditure: On
the household levels the purchasing power
of the people could be so low that they
cannot afford the cost of branded drugs as
such people tend to go for cheaper generic
products, not that generic products are
fake but unscrupulous elements in the
society do seize this opportunity to bring
in the fake versions of these good generic
drugs. This situation may give room for
the importation, distribution, patronage
and sales of fake and adulterated drugs to
the detriments of the society at large. Drug
shortage could lead to increases in price for a
legitimate drug and increase opportunities
and ability for unscrupulous people to
make financial gain by introducing fake
versions of the drug into the market. Poor
governance, fragile and weak health care
system tends to promote the manufacture,
importation, and sale of medical products
without adherence to good manufacturing
and distribution practices. Increasingly
easier access to sophisticated printing and
manufacturing technologies has facilitated
counterfeiting of drugs and other medical
products. Other factors that are aiding the
importation and circulation of counterfeit
drugs in Nigeria are our porous border,
corruption, rapid expansion of the internet
and globalization.
Effects of fake drugs on the patients and

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the Health Care System
Substandard and falsified drugs
promote drug resistance, threaten the
weak and fragile health care system and
the health of populations now and in
the future. Treatment with substandard
and falsified drugs wastes time and
money, raising drug costs to patients and
the health care system. The health care
service providers who don’t normally
suspect that the drugs they prescribe
and use are fake will respond to a
poor therapeutic response by ordering
more tests or by repeating the course
of treatment. The patients will have to
shoulder the additional cost of the tests
and the drugs for repeated treatment
while the government caters for the cost
of falsified and substandard drugs. It is
important to note that in addition to the
direct financial costs of treatment, there
are also opportunities costs incurred to
patients who miss work for additional
doctors’ visits or become too sick to
work. Drug resistance could as a matter
of fact reduce the effective life of a drug,
and not only that, the society would
one way or the other bear the cost of
developing a new drug. Uncontrolled
circulation, distribution and sales of fake
drugs will make the consumers to lose
confidence in drugs, health care system,
health care providers, and national drug
regulatory agencies. As a result of drug
faking patients/consumers may start to
distrust pharmacies thus losing faith in
public health system. Corruption in the
health care system can cause the patients
to assume and believe that all drugs
supplied and used are fake. Counterfeit
drugs not only take income from the
consumers by having to pay for products
that have little or no medical value but
the can also lead to unresolved health
problems and deaths. Poor drug quality
can destroy the perception of health
care system. Counterfeiting of drugs
could lead to reduction in the incentive
to engage in research and development
of new products. Intellectual property
represents original, creative works
and innovations that belong to the
investor. This protection encourages
innovations and creativity but the
rewards for innovation and creativity
can be undermined by widespread
counterfeiting of the products
Way forward
There is the need for more holistic
and multidisciplinary approach to
drug quality research that incorporates
anthropology, epidemiology, statistics
and economics. There is need for multistakeholder
engagement on a national
and global scale that would include
regulatory agencies, customs and police
supported by enforceable legislation.
We need to build or strengthen a
functional and robust national drug
regulatory outfit and technical capacity
that is sustainable. We need to develop
a deeper understanding of the public
health impact of substandard drugs
both in terms of the immediate clinical
implications as well as the propagation
of drug resistance.

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