Stamping out menace of expired, counterfeit drugs

A recent report by Bloomberg put Nigeria as the most counterfeit market in the developing world, occupying a top seat among African countries losing thousands of citizens annually to fake drugs.

In an earlier report published by another international media organisation, it corroborated the unenviable position, quoting the National Agency for Food and Drug Administration and Control (NAFDAC) as having described the country as “the developing world’s largest counterfeit drugs market.”

The World Health Organization (WHO) estimates that in sub-Saharan Africa alone between 64,000 and 158,000 people die every year from taking fake anti-malaria medications. Counterfeit medicine has no frontiers and the WHO estimates that the global market is worth around $200 billion, making it the most lucrative and dangerous trade in illegally copied goods.

In Nigeria, the government destroyed N29 billion worth of fake drugs between 2015 and 2017 and set up the Anti-Counterfeiting Collaboration of Nigeria (ACC) to take on the hydra-headed problem of counterfeiting.

Sometime last year, the National Primary Healthcare Development Agency, (NPHDA), also disclosed that over 70 per cent of medicines being dispensed in Nigeria were substandard. This was as the agency noted that the majority of Nigerians had no access to quality health services.

This explains why, at regular intervals, officers of the Nigeria Customs Service in collaboration with other sister agencies like the National Drug Law Enforcement Agency and the National Agency for Food and Drug Administration and Control, announce the confiscation and subsequent destruction of containers of substandard drugs imported into the country.

But the Nigerian state is not just up in arms against the menace of counterfeit drugs, it also battles the malaise of expired drugs and tries almost without success to save its teeming unsuspecting population from exposure to the expired drugs and the attendant fatalities.

The quest to rid society of expired and counterfeit drugs has been an age-long battle and it seems to be a herculean task in Nigeria, given the widespread availability and use in urban and rural communities.

Most streets in the country have medicine merchants in various corners dispensing drugs at will, oftentimes without certification. A good number hawk the drugs, while a few have hidden ‘factories’ where the sub-standard drugs are manufactured and distributed to vulnerable Nigerians.

The attendant damages to lives and the well-being of citizens are quite worrisome. Health experts and other relevant stakeholders say that some of the predominant health issues in society today, ranging from loss of sight, hearing defects, kidney and liver issues, cancer to untimely deaths are caused or triggered by substandard drugs and/or abuse.

Counterfeit medicines not only pose significant threats to health, increase disease prevalence and antimicrobial resistance, but also cause loss of public confidence in healthcare professionals and health systems. They impede access to healthcare and ultimately the goal of Universal Health Coverage (UHC).

Having quality healthcare includes access to quality medicines and it is among the best investments a society can make to achieve thriving and productive people. Investing in UHC protects people from out-of-pocket medical expenses and reduces the risk of being pushed into poverty and financial ruin due to unexpected illness, destroying their futures and often those of their children too.

Aside from the health challenge of counterfeit drugs, the economic losses to the nation are huge. For instance, earlier this month, NAFDAC burst a sexual enhancement store in the Progressive Science and Allied Dealers lane, Bridge-Head Market, Onitsha, Anambra State.

The Chief Laboratory Technologist of the agency, Usman Amen, who led the investigation and enforcement of the directorate team from Lagos, said the store was discovered for selling unregistered and expired drugs.

Amen gave the names of the sexual enhancement drugs as Delay viagra, Afrofranil, Breast enhancement, Ass enhancement, Rocket in pocket men gel, Tramadol, among others.

He said, “We came from Lagos based on a tip-off. Before we arrived here, the owner of the drugs abandoned his store and ran away. We had to break the store. On entering the store, we saw some expired drugs like tramadol, breast enhancer and sexual enhancement drugs.”

Mojisola Adeyeye, NAFDAC DG. Photo: TWITTER/NAFADACAGENCY

Similarly, last month, NAFDAC destroyed fake drugs and expired products worth N326,833,592.80, which were seized from pharmaceutical stores and other business enterprises across the states of the North Central geo-political zone of the country.

Speaking at the destruction exercise in Lafia, the Nasarawa State capital, the Director General of NAFDAC, Prof. Christianah Adeyeye, described the act of some Nigerians who sell such substances to other citizens as the gravest onslaught on human life.

Adeyeye, who was represented at the exercise by the NAFDAC Director, of Investigation and Enforcement, Francis Ononiwu, said the products were seized from manufacturers, importers and distributors in other to safeguard the health of the entire citizens of the nation.

The NAFDAC DG said, “It is important to note that the importation, distribution and sales of fake and unsafe products represent a grave onslaught on human life. These products include medicines, foods, and cosmetics.”

Director, Public Affairs at NAFDAC, Dr. Jimoh Abubakar, said the Agency has multi-dimensional approaches to eradicating use of counterfeit medicines, which they have adopted over the years, adding that the agency has trained 150 healthcare personnel across the country on drug counterfeit eradication.

Abubakar noted that NAFDAC has a programme called track and trace approach, including scratch and text, a technological approach where the agency receives text messages from drug consumers in collaboration with telecommunications companies.

He said the scratch and text system is where every medicine has number codes that could be used to confirm whether a particular drug is counterfeit or not, which started in the year 2010. “We started this scratch and text with antibiotic drugs because that is
where there is huge volume of counterfeit drugs. We also have NAFDAC safety mobile app, which helps in monitoring authenticity of drugs in conjunction with the track and trace system.”

“We started training health workers to enable them to educate members of the public on dangers of drug counterfeiting, especially at Primary Healthcare Centres (PHC), across the states and the agency partners with these trained health workers.”

Abubakar explained that NAFDAC has another device called true scan machine, which the agency gave to medicine dealers across the country to detect fake and adulterated drugs. This is to enable them easily
detect fake drugs in their localities.

He said: “The true scan machine is being used by our security officers whenever they are go for inspection as it helps to detect
counterfeit drugs in shops through random test approach. The device gives
results immediately without delay.”

Abubakar disclosed that NAFDAC also has public enlightenment programmes to enable the agency equip people with useful information because information is power.

He said the agency has another informative and educative programme, called NAFDAC and your health, which runs on television
stations and the Federal Radio Corporation of Nigeria (FRCN), in the 36 states all over the country.

He noted, however, that it is not only counterfeit drugs that the agency inspects, as it also checkmates other public health issues such as substandard foods, cosmetic products, poorly packaged table water, and
chemicals, among others, in order to safeguard the health of the nation.”

Abubakar said: “At the extreme end, we have legal dimension, where our men at the NPA track the drug barons and take them to
court to face the wrath of the law. For instance, in the last five years, several container loads of tramadol were destroyed by the agency.

“Another dimension is where we enforce drug law at the land borders before the drugs will be taken into the country. We also have post-marketing enforcement at drug warehouses to ensure no fake drug is left.”

Abubakar noted that the dangers of counterfeit drugs cannot be over-emphasised because everyone in the society is a potential victim, even the NAFDAC workers, which is why the agency fights to ensure zero tolerance on counterfeit drugs.

He said: “ If you talk about total eradication of expire drugs with 100 per cent, with my experience over the years it is not easy to
achieve. Because those who engage in selling expired drugs are criminals, because as well as human society exists they continue
claiming to be smart”.

Abubakar stressed the need for members of the society to join hands with the agency in the fight because “NAFDAC alone cannot achieve it.”

He said: “I will advice Nigerians to shine their eyes and follow all the safety rules and regulations laid down, people should avoid
buying drugs exposed to sunlight, they should only buy drugs at the registered pharmacies, and ask questions for their personal safety.”

Though regulators insist that the sustained fight against the menace is yielding results, stakeholders contend that it is yet a long road to winning the war and offer suggestions on how to achieve better results.

[FILES] NDLEA Chairman Buba Marwa

While disclosing that there is an upsurge of expired drugs with its antecedent health challenges and other vicious effects on society, he said the NDLEA, with a view to addressing the problem, has partnered with other agencies to ensure reduction of drug counterfeiting and abuse of drugs as well as safeguarding health and well-being of humankind.

He explained that NDLEA, on its part, collaborates with NAFDAC in ensuring that measures are put in place to prevent drug counterfeiting.
In some instances, NDLEA had intercepted and prosecuted some traffickers with controlled or narcotic substances intended to be diverted to illicit uses.

He said: “It is quite worrisome that chemicals intended for research and industrial purposes are finding their way into the illicit drug
manufacture. This is the area that NAFDAC and NDLEA need to deepen collaboration to ensure that such unwholesome acts are completely
eliminated.

“NAFDAC and NDLEA will continue to collaborate with major stakeholders at all levels to develop an efficient value chain and
support system that will ensure access to genuine drugs and controlled substances for medical and strategic purposes while
preventing diversion for illicit use.”

The National Chairman, Association of Community Pharmacists of Nigeria (ACPN), Pharm. Adewale Oladigbolu said his association has over the years committed to ensuring safe and efficacious medicines, through technologies to prevent use of counterfeit drugs.

The association called for more support and collaboration among stakeholders in the health sector on sanitising drug distribution systems in Nigeria and endorsement of technology-enabled supply chain coordination platforms.

He stressed the need for a new guideline that promotes timeliness, provision of service medicines and traceability of quality assured
service medicines and the need to collaborate with relevant stakeholders for the review of National Drug Distribution Guideline
(NDDG).

Oladigbolu explained that there is need for drug labelling and classification of every product.

He noted that there is need for regulation of herbal medicines advertisement and the need to make progress on verification of claims,
clinical trials, genomic variations and the involvement of Pharmacists across all the technical groups.

Oladigbolu stated that with NAFDAC on their side, the association would achieve a society free of expired medicines without compensating the manufacturers and sellers of the drugs.

He said the major challenge the associations in expired drug eradication is where the manufacturers and dealers of expired drugs
demand compensation before the drugs could be destroyed.

He advised drug consumers to always check the expiry date on drugs, before consuming. He lamented that most people do not care to check to expire dates on items before consuming, adding that such an attitude could be risky and dangerous to their health. He urged drug dealers in Nigeria to desist from selling expired drugs.

Oladigbolu warned drug dealers, and pharmacists, among others, to desist from sharp practices or face the wrath of the law.

He said. “Pharmacists should practice within the laws stipulated and, please do not revalidate expire regulated products nor engage in any fraudulent practices.

“If we have additional support from NAFDAC, I can assure you, we will take regulation to almost all parts of this country and
ensure that no unwholesome medicine product is sold or consumed in Nigeria.”

He explained that certain expired medications are at risk of bacterial growth and sub-potent antibiotics leading to more serious illnesses and antibiotic resistance, which may lead to untimely deaths.

The National Secretary ACPN, Ambrose Eze said the association is partnering with NAFDAC to contain open drug markets in the country such as sale of drugs in car parks, hawking in the streets, and buying from mallams, as all these would become things of the past.

Chairman ACPN, Lagos State chapter, Pharm. Lawrence Ifeato, said the association has had series of meetings with stakeholders for the benefit of Lagos residents and Nigerians at large, especially toregulate and perfect drug distributions.

He said: “Expired drugs can lead to behavioural changes such as reckless, impulsive and compulsive acts and eventually mental
disorder. It can also lead to the precipitation and worsening of already existing
major mental illnesses such as depression and anxiety disorders amongst others.

“Severe physical health outcomes including liver damage, respiratory depression, coma and death are not left out,” he said.

He advised on how to avoid expired drugs, saying that pharmacists should assign one person to check for expiration dates at the end of each month. “They could also use calendars, notes, and electronic reminders, among others, as reminders to complete this task every month. Drug dealers should centralise all their drugs and materials that expire in one location or limit the number of locations where materials are kept in order to prevent expired drugs,” he said.