Fake Drugs: Independent Pharmacies & Chemists Identified as Main Point of Sale

Abuja, Nigeria. February 24th, 2015 – Latest snap poll results released by NOIPolls Limited have revealed that 18 percent of Nigerians say they have personally been victims of fake, counterfeit and substandard pharmaceutical products, medicines & drugs; and of those that have been victims, “Independent pharmacy/chemist” (68 percent) and “drug hawkers” (14 percent) have been identified as the two main points of purchase of fake drugs/medicines in Nigeria.

While these figures represent the perceptions of Nigerians, pharmaceutical experts’ suggest that many Nigerians may not be aware they have been victims of fake pharmaceutical products, especially in the absence of obvious negative effects.[1] The poll results further indicated that the effects of fake drugs can be experienced in various dimensions depending on the ingredients that make up the counterfeit drugs thus leading to clues for the identification of fake drugs by users. For instance, about one-third (35 percent) of the respondents who have been victims were only able to identify that the drugs were fake when there was ‘no improvement in health at the completion of dosage’, followed by 29 percent who cited ‘adverse reaction’More findings from the poll revealed that about one-third (33 percent) of respondents who have been victims ‘took no action’; however 32 percentclaimed they ‘discarded/destroyed the drugs’ upon realising they were fake.

Finally, as Nigerians recognise the prevalence of fake drugs in the country, several suggestions have also been proffered to combat the sale of fake, counterfeit and substandard drugs, which include – the ‘shutting down any outlet identified for selling fake drugs’ (29 percent); ‘arrest & prosecution of offenders’ (15 percent); andthe enforcement of ‘drug authentication’ (10 percent) among others. While these suggestions are not entirely new in the battle against the sale and distribution of fake drugs by NAFDAC, it is imperative that the agency and other stakeholders intensify efforts in the regulation and control of the importation, manufacture, distribution and sale of drugs in order to ensure the availability of safe and quality pharmaceutical products, medicines and drugs to Nigerian citizens. These are the key findings from the fake pharmaceutical drugs pollconducted in the week of February 16th 2015.

Brief Background 

Fake pharmaceutical products, medicines and drugs are a threat to public health and are part of the broader incident of substandard pharmaceuticals – medicines manufactured below established standards of character and are therefore dangerous to patients’ health and ineffective for the handling of any disease. It causes distress and deaths that some experts regard as attempted murder,[2] while The National Agency for Food and Drug Administration and Control (NAFDAC) refer to it as “the greatest evil of our time and the highest weapon of terrorism against public health, as well as an act of economic sabotage”.

The World Health Organisation (WHO) described fake drug (also known as counterfeit medicine) ‘as one which is deliberately and fraudulently mislabelled with respect to identity and/or source. Counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging." Fake drugs are discovered to be non-effective as most of them are either without active ingredients, with wrong ingredients or incorrect quantities of active ingredients. Thus the use of these drugs negatively affects patients thereby prolonging treatment periods as the health of patients may not improve upon usage. Also they may worsen the conditions being treated and even lead to death.

Nigeria is renowned for its battle with the menace of fake drugs in conjunction with NAFDAC, a prominent government agency responsible for regulating and controlling the manufacture, importation, exportation, advertisement, distribution, sale and use of food, drugs, cosmetics, medical devices, chemicals and packaged water. The combative actions of the agency include the destruction of drugs worth billions of naira, as well as the conviction of counterfeiters. Some noteworthy instances includes the seizure of fake drugs worth about two billion naira (US$ 16 million) seized by NAFDAC in 2006 under the administration of late Professor Dora Akunyili.[3] In the recent times under the administration of Director General of NAFDAC, Paul Orhii, it was reported that five containers of drugs suspected to be fake amounting to N270 million was seized in January 2015.[4] Despite such achievements, the issue of fake drugs continues to plague the Nigerian health system.

Against this background, NOIPolls conducted its recent poll on the issue of fake drugs to gauge the perception of Nigerians on the prevalence of fake drugs in Nigeria and experiences surrounding it, as well as possible suggestions for its eradication.

Survey Findings

Respondents to the poll were asked six specific questions. Firstly, to gauge the perceptions of Nigerians on the prevalence of fake drugs in Nigeria, respondents were asked: To what extent do you think there is a prevalence of fake pharmaceutical drugs/medicines in Nigeria? Findings revealed that the majority (74 percent) of respondents surveyed believe that there is a prevalence of fake pharmaceutical drugs in Nigeria where40 percent believe it is to ‘some extent’; while 34 percent say it to ‘a high extent’. Though some respondents think it is to a ‘high extent’ (34 percent), while 16 percent believe it is ‘to no extent at all’. This finding therefore supports previous research findings by other research organisations and think tanks such as Stimson centre which revealed that fake pharmaceutical drugs remains one of the world’s fastest growing industries, with recent trends suggesting an increase in the sale of fake drugs by over 90 percent in 2010 from 2005, translating to over $70 billion. [5]

 

Respondents were further asked: Which of these statements apply to you in the purchase or use of fake pharmaceutical drugs/medicines in Nigeria? The result shows that a higher proportion of respondents (69 percent) have neither had any personal experience in the purchase or use of fake pharmaceutical drugs nor know someone who has purchased or used fake drugs/medicines in Nigeria. On the other hand, 18 percent of the respondents interviewed admitted they have either personally purchased or used fake drugs/medicines whereas, while  13 percent claimed they know someone who has purchased or used fake drugs/medicines in the country. While these figures reflect the perceptions of Nigerians, they may not be absolute as experts revealed that some Nigerians may not be aware that they have been victims of fake pharmaceutical drug especially in the absence of obvious negative effects.

Analysis based on geo-political zones revealed that the North-East region (35 percent) accounted for the largest proportion of respondents who have either personally purchased or used fake drugs, followed by the North-West region (20 percent). This finding may be attributed to the high distribution of fake drugs especially for the treatment of malaria and other tropical ailments across the region. For instance theSabon Gari market of Kano has been rated as Africa’s largest source of fake anti-malarial drugs by the World Health Organisation (WHO), to the northern parts of Nigeria; and this led to its closure by the government.[1] In addition, the South-South zone accounted for the largest (21 percent)proportion of respondents who know a victim of fake drugs.  


[1] http://www.irinnews.org/report/97249/slow-progress-on-fake-drug-war-in-northern-nigeria

 

Subsequently, respondents who either have personal experience or know a victim of fake drugs (31 percent of the total) were asked: How did you find out they were fake drugs? Findings revealed that more than one-third(35 percent) of the respondents were able to identify fake drugs when there was ‘no improvement in health at the completion of dosage’, while 29 percent cited ‘adverse reaction’ to the drugThese findings further portray that the effects of fake drugs can be experienced in various dimensions depending on the ingredients that make up the counterfeit drug. Pharmaceutical experts reveal that a counterfeit drug that contains no active ingredient or no harmful ingredients will fail to help the patient get better; this can ultimately harm the patient. For instance, in the case of antibiotics, this can promote antibiotic resistance and the use of stronger antibiotics.

Other ways in which respondents were able to identify fake drugs include ‘discovered alteration on the drug/package’ (23 percent)‘expiry date’ (19 percent)‘absence of NAFDAC number on the drugs’ (10 percent), and ‘wrong PIN on mobile authentication service’ (7 percent). In addition, 3 percent of the respondents indicated ‘resulting death of individual’; just as the case in November 2008 when 34 children died and more than 50 were hospitalized with severe kidney damage after using a fake drug.[1]


 

To determine the point of purchase of fake drugs, respondents were asked: Where did you purchase/get the fake drugs from? In response to this question, ‘independent pharmacy/chemist’ was cited as the primary source where respondents purchased fake drugs/medicines as reported by 68 percent of respondents surveyed. This is followed by ‘drug hawkers’ (14 percent), and these have been known to mostly operate at night time in order to dodge inspection by officials of the National Agency for Food and Drug Administration Control (NAFDAC),[1]  Other points of purchase of fake drugs cited  by respondents include ‘shops’ (11 percent)‘Hospital/clinic pharmacy’ (10 percent) and ‘Supermarkets’ (1 percent).

 

To gain insight on actions taken by respondents at discovery of fake drugs, respondents were asked: What action(s) did you or the victims take upon discovery of fake drugs? The outcome of the survey reveals that the one-third of the respondents ‘did not take any action’ whereas, 32 percent ‘discarded/destroyed the drugs’ upon discovery, 30 percent ‘returned the drug to the point of purchase’ while,  10 percent ‘Reported to the pharmacy management’ amongst others.

 

Finally, respondents were asked: In your own opinion, what do you think the government should do to eradicate fake drugs in Nigeria? Findings revealed a variety of recommendation for eradicating fake drugs in Nigeria with top recommendations indicating ‘shutting down any outlet identified for selling fake drugs’(29 percent);the ‘arrest & prosecution of offenders’ (15 percent), as well as the enforcement of ‘drug authentication’ (10 percent) amidst other suggestions.

 

In conclusion, current poll results have revealed that the majority (74 percent) of respondents surveyed believe that there is a prevalence of fake pharmaceutical drugs in Nigeria. In addition, 18 percent of the respondents interviewed admitted that they have personally purchased/used fake drugs/medicines which resulted in ‘no improvement in health at the completion of dosage’ (35 percent) and ‘adverse reaction’ (29 percent), amidst other effects. Also, 68 percent of respondents who have either been or know a victim of fake drugs identified‘independent pharmacy/chemist’ as the point of purchase of such drugs, followed by drug hawkers. The survey also shows that most respondents (33 percent), ‘Did not take any action’ upon discovery of fake drugs, whereas, 32 percent ‘discarded/destroyed the drugs’. Finally, in eradicating the sales and distribution of fake drugs in Nigeria,29 percent of Nigerians suggest the ‘shutting down any outlet identified for selling fake drugs’‘arrest & prosecute offenders’ (15 percent) andthe enforcement of ‘drug authentication’ (10 percent) among other recommendations.

Survey Methods

The opinion poll was conducted in the week of 16th February 2015. It involved telephone interviews of a random nationwide sample. 1,000 randomly selected phone-owning Nigerians aged 18 years and above, representing the six geopolitical zones in the country were interviewed. With a sample of this size, we can say with 95 percent confidence that the results obtained are statistically precise - within a range of plus or minus 3 percent. NOIPolls Limited, No1 for country specific polling services in West Africa, which works in technical partnership with the Gallup Organisation (USA), to conduct periodic opinion polls and studies on various socio-economic and political issues in Nigeria.. More information is available at www.noi-polls.com

Disclaimer

This press release has been produced by NOIPolls Limited to provide information on all issues which form the subject matter of the document. Kindly note that while we are willing to share results from our polls with the general public, we only request that NOIPolls be acknowledged as author whenever and wherever our poll results are used, cited or published.

NOIPolls hereby certifies that all the views expressed in this document accurately reflect its views of respondents surveyed for the poll, and background information is based on information from various sources that it believes are reliable; however, no representation is made that it is accurate or complete. Whilst reasonable care has been taken in preparing this document, no responsibility or liability is accepted for errors or fact or for any views expressed herein by NOIPolls for actions taken as a result of information provided in this report. Any ratings, forecasts, estimates, opinions or views herein constitute a judgment as at the date of this document. If the date of this document is not current, the views and content may not reflect NOIPolls’ current findings and/or thinking.

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Email: editor@noi-polls.com


[1] http://www.nigeriapharm.com/Library/Drug_regulation.pdf

[2] http://www.medwelljournals.com/fulltext/?doi=rjmsci.2011.257.261

[3] http://www.who.int/bulletin/volumes/84/9/06-020906/en/

[4] http://dailytrust.com.ng/daily/news/45440-nafdac-hauls-n270-counterfeit-drugs

[5] http://www.stimson.org/images/uploads/research-pdfs/Full_-_Counterfeit_Drugs_and_National_Security.pdf

[1] http://www.ajol.info/index.php/nqjhm/article/view/12765

 

[1] http://www.health24.com/Medical/Meds-and-you/News/Counterfeit-medicine-threatens-Africa-20140619