Fake Drugs: A Global Problem

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In my travel clinic I regularly counsel patients who are traveling abroad that they need to carry a full supply of any prescription medications they regularly take with them, and bring a small cache of over-the-counter medications they might need, as well. In the few instances patients have asked me whether it is safe to purchase a portion of their anti-malarial medications abroad (as the drugs are often much cheaper) I have recommended against this over fear of the quality of the medications they would purchase. Although my practice is consistent with guidance provided by the CDC, we don't know the true scope or nature of this problem.

Here is a link to a nice New York Times article discussing the issue of fake and substandard drugs. This article links to a detailed analysis of this subject by Attaran and colleagues that appeared in this month's BMJ (the full text of this paper is available here).

It is clear that many of the drugs available to consumers (especially in developing countries) are either fake or substandard. The true scope of this problem is unknown, but it has been estimated that half of some drugs for life-threatening diseases may be fake. The article by Attaran and colleagues cites the following real-world examples: > 120 people dying in Pakistan after receiving tainted medication for heart disease, an anti-cancer drug being distributed throughout the world that had no active ingredient and the distribution of substandard HIV drugs in Kenya.

Although this problem is widespread in developing nations, it is a problem for first-world countries, as well. An example of this is the aforementioned issue with the anti-cancer drug bevacizumab, wherein a fake version of the drug (that contained no active drug) was distributed in the United States.

Attaran and colleagues call for a comprehensive international strategy that universally defines what substandard and fake medications are, and that creates legal consequences for trafficking these products. We also need better information about the true scope of this problem.