Before the current health crisis, experts and organizations worldwide were ringing the alarm of a different pandemic, driven by criminal minds: the counterfeit or fake medicine industry that affects people in the entire world, including Sierra Leone.
The Pharmacy Board of Sierra Leone is responsible to detect, confiscate and destroy fake medication in the country, but they lack the support of other institutions to help put drug peddlers behind bars.
In 2020 alone, the Pharmacy Board seized illegal imported and suspected counterfeit medicine estimated to cost Le 227,121,000.
Border areas are targeted by drug peddlers
Mr Tamba Buffa, Regulatory Officer with the Pharmacy Board of Sierra Leone (PBSL), said that counterfeiters skillfully reproduce the packaging of the fake medicine to look like the real ones, but the actual medication is made of inadequate materials.
If a medicine is bough from a drug peddler, Buffa said, expect it to be fake.
“If the smuggling of counterfeit medicine does not cease, there would be serious health consequences in the country. The population would lose confidence in the health system. For example, if a doctor prescribes an antimalarial medicine for a patient, and the patient ends up buying counterfeited medicine, that medicine will automatically not work, because it is fake. Then, that patient questions the professionalism of the doctor, and lose confidence and probably abandoning the health facility,” Buffa explained.
Other negative impacts of buying medicine from the streets are increased cost of healthcare to patients who become more ill from counterfeit medication, prolonged illness, suffering, and ultimately increased morbidity.
“Do not buy medicine from peddlers. They do not sell genuine products. Even if their products may be genuine, they are selling it under the sun as those medicines would lose it efficacy and potency because of the high temperatures,” Buffa warned.
To trick the people, peddlers also sell medicine at a very low price.
“The cheapest antimalarial in the pharmacies costs Le 12,000 for children, and for adults it costs Le 15,000 to Le 25,000. If you see drug peddlers selling for less than the prices, the person should be reasonable to realize that the product is counterfeit or fake.”
The Pharmacy Board conducts joint raids with the Transnational Organized Crime Unit (TOCU) four times a year.
No cooperation from the Judiciary
But when drug peddlers are arrested during raids, they always get away with a small fine.
The Board and TOCU arrested and prosecuted 188 drug peddlers in the past three years. Not one got convicted, and in the worst cases they got away with a fine between Le 250,000 and Le 1,000,000 and went back to drug peddling.
“The Judiciary should view drug peddling as serious criminal offences and should take drastic steps to support the Pharmacy Board to address the cases. In such situation, Pharmacy Board would like the Judiciary to be convicting persons involved in the sales of counterfeit drugs and where fines apply, it should be heavy,” Pharmacy Board stated. It added that the Sierra Leone Police should also be strengthened in fighting counterfeiters, and the SLP should see illegal sales of drugs as criminal offences.
Counterfeit medicines are products that are purposefully and illegally manufactured to be mistaken for legitimate drugs. They are widespread, dangerous, and sometimes deadly.
Fake antimalarials and antibiotics
Antimalarial medications are the most trafficked in Sierra Leone.
“Because of the prevalence of Malaria in the country, the demand for antimalarial medicines is high, and counterfeiters tend to progressively, and grossly, engage in the manufacturing and smuggling of these fake antimalarial drugs,” Buffa said.
Executive Director for Health Alert Sierra Leone, Victor Lansana Koroma, warned that people who use fake antimalarials have a high risk of liver damage and could make their medical condition worse.
“The liver would be damaged because it is the first organ of contact in the body where the drugs would regulate its potency and usefulness. Fake antimalarials and narcotics could lead to death and brain damage. These drugs would accumulate into the immune systems and could be attributed to the increase in Hepatitis B in the country,” Mr Koroma said.
He asks Sierra Leoneans to always contact a doctor for check-up and medication when they feel unwell, and to not buy from street peddlers.
“Squarely I would blame the Pharmacy Board for the influx of counterfeit drugs in the markets. The Board is not stepping up to their task. The job and role of the Pharmacy Board is not only to monitor drug importations, but they must ensure that they sensitize the public through outdoor education,” Koroma added.
But Mr Buffa countered that in 2020 the Pharmacy Board carried out extensive sensitization on the dangers of counterfeit drugs, engaging with 13 radio stations across the country.
“We also developed jingles on fake or counterfeit drugs in four different [local] languages, which were aired in 21 radio stations for a period of one month,” Buffa detailed.
The Pharmacy Board of Sierra Leone was established through an Act of Parliament to regulate Pharmaceutical Products and other related substances.
Fake medicine take over the markets
The World Health Organization (WHO) warned that an estimated 1 in 10 medical products in low and middle income countries is substandard or falsified. In some countries, fake medicine account for 70% of all drugs, according to the US National Crime Prevention Council.
Nearly half of the WHO reports on falsified medical products (42%) originate from the African region, and many are linked with antimalarial drugs. In sub-Saharan Africa, substandard and falsified antimalarials are estimated to cost US$38.5 million and 116,000 additional deaths.
Narcotics
Victor Lansana Koroma of the Health Alert said that narcotics are dangerous to human beings and should only be sold with a doctor’s prescription. However, in Sierra Leone, he said, narcotics are freely sold in pharmacies and by peddlers in street markets with no legal control.
“The current trend poses serious national health risk to the country’s entire population,” Mr Koroma concluded.
Health Alert is a civil society advocacy platform that monitors and advocates for affordable, quality healthcare services in Sierra Leone.
“If those drugs do not go through quality control checks in order to certify their potency, efficacy, and usefulness, it would be dangerous to [the] health and life of Sierra Leoneans. Medicines like Paracetamol, of which most are chalk, are a living testimony of counterfeit medicine,” Mr Koroma said.
Tramadol
According to the United Nations, trafficking of pharmaceutical opioids and their non-medical use has reached an alarming level in West Africa.
Tramadol is a synthetic opioid used to treat moderate to moderately severe pain. It is cheap and widely available both in pharmacies and on the peddler/illegal market.
Government Psychiatrist Consultant, Dr. Edward Nahim, said that when taken for a long period of time Tramadol can cause brain and liver damage, destroy the nervous system, create body weakness, and could even lead to paralysis.
Tramadol is officially a prescription-only drug, meaning that pharmacies should sell it only when the buyer presents a valid prescription signed by a medical doctor.
Dr Nahim warned pharmacists to not sell Tramadol to people who fail to present an authorized prescription. If people need to treat minor aches and pains, Dr Nahim says that “Panadol” is a safer alternative, when bought from authorized and licensed pharmacies.
Huge risk of buying street medicine
The Chief Pharmacist of Connaught hospital, Junior Lamin Kamara said that risk is huge when buying medicine on the street.
“A publisher [Melvin H. Kirschner] once said that all medicines are poison, and that the difference between a poison and medication is the right dose. This indicates that there is no medicine that is safe for human consumption, not even paracetamol,” Kamara said.
Buying medicine from drugs peddlers is the same as committing suicide, Kamara said, adding that the act in itself is an economic burden because it negates the government’s effort to eliminate drugs peddling.
When asked, people find it difficult to admit that they took antimalarials bought from drug peddlers, even though Malaria treatment is free in all government hospitals.
How to identify a substandard or falsified medical product:
Here are some steps recommended by the WHO and the Pharmacy Board to help you avoid buying fake medicine:
- Look at the package to be in good condition, and look spelling mistakes, sentence structure and other grammatical errors.
- Check the manufacturer details, including their name and location; ensure that any details on the outside package match the ones on the inner packaging. Look for the expiration date, which should be the same on the outside as well as inside packaging.
- Ensure the medicine looks correct, that it is not broken, discolored, degraded, or has an unusual smell or color.
- discuss with a healthcare professional as soon as possible if you suspect the product is not working properly or you suffered an adverse reaction.
- Report suspicious medical products to the authorities, such as the Pharmacy Board of Sierra Leone.
By George M.O. Williams
19/02/2021. ISSUE NO: 8005