POPPING (THE WRONG) PILLS – THE EFFECT OF SUBSTANDARD AND FALSIFIED DRUGS WORLDWIDE

BY EMMA ELLIS – Victoria Amponsah arrived at the hospital with a slew of symptoms. According to USP, it was there that she learned of the child nestled in her stomach, soon to become the center of her world. It was also there that she discovered that she was one of the 3.5 million Ghanaians who had contracted malaria that year. A trip to the local pharmacist should have prepared her body for both, yet, hours later, she once again stood in her hospital gown, now with an empty jar of counterfeit medication in her purse. A mere seven months later, Victoria again became devastatingly ill, as she began to uncontrollably shake, vomit, and bleed after taking what she thought to be a basic painkiller. Victoria once again found herself the victim of the worldwide falsified and substandard drug epidemic, this time nearly losing her daughter’s life as well as her own.

The World Health Organization quantifies the frequency of cases like Victoria’s, stating that around 10% of all medical products in low and middle income countries are either substandard or falsified. Substandard medications refer to drugs that are in inadequate condition when consumed by a patient, even though they were approved by the country in which they were produced. These drugs may be past expiration, damaged during transport, or simply lacking the appropriate amount of active ingredient. Falsified drugs, on the other hand, are the product of purposeful deception, created as a part of a $30 million fake drug business.

The effects of both types of drugs can be devastating. Approximately 72,000 children die of pneumonia from fake or substandard drugs, as well as 69,000 individuals from malaria, according to recent data from the World Health Organization. Beyond death, falsified drugs have also fed the opioid crisis, with individuals unknowingly consuming, and then becoming addicted to, opiods hidden within basic medications like cough syrup. Drug shortages exacerbate the issue, as pharmacies and individual shoppers become more desperate to stock their shelves. Vulnerable populations, in particular, gravitate towards falsified or substandard drugs because of their discounted prices. Drugs are additionally more likely to be falsified when there is a stigma attached to purchasing the medication, forcing individuals to obtain the drug from someone other than their doctor. Viagra and birth control, for example, are often counterfeited.

Substandard drugs are especially problematic, as they help perpetuate bacterial resistance. When bacteria is treated with a drug that lacks enough active ingredient, the bacteria will be exposed to the antibiotic but not actually killed. When this occurs, all other patients receiving treatment in the same hospital are put at greater risk of contracting the disease. The contagious nature of these illnesses makes each country’s use of substandard drugs the business of another’s, as antibiotic resistance is not able to be contained within the borders of a nation. Thus, members of the countries who supervise the spread of substandard medication will feel the same ramifications as those who do not, making the call to better regulate the drug market a global challenge.

Looking to the future, an international consensus is needed regarding the best possible way to detect falsified medications at the lowest cost to all parties involved. Joel Breman of the National Institutes of Health argues that the success of the United States’ Food and Drug Administration (FDA) in decreasing counterfeit drugs suggests that forming a similar worldwide organization is necessary in creating and enforcing international regulations. Smaller solutions, such as improving methods of trash disposal to avoid the reuse of pill vials, are equally needed, as well as inexpensive devices that can judge the legitimacy of pills in the field. Individuals like Victoria Amponsah, who should not even be contracting malaria in light of today’s medical advancements, need the certainty that the medicine they recieve will improve their condition.