Counterfeit drugs, medicine & pharmaceuticals are very common around the world

West Africa was my training ground to spot fake medicines. So fake are many of the pharmaceutical drugs over there that it’s become normal to take counterfeit medicine. Why? Well, the blunt reality is: it’s cheaper. And maybe, just maybe, might work.

Think of it this way, when you earn very little, or live off the land and you are sick. And, you can’t afford a doctor, let alone “real” medicine; you go with what ever you can find.

You then pray, and hope the bandits that made the medicine left some trace of the original chemical composition behind that might help you.

Counterfeit or real drugs, pharmaceuticals, & medicine in developing countries

I had originally assumed that counterfeit medicine was actually quite useless. A placebo of chalk and maybe a dash of food coloring. And, in some cases it’s just that. However in many developing countries fake medicine can mean something else.

It can be a drug that is nationally produced and not made by one of the big multinational companies.

It can be a medicine that says it does something and maybe it does but no one knows for sure.

It can be a watered down version of another drug. For example instead of containing 500mg of a drug, it actually contains 250mg. Yet, the label will say 500mg.

Typhoid keeps coming back despite the drugs

A Nigerian former work colleague of mine constantly had typhoid. At least once every 3 months either he, or a member of his family would get it, and then go missing for a week with fevers etc.

I remember going through with him about all the preventative measures needed to avoid typhoid, mainly surrounding his water supply. Everything checked out. Though in this village Typhoid was rampant, and not easily avoided.

The problem was why his family were constantly sick. One day after two months of delayed pay, a common occurrence, his son was so sick he ended up having to take a loan from his church for some medicine.

I went with him to buy the medicine. He bought 3 days worth of drugs for his son and 3 for himself.

There was a 300% difference in the price between the two.

His son’s was a branded name so he could only afford 3 days worth. His own was a generic counterfeit brand, again well short of the recommended course duration.

Outcome of fake Typhoid treatment vs real drugs

One week later my colleague was back at work. He still had a fever and was off again a month later. His son had recovered but to look at him you could tell the boy was not 100%.

And so, the cycle of illness will and did continue.

During my time in West Africa I too contracted Typhoid on many an occasion. During a security outbreak restricting access to a main city I had to take the “fake” drugs too.

It’s a strange thing to wonder if a medicine is real or not as you sit with a fever and no other option.

Worse yet is counterfeit Malaria medicine which really did knock me down. While Typhoid to a strong person will not be pleasant, it’s not a killer. Malaria on the other hand is a killer.

Mix in bad diagnosis, counterfeit medicine, and belive me you will not be in a good place physically.

Now imagine you are not eating a great diet, living below the poverty line and you can see why Typhoid becomes a killer to many people.

Something which can easily be treated with “real” medicine … If only it was available, regulated, and affordable.

Countries I’ve come across known to sell counterfeit medicine, pharmaceuticals and drugs

Turkey: It’s not so wide-spread. But, I did see the tell-tale signs of imported medicines sold for a lot less than original brand names.

Iran: I’ll go out on a limb here and wonder aloud if trade embargoes have affected this well-educated society with fake medicines. I would be wary of buying medicine from some places here. Though, most did seem to be legitimate.

Pakistan: Rampant fake medicine fills the streets. In Peshawar finding simple Giardias treatment was a problem. My friends there spent a day going from one pharmacist to another to find “real” giardias treatment. Sitting with a pharmacist, he even called a few colleagues to be sure if this “branded” box of pills worked, or not.

India: One of the better known countries for counterfeit medicine. There are huge factories here pumping out many watered down drugs. counterfeit antibiotics and daily over-the-counter medicines. The problem in India is that there are also some generic and Indian based pharmaceutical companies producing genuine medicines at a fraction of the cost for people that need them.

Nepal: Nepal is rife with counterfeit pharmaceuticals, many coming from Bangladesh / India, and China. There are also many real drugs on sale here too. The main problem is deciphering real, from counterfeit.

China: The land of cheap copies of everything and no restrictions is said to be a huge counterfeit drug producer. I was very wary of medicine here. However, many locals seemed to know the good from the bad quite easily, unlike in other countries.

The Philippines: Medicine in The Philippines is expensive compared to many other countries in its economic class. There is little talk of fake medicine, but lots of talk about generic, and branded. Many people again will try to opt for branded medicine as “it works better” than generic. I’ve seen plenty of chalky big pills here crumbling away in blister packs.

The Philippines also has a “candy sweet” like attitude towards medicine with many giant pharmaceutical companies handing sample blister packs out on the streets. Be very, wary.

Malaysia: I saw a lot of generic medicine here again. It looks better than in many places, but looks can be deceiving.

West Africa: The whole region is fraught with counterfeit drugs. While there are agencies distributing real drug. On the ground realities tell tales of corruption at the highest level. Real drugs are worth a lot of money in terms of aid and in black market sales.

How to spot fake or counterfeit drugs?

• Ask to inspect the medicine packaging

• All branded pharmaceutical products should have high quality printed boxes or packaging

• Make sure the print is strong, and the colors strong on all packages

• Make sure the writing on packaging is spelled correctly

• Most genuine pharmaceuticals in boxes come with a piece of instructional paper inside. The paper is high quality and slightly crisp. Many will be written in several languages

  

• Look on the packaging for indented expiry dates. Good quality high-grade pharmaceuticals will have indented expiry and batch dates /numbers on them. Run your finger over the box to feel

• Don’t buy medicine that comes out of huge bottles and then sold individually

• Inspect blister packs for bad foil printing. Faded, misspelled, and very cheap looking foil backs are bad signs

• Inspect the tablets inside the blister packs. If they look misshapen, or swollen and cracked, there’s a high chance they are either not genuine, or there are issues with their packaging quality

• Many high-grade pharmaceuticals will have logos or names indented onto the tablet or pill. Lower grade will not have these, unless seriously well produced

• Ask the pharmacist to show you all the brands of the particular drug you are looking for. Inspect each packet

• Ask the pharmacist which particular drug is “better”. If they struggle with an answer. Mention “fake” and “not fake”. Sometimes it’s due to linguistic problems, sometimes its pride, legal or financial reasons that they will struggle with. Generally I find this has not been an issue

• Ask a hotel worker, or local person you can trust to help you find legitimate medicine from a legitimate pharmacy

• Lastly, always seek the help and advice of a medical practitioner when you are ill, and before you travel. Many will prescribe you with medicine from back home that you can trust should you need it when traveling

Beware the local doctor too …

Last week I went into the jungle for a few days. Coming back I was pretty exhausted from the extreme heat, humidity no running water or fresh food. I had a mild sore throat, aches and pains and thought nothing of it.

A couple of days ago I woke up and my hands were tingling and my legs felt as if they were very old. I went to reception as there’d been no electricity for 12 hours. The girl stared at me and then ignored most of what I was saying.

Back in my bathroom I saw why. My face was covered with a red rash. As was my whole upper body. So if was off to  a local doctor. I would have been better off with my Lonely Planet Asia health book.

“Are your joint’s hurting?”  They said peering into by swollen throat.

I nodded.

“And you are being hot?”

I sincerely hoped I was not paying for this. Again, I nodded.

“Measles.”

I shook my head, “Already had it.” 

The doctor looked to the people around me. I knew what was coming next. Saving face. So I saved face for them.

“It’s Dengue.” 

“Indeed,” they confirmed. “Very similar.”

There was a chorus of ohh’s and ahh’s.

I cringed. Then silence. For this great revelation from a local doctor I would indeed have to pay.

Yes, when traveling in remote areas anywhere in the world let alone Nepal you will also have to contend with doctors who might not be so up to date as you would wish. To put it mildly. The saving face here is that they are not used to treating a “foreigner”.

Likewise beware of non-qualified locals who “think” they know what the problem is.

Thankfully I carry a stockpile of medicine with me so I didn’t need their mass of additional multicolored medicines. I am choosing to stick with my own painkillers. I’m doing better than I expected. I learned well from the extremes of West Africa.

Feeling like my bones are breaking is one thing, not being able to swallow is another but looking like a 70-year-old man covered in a diaper rash is rather difficult.

Then again I am writing all this with a fever so who knows!

Health vs Budget when traveling

My painkillers and a host of antibiotics for other things are real. They cost more than generic medication. I know the 500mg is what it say it is.  The local crumbling indigo pills in the drug store that seconds as a hardware store and cafeteria I have serious doubt over.

While skimping on accommodation, 1st class vs 2nd class train tickets, and eating locally are all good for reducing your costs.

I really can’t emphasize enough that your should never, ever, skimp on looking after your health when traveling.

Forget your budget restrictions when it comes to buying quality medicine overseas or at home. Get qualified advice from a genuine well-traveled doctor. Make sure you have travel insurance that covers you medically. Buy the best medicine, make sure it’s genuine and don’t take chances with your health.

This is an additional editorial featuring how to avoid buying counterfeit medicine or drugs when you travel