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Epidemic of counterfeit drugs

By Khalilur Rahman
An epidemic of counterfeit medicines, now sweeping the country, has exposed hundreds of thousands of users to serious health hazards. Tons of fake pharmaceuticals have flooded drug markets across the country and the innocent buyers are taking those home quite unaware of the danger involved tn it
Citing an example of drug-related fatality a famous physician of the counUy told The Daily Star that 109 children, belonging to age groups from six months to six years, died of kidney failure in Nigeria in September last year after they were administered paracetamol in two hospitals. This most common drug, similar to aspirin was spurious containing industrial solvent. The tragic death of the Nigerian children drew attention of the medical profession throughout the world. But it was too late.
The physician said the effect of fake drugs is hardly known as most cases go unrecorded. In Bangladesh no monitoring on the ill effects of medicines is carried out systematically by any competent authorities, he added. He. however, said even In the most advanced countries of the world ultimate result of using a fake medicine is not always fully known to the medical profession.
A Health Ministry source pointed out that fake drugs were previously confined to the rural areas and these were available mostly in over one lakh drug shops spread over the rural areas of the country. But for the last one year, a substantial quantity of counterfeit drugs has found its way into the capital and In other big towns outside Dhaka. The fake drugs bearing labels of big pharmaceutical firms enter Bangladesh from across the border (India), the source said. In some cases the members of the law enforcing agencies have found out small factories producing the fake drugs within the country. But their number is too small, the source added.
The counterfeit medicines include many life-saving recipes, eye drops and tonics. It is interesting that many drugs which were banned by the government of deposed President HM Ershad seven years ago now enter Bangladesh from India and those have high demand.
Narrating his experience, a pharmacist told me that the cough syrups produced previously by the multinational
firms in Bangladesh were banned tn 1984. The cough syrups produced locally were used largely throughout the country. The price of a particular brand of cough syrup, manufactured by a multi-national company, was only Taka 8 per phial. The same product but much inferior in quality coming from across the border now sells at Taka 70 each. In many places people buy several bottles and take at a time to get the intoxicating effect that the cough syrup provides. One of the main ingredients of this syrup is opium, a pharmacist said.
Faking of drugs Is carried out so perfectly that even in expert eyes these can hardly be detected, one drug shop owner in the city said. Hand machines at a comparatively cheap rate are largely available along the border zones for producing tablets, sealing bottled medicines and making strips.
Normally. names of big firms are used In counterfeiting the drugs, he added. The firms are very much reluctant to put up strong resistance against faking for the fear of publicity. These firms appear to be afraid of linking their names with the spurious drugs, a health official said. Their silence has largely encouraged the counterfeiters, he viewed.
The health official opined that banning of most popular drugs was also responsible for large scale production and sale of fake medicines in the country. A physician told me that the identification of a spurious and sub-standard medicine becomes possible. at times, when a patient complain about no visible cure even after taking much of the prescribed drugs. The doctor then changes the brand and asked the patient to buy the same from a most reliable pharmacy, the physician added.
But to chose a right type of pharmacy is again a difficult task. The number of licensed drug shops in the country is 20,000 including 7.000 in the metropolis. But the number of shops may be one and a half lakh to two lakhs, the rest obviously is run without licence, a health official said. The Drugs Administration under the Ministry of Health is assigned to Inspect the pharmacies and pharmaceutical plants in the country to ensure qualify control and sale of standard drugs. But the department is hard put to do Its Job properly in the
absence of required number of staff and other facilities. It is alleged.
Another health official said tn some cases a section of unscrupulous traders collect empty bottles and phials from hospitals and different other sources and fill those with spurious medicines and sell in the market. Health staff collect samples of 'doubtful' drugs and send those to the government testing laboratory at Mahakhali for chemical analysis. It takes a long time to get the results of a test as the laboratory is heavily under staffed and runs short of chemicals, the health official state. In the absence of laboratory test results action cannot be taken against an offender. he added.
The sub-standard drugs which are also available in abundance invariably lack the most essential but costly ingredient and as such Instead of acting as healer the drug causes adverse effect on the users, the health official pointed out.
Narrating his experience with a sub-standard drug a patient told me that an anti-al-lerglc tablet slipped from his hand and fell into a glass full of water. The tablet did not dissolve except its thin coating which was eroded. The patient. who himself is a chemist kept the tablet produced under the name of a multi-national firm In the water of the glass for the whole day. The tablet was like a solid piece of rock and showed no sign of melting. The chemist tried to dissolve it by pouring spirit but to no effect. He concluded that gum acacia was used in massive dose to bind inferior imported pharmaceutical raw materials used to produce the tablet In the name of a world reputed company.
Import of low-grade raw materials for producing drugs Is another problem now facing us. the chemist regretted. Fixing of price limit of all types of imported pharmaceuticals by the government is one of the most Important reasons for bringing low grade materials by Importers in the country, one company manager stated.
The situation arising out of the use of fake and substandard drugs is simply alarming. This calls for effective measures including constant vigilance by the health squads in adequate number in the drag shops and factories. This view was expressed by an executive of a big pharmaceutical firm. .