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Counterfeit drugs are pervasive health threats to the global population.

Counterfeit drugs adversely affect health in multiple ways. These drugs are ineffective due to insufficient or no active ingredients, and they are often seriously toxic due to overdose or contamination with toxic products. Their use causes death and treatment failures and increases the risks of complications and other morbidities. Their ineffectiveness leads to erosion in public trust in the use of drugs and vaccines.  Extensive use of counterfeit antimicrobial and antimalarial drugs is considered a major attributable factor for increasing drug resistance to malaria, TB, and infectious diseases in LMICs. Concurrently, counterfeit drugs impart huge economic burdens to patients and health systems for undertaking ineffective treatments and management of prolonged illness.

In China, it was reported that almost 192,000 people died as a result of counterfeit medications. It was estimated that 122,350 children under 5 years of age die each year from poor-quality antimalarial drugs, of which 74,188 deaths per year were in Nigeria alone.  Hundreds of children died from taking cough and paracetamol syrups in Nigeria, India, Gambia, Haiti, Argentina, containing diethylene glycol instead of glycerine.  In 2017, several middle-school children died in Canada after ingesting counterfeit Percocet, a pain reliever, which contained a lethal dose of fentanyl. Non-prescribed benzodiazepine use is increasing in North America, especially among youth. Owing to increasing demand, counterfeit benzodiazepine tablets with fentanyl are in mass production. In 49 states of the USA, the presence of fentanyl was found in confiscated pills with deaths attributed to use in 38 states. Xanax tablets produced by Pfizer obtained from the unregulated drug market were found to be mostly counterfeit and did not contain alprazolam but contained fentanyl. A number of deaths were attributed to counterfeit Norvasc, a Pfizer drug for treating hypertension and angina, in Canada. The pills contained only talcum powder. Counterfeit phosphodiesterase type-5 inhibitors, (PDE5i, e.g., Viagra by Pfizer) one of the most common counterfeit drugs available on online Internet resources, poses immense direct and indirect health and economic risks to the users.  The lack of awareness of the potential health risks of counterfeit PDE5i/Viagra is considered a key reason for purchasing the drug online.

Pfizer’s analysis of suspected counterfeit viagra samples seized by drug regulatory authorities worldwide found that only 14% of samples were authentic. Of the UK samples, 51% of them were ordered via the Internet and 83% of these samples were counterfeit.More than 18 million atorvastatin tablets sold in the United Kingdom were recalled after the detection of a smuggling operation of counterfeit Pfizer’s Lipitor.

Life-saving drugs like vaccines are not even spared from counterfeiting.  The deaths of 2500 people in Niger after receiving the meningitis vaccines that were donated by Nigeria were attributed to the use of vaccines that had no active ingredient. Counterfeit Covid vaccine, Covishield, was detected in India. Counterfeit Covid vaccines were also found in South Africa, Mexico, and Poland.

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