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Persson A, Troein M, Lundin S, Midlöv P, Lenander C. Swedish community pharmacy employees' knowledge and experience of substandard and falsified medical products: a cross-sectional descriptive survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:414-419. [PMID: 35849136 DOI: 10.1093/ijpp/riac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/28/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Substandard and falsified medical products are, according to the World Health Organization, a global threat to public health. To evaluate if community pharmacy employees can guide the public to safer medication purchases, their knowledge and experience about SF medical products was examined. METHODS A digital questionnaire was distributed to the five dominating pharmacy companies in Sweden, representing 97% of the community pharmacies (1391/1433), giving the theoretical possibility of reaching 6200 employees. Three companies published a link to the questionnaire on their intranets, one distributed the link via e-mail to the responsible pharmacist for quality and knowledge, respectively. The fifth company did not pass on, due to technical problems. Employees aged 18 years or older with customer contact were invited to participate. KEY FINDINGS The questionnaire was available for 74% of all community pharmacies (1067/1433), having approximately 4900 employees with customer contact. The response rate was 5% (228/4900). Of the respondents, 89% were pharmacists (203/228), 84% were women (191/228) and 43% were 35-49 years (98/228). The respondents worked in pharmacies of different size, located both in rural and urban areas. The definition of substandard and falsified medical products was known by 182 of the 228 respondents (80%) and the main source of knowledge was media (61%, 111/228). The common European logo for authorized online pharmacies was not recognized by 74% (169/228). CONCLUSIONS For pharmacy employees to guide the public to safer medication purchases, knowledge about substandard and falsified medical products needs to be enhanced specially about legal international e-commerce.
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Affiliation(s)
- A Persson
- Department of Clinical Sciences Malmö, Lund University, Center for Primary Health Care Research, Malmö, Sweden
| | - M Troein
- Department of Clinical Sciences Malmö, Lund University, Center for Primary Health Care Research, Malmö, Sweden
| | - S Lundin
- Department of Arts and Cultural Sciences, Lund University, LUX, Lund, Sweden.,Stellenbosch Institute of Advanced Study (STIAS), Wallenberg, Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - P Midlöv
- Department of Clinical Sciences Malmö, Lund University, Center for Primary Health Care Research, Malmö, Sweden
| | - C Lenander
- Department of Clinical Sciences Malmö, Lund University, Center for Primary Health Care Research, Malmö, Sweden
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Ozawa S, Chen HH, Lee YF(A, Higgins CR, Yemeke TT. Characterizing Medicine Quality by Active Pharmaceutical Ingredient Levels: A Systematic Review and Meta-Analysis across Low- and Middle-Income Countries. Am J Trop Med Hyg 2022; 106:1778-1790. [PMID: 35895431 PMCID: PMC9209904 DOI: 10.4269/ajtmh.21-1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/03/2022] [Indexed: 11/07/2022] Open
Abstract
Substandard and falsified medicines are often reported jointly, making it difficult to recognize variations in medicine quality. This study characterized medicine quality based on active pharmaceutical ingredient (API) amounts reported among substandard and falsified essential medicines in low- and middle-income countries (LMICs). A systematic review and meta-analysis was conducted using PubMed, supplemented by results from a previous systematic review, and the Medicine Quality Scientific Literature Surveyor. Study quality was assessed using the Medicine Quality Assessment Reporting Guidelines (MEDQUARG). Random-effects models were used to estimate the prevalence of medicines with < 50% API. Among 95,520 medicine samples from 130 studies, 12.4% (95% confidence interval [CI]: 10.2-14.6%) of essential medicines tested in LMICs were considered substandard or falsified, having failed at least one type of quality analysis. We identified 99 studies that reported API content, where 1.8% (95% CI: 0.8-2.8%) of samples reported containing < 50% of stated API. Among all failed samples (N = 9,724), 25.9% (95% CI: 19.3-32.6%) reported having < 80% API. Nearly one in seven (13.8%, 95% CI: 9.0-18.6%) failed samples were likely to be falsified based on reported API amounts of < 50%, whereas the remaining six of seven samples were likely to be substandard. Furthermore, 12.5% (95% CI: 7.7-17.3%) of failed samples reported finding 0% API. Many studies did not present a breakdown of actual API amount of each tested sample. We offer suggested improved guidelines for reporting poor-quality medicines. Consistent data on substandard and falsified medicines and medicine-specific tailored interventions are needed to ensure medicine quality throughout the supply chain.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Yi-Fang (Ashley) Lee
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Colleen R. Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Tatenda T. Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
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Ming Kenneth Ho H, Xiong Z, Ying Wong H, Buanz A. The Era of Fake Medicines: Investigating counterfeit medicinal products for erectile dysfunction disguised asherbal supplements. Int J Pharm 2022; 617:121592. [PMID: 35182703 DOI: 10.1016/j.ijpharm.2022.121592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
Sales of substandard and falsified medical products (SF) are rising rapidly everywhere around the globe. The wide and easy access to these products is an alarming issue to the global health systems and undermined the health of patients, especially with the thrive of online commerce. To tackle this threat to public health, new ways to access these products should be identified and detection technologies should be strengthened. The overarching aim of this study was to investigate if herbal supplements sold online claiming to be natural alternatives to Viagra® were amongst these SF medical products and how effective different analytical techniques are in providing information about these products. 3 products which claimed to be herbal supplements for men sexual performance were purchased from an e-commerce platform. Two products were received as unregistered generic sildenafil citrate tablets manufactured in India (and thus different to the products information on the website) while one product was received in the same packaging as shown on the website, claiming to be an herbal product. Nevertheless, all products were proven to contain sildenafil citrate, the active pharmaceutical ingredients in Viagra® after the comprehensive analytical tests. The results elucidated that the quality standards for the unregistered generic sildenafil citrate tablets were fulfilled according to the British Pharmacopeia, but the falsified product failed the quality tests and contained approximately 200 mg sildenafil citrate, which is equivalent to 2-fold of the daily maximum dose. Furthermore, physical characterisations, including powder x-ray diffraction and thermal analysis were performed and revealed that the polymorphic forms of sildenafil citrate were different, demonstrating the importance of employing thermal analysis in addition to the conventional analysis techniques for the substandard and falsified medical products. These techniques provided valuable insights into the physical form of the active ingredient in these products. What is more, the ease with which these SF products were obtained and confirmed to be misleading consumers emphasises the need for tighter regulation for e-commerce websites in line with those enforced on online pharmacies.
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Affiliation(s)
- Hei Ming Kenneth Ho
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Zhaoan Xiong
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Hui Ying Wong
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Asma Buanz
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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Ahmed J, Modica de Mohac L, Mackey TK, Raimi-Abraham BT. A critical review on the availability of substandard and falsified medicines online: Incidence, challenges and perspectives. THE JOURNAL OF MEDICINE ACCESS 2022; 6:23992026221074548. [PMID: 36204527 PMCID: PMC9413502 DOI: 10.1177/23992026221074548] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Simultaneous expansion of the Internet and increased globalisation of the
pharmaceutical industry have meant medication can be accessed transnationally
from both legal and illicit sources. This has coincided with the rise of
substandard and falsified medicines (SFMs) online. These products fail to meet
regulatory or quality standards and/or are constituted with substandard
ingredients, causing undesired pharmacological effects, including possible
injury and death. This review aimed to identify original research studies that
examined characteristics of SFM online sales, attitudes towards purchasing
medicines online and strategies to address this drug safety challenge. Keywords
of ‘Substandard’ and ‘Falsified’/‘Counterfeit’ and ‘Medicines’/‘Drugs’ and
‘Online’/‘Internet’ were searched using Web of Knowledge and PubMed databases.
Resulting literature, which satisfied the study’s inclusion criteria, was
included in the review, and the findings from each paper were assessed. From an
initial 185 literature articles, 7 were eligible according to the inclusion
criteria to be reviewed. These articles identified studies testing SFMs
purchased online, surveys of attitudes and knowledge about SFMs online, and
website content analysis to detect illegal online sales. Challenges identified
were lack of knowledge and awareness among consumers and physicians, in addition
to the use of direct-to-consumer-advertising, via Internet platforms and social
media, providing easy access to SFMs. Despite this, medicine authentication
technology, website verification approaches and new detection methods were
identified as potential solutions specific to online SFM sales. To address
online sales of SFMs, more robust research, greater awareness/educational
programmes, analytical detection methods and more stringent online global
governance are required.
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Affiliation(s)
- Jamee Ahmed
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Laura Modica de Mohac
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Science, King’s College London, London, UK
| | - Tim K Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
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Al-Jumaili AA, Younus MM, Saleh MZ. The Epidemic of Substandard and Falsified Medications in Iraq: Evaluating the Effectiveness of National Pharmacovigilance Alerts to Community Pharmacies. Pharmaceut Med 2021; 35:169-186. [PMID: 33864206 PMCID: PMC8051281 DOI: 10.1007/s40290-021-00386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Abstract
Background Assessing Iraqi experience with the impact of substandard and falsified (S/F) medicines can help other countries deal comprehensively with the underlying causes of this multifactorial problem. The tools used in this study to assess strategies to prevent the use of S/F medications can be used in other developing countries. This study investigated the problem of S/F medications at three levels: the Ministry of Health (MOH), pharmaceutical company representatives, and community pharmacists. Objectives Study objectives were to evaluate the effectiveness of alerts about S/F medications issued by the national Iraqi Pharmacovigilance Center (IqPhvc) to community pharmacies and to explore the reasons and potential solutions for this problem from the perspective of both pharmaceutical companies and pharmacists. Methods This was an exploratory mixed-method study. The qualitative phase comprised seven 1-h semi-structured interviews and one focus group conducted via Zoom. Thematic analysis was used to analyse the qualitative data. The findings of the qualitative phase were then used to develop the survey items. The quantitative phase included an electronic survey distributed among pharmacists via two professional Facebook groups between 23 April and 19 May 2020. The Kruskal–Wallis test was used to measure differences in pharmacists’ knowledge of and ability to detect S/F medications according to their years of experience in the private sector. Results Over the last 5 years (2016–2020), the IqPhvc received 183 reports about S/F medications from representatives of 25 international companies. Only 29 (15.8%) of the reports were about falsified medications; the majority were about substandard (parallel) medicines. We interviewed 12 pharmacists (11 male, 1 female) representing ten large international pharmaceutical companies. We also received surveys from 590 pharmacists, of whom 475 (80.9%) were women. Although 72% of the participants had not received any training in the identification of S/F medications, 59.4% of them easily identified S/F medications. Likewise, approximately three-quarters of the participating pharmacists recognized genuine registered medications through three means: medication price sticker, cost, and packaging features. Although 61% of the pharmacists followed-up alerts about S/F medications, only 25.6% were willing to report S/F medications. Conclusions Most reports to the IqPhvc were about substandard medications. Participants of the two study phases agreed on several reasons for the problem of S/F medications, including their low prices, the unavailability of registered medications, the lengthy medicine registration process, and inadequate awareness of S/F medications among healthcare providers and the public. They also agreed that national alerts and price stickers are helpful in the identification of S/F medications. Community pharmacists can increase their efforts to report S/F medicines, but they need training, awareness, and tools. The study highlighted the need for a track-and-trace system to detect S/F medicines in the supply chain. In brief, the problem of S/F medication is multifaceted. Reducing it will require effective collaboration among different entities, including health officials, border agencies, healthcare providers, and registered pharmaceutical companies.
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Affiliation(s)
- Ali Azeez Al-Jumaili
- University of Baghdad College of Pharmacy, Baghdad, Iraq. .,The University of Iowa College of Pharmacy, Iowa, USA.
| | - Manal Mohammed Younus
- Pharmacovigilance Center, Iraqi Ministry of Health, Baghdad, Iraq.,International Society of Pharmacovigilance (ISoP), London, UK
| | - Mena Ziad Saleh
- University of Baghdad College of Pharmacy, Baghdad, Iraq.,Directorate of Operations and Emergency Medical Services, Iraqi Ministry of Health, Baghdad, Iraq
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Comparative Quality Evaluation of Selected Brands of Cefuroxime Axetil Tablets Marketed in the Greater Accra Region of Ghana. ScientificWorldJournal 2021; 2021:6659995. [PMID: 33927582 PMCID: PMC8049799 DOI: 10.1155/2021/6659995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
The ever-growing commercialization of poor-quality and substandard medicines, especially anti-infectives characterized by inadequate postmarket surveillance by stakeholders remains a major global health challenge, particularly in developing countries, where antibiotic drug resistance and its repercussions on human health remain dominant. This research sought to evaluate the pharmaceutical quality of six randomly selected brands of cefuroxime axetil tablets (250 mg) marketed in the Greater Accra region of Ghana. The selected brands were coded and subjected to both compendial and noncompendial tests. Statistical analysis and model-independent parameter (similarity factor, f2) were employed in analyzing the dissolution profiles of all the brands. All brands including the reference brand conformed to the pharmacopeial specifications for both compendial and noncompendial tests, indicating that they were of good quality. However, there were significant variations (p < 0.05) in the disintegration time amongst the various brands. All the brands had ƒ2 values > 50 indicating similarity of their drug release profiles with the innovator. Hence, all the sampled cefuroxime axetil brands can be considered as pharmaceutical equivalents to the innovator drug. These brands can, therefore, be used as a substitute for the innovator drug by physicians to patients in cases of unaffordability or unavailability of the innovator brand.
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Kniazkov S, Dube-Mwedzi S, Nikiema JB. Prevention, Detection and Response to incidences of substandard and falsified medical products in the Member States of the Southern African Development Community. J Pharm Policy Pract 2020; 13:71. [PMID: 33088577 PMCID: PMC7574476 DOI: 10.1186/s40545-020-00257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 05/30/2023] Open
Abstract
Background Medical products are an integral and pivotal part of health care delivery. They need to be available, affordable and quality-assured. The SADC region is prone to threats arising from the availability and use of substandard and falsified (SF) medical products. This is something that needs to be actively addressed. Method A survey, constructed around four themes, was carried out between September 2018 and January 2019. The National Medicines Regulatory Authorities (NMRAs) of the 16 Member States within the SADC region were asked to respond to the survey questionnaire. The objective was to map existing fameworks, mechanisms and approaches to prevention, detection and response (PDR) to SF medical products. Results Responses were received from twelve out of the sixteen NMRAs. Only three of the twelve respondents had included elements for PDR for SF medical products in their national medicine policies. Regardless of the status in terms of policies, legislation is however in place for the majority of NMRAs. The mandate for regular sampling, an important detection mechanism, was enshrined in the legislation of nine of the twelve respondents. In terms of response mechanisms, six of the respondents had both inter-agency and intra-agency co-ordination for responding to SF products. Conclusion Though findings point to some deficiencies in terms of policies and implementation plans, the majority of countries have the mandate and legislation to deal with substandard and falsified medical products. Effective enforcement requires more investments into human resources, infrastructure, stakeholder coordination and public outreach. WHO has an important source of actionable information about incidience of substandard and falsified medical products. It needs to be leveraged to improve outreach to stakeholders and to raise awareness about SF problem and mechanisms available to address it. The extent, to which mechanisms and procedures are in place, varies. Some elements of the desired approach exist in the region; however, they will benefit from targeted strengthening to ensure a holistic approach across 12 action areas recommended by WHO.
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Lundin S, Liu R. 'Where and how do you buy medicines?' A pilot survey of consumption strategies among the public in Sweden. J Public Health (Oxf) 2020; 42:e268-e271. [PMID: 31334767 PMCID: PMC7435214 DOI: 10.1093/pubmed/fdz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 06/13/2019] [Indexed: 11/15/2022] Open
Abstract
Background Substandard and falsified (SF) medical products are a major danger to public health. They affect every region of the world, and have been identified in all major therapeutic categories. Studies from medicine, pharmacology, law and public health dominate this research area with a focus on the supply side. However, the spread of SF medical products cannot be fully understood without information about the demand side or a sociocultural perspective on market formation. The aim of this short report is to present findings from a pilot study that examines the attitudes of the Swedish public regarding consumption of medicines. Methods We conducted a pilot survey in 2016 ‘Where and how do you buy medicines?’ using LimeSurvey, an open-source online survey software. In total 155 respondents completed the survey. Results The majority of respondents turn to doctors within healthcare for prescription-only medicines (POM). Simultaneously, some respondents would consider buying POMs without prior contact with experts even if medicines may come from unsafe sources. Conclusions There is a tendency that people move away from formal healthcare towards an unregulated market. In parallel, people’s approach to doctors becomes more personalized and pragmatic than in former patriarchal relationships. Risk becomes a negotiable concept.
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Affiliation(s)
- S Lundin
- Department of Arts and Cultural Sciences, Lund University, LUX, Helgonavägen 3, SE-221 00 Lund, Sweden & Stellenbosch Institute of Advanced Study (STIAS), Wallenberg, Research Centre at Stellenbosch University, Marais Road, Stellenbosch, South Africa
| | - R Liu
- Department of Service Management and Service Studies, Universitetsplatsen 2, SE-252 25 Helsingborg, Lund University
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