Utilizing experimental design and desirability function in optimizing RP-HPLC method for simultaneous determination of some skeletal muscle relaxants and analgesics

An experimental design and response surface methodologies using Plackett-Burman and Box-Behnken designs were applied for selecting and optimizing the most appropriate parameters which significantly affect the separation and quantitative estimation of five skeletal muscle relaxants and four analgesic drugs (baclofen, methocarbamol, dantrolene sodium, orphenadrine citrate, cyclobenzaprine hydrochloride, ketoprofen, etoricoxib, ibuprofen, and mefenamic acid) with a relatively short duration of analysis in a single run. For the separation of the nine drugs, an INERTSIL ODS-V3-5 µm C18 column (250 × 4.6 mm I.D.) was used with the optimum mobile phase conditions (45.15 mM ammonium acetate buffer pH 5.56 adjusted with acetic acid, acetonitrile, and methanol in a ratio of 30.5:29.5:40, v/v/v with a flow rate of 1.5 mL/min) and UV-detection at 220 nm. The optimized method was successfully subjected to the validation steps as described in ICH guidelines for linearity, precision, accuracy, robustness, and sensitivity. The optimized and validated method was effectively applied to determine the content of the studied drugs in their pharmaceutical preparations and to expand its applicability to the counterfeit estimation of etoricoxib in different brands of tablet dosage forms.

Cross-border forensic profiling of fraudulent identity and travel documents: A pilot project between France and Switzerland

The serial character of document fraud and its connection to organised crime groups who produce, sell and/or use fraudulent documents is a challenge for security and crime fighting. As a response, the added value of forensic intelligence is increasingly recognised. Using a forensic profiling method and a dedicated system deployed in Switzerland, document examiners can detect series (i.e., documents that share a common source) of fraudulent documents conveniently and efficiently. This detection can trigger or orientate investigations, supports crime intelligence efforts, and facilitates cross-jurisdictional cooperation. This study aims to assess the suitability of the forensic profiling system for international purpose and the efficiency of the method to detect cross-border series. The forensic profiling system has been deployed in France in the framework of a cross-border pilot project conducted by the School of Criminal Justice from the University of Lausanne and the French National Police (Division Nationale de Lutte contre la Fraude Documentaire et à l'Identité) over the period July 2019-May 2020. Data from the Swiss and French forensic profiling systems were compared to each other to detect cross-border series. The study sought to create operating conditions as close as possible to the real-life conditions of the profiling systems. The results are extremely positive both quantitatively and qualitatively. They demonstrate the benefit of setting up a systematic exchange of forensic data issued from profiling systems for fraudulent identity documents between France and Switzerland, let alone between any other countries. The results open up a very promising prospect for a sustained operational implementation by the police services of both countries and the extension of the exchanges internationally.

Post mortem blood bromazolam concentrations and co-findings in 96 coronial cases within England and Wales

Bromazolam is a newly emerging benzodiazepine drug which is not licensed for medicinal use. It may be sourced as a New Psychoactive Substance (NPS) for its desired effects or be consumed unknowingly via counterfeit Xanax® or Valium® preparations. As part of our Coronial workload, we observed an increase in the detection of bromazolam from September 2021 to November 2022. We report a series of 96 cases in which bromazolam was quantitated by high resolution accurate mass - mass spectrometry (HRAM - MS) in post-mortem blood. The mean (SD) post-mortem blood bromazolam concentration from our case series was 64.6 ( ± 79.4) µg/L (range <1-425 µg/L). Routine toxicological screening results have also been reported; the most commonly encountered drugs taken in combination with bromazolam were cocaine, gabapentinoids and diazepam. In 48% of cases at least one further designer benzodiazepine drug was also present (etizolam, flualprazolam, flubromazolam, flubromazepam). It is essential that laboratories providing toxicological investigations are aware of the limitations of their assays; and inclusion of bromazolam within targeted screening panels using LC-MS/MS is encouraged. Bromazolam has not been associated with death in isolation from resulting toxic concentrations; however, it is likely to enhance adverse clinical effects when taken in combination with stimulant and/or centrally-acting depressant drugs (poly-drug deaths). Bromazolam, similar to other benzodiazepines, may also impair cognition and decision making skills.

Vaccine traceability: Key learnings from the supply chain initiative by manufacturers from emerging countries

The use of global standards, and the placement of barcodes and data matrix codes on vaccine labels and other levels of packaging are crucial elements for the traceability of finished vaccine products. Vaccine manufacturers are committed to improving health through their products, as vaccine production offers opportunities that can be leveraged to benefit immunization systems. In 2019 the Developing Countries Vaccine Manufacturers Network (DCVMN) created the Supply Chain Initiative aimed at prioritize and explore traceability opportunities; concomitantly procurement agencies announced traceability requirements for vaccine global supply. Vaccine traceability brings benefits including supply chain reliability and safety through enhanced product movement visibility, and a reduction of falsified and expired vaccines circulating in the supply chain. DCVMN has coordinated the development and implementation of global traceability standards, at both primary and secondary vaccine packaging levels, to encourage and enable sharing these experiences. Six pilot studies in four different countries showed successful implementation, and constituted part of larger vaccine traceability work within the respective organizations. The main findings from these pilot studies indicated that stepwise approaches to the adoption of traceability standards allowed vaccine manufacturers to learn by doing, initially with lower risk, and to spread their investments over time. Because the value of traceability is in its scale of adoption and the use of the data, it remains important for all stakeholders to engage in and prioritize the journey of vaccine traceability, but also to suitably manage the financial risks. The DCVMN Supply Chain Initiative has demonstrated that its members are committed to driving supply system changes that benefit immunization, while recognizing that supply chain traceability is part of a larger healthcare ecosystem and should be adopted by countries and immunization programmes as well.

Innovative method for rapid detection of falsified COVID-19 vaccines through unopened vials using handheld Spatially Offset Raman Spectroscopy (SORS)

Preventing, detecting, and responding to substandard and falsified vaccines is of critical importance for ensuring the safety, efficacy, and public trust in vaccines. This is of heightened importance in context of public health crisis, such as the COVID-19 pandemic, in which extreme world-wide shortages of vaccines provided a fertile ground for exploitation by falsifiers. Here, a proof-of-concept study explored the feasibility of using a handheld Spatially Offset Raman Spectroscopy (SORS) device to authenticate COVID-19 vaccines through rapid analysis of unopened vaccine vials. The results show that SORS can verify the chemical identity of dominant excipients non-invasively through vaccine vial walls. The ability of SORS to identify potentially falsified COVID-19 vaccines was demonstrated by measurement of surrogates for falsified vaccines contained in vaccine vials. In all cases studied, the SORS technique was able to differentiate between surrogate samples from the genuine COVISHIELD™ vaccine. The genuine vaccines tested included samples from six batches across two manufacturing sites to account for any potential variations between batches or manufacturing sites. Batch and manufacturing site variations were insignificant. In conjunction with existing security features, for example on labels and packaging, SORS provided an intrinsic molecular fingerprint of the dominant excipients of the vaccines. The technique could be extended to other COVID-19 and non-COVID-19 vaccines, as well as other liquid medicines. As handheld and portable SORS devices are commercially available and widely used for other purposes, such as airport security, they are rapidly deployable non-invasive screening tools for vaccine authentication.

Trends in retail sales of insecticide-treated nets and untreated nets in Tanzania: cross-section surveys

BACKGROUND

The commercial sector plays a vital role in mosquito net ownership and access in Tanzania. The National Malaria Strategic Plan (NMSP) includes long-lasting insecticidal nets (LLIN) delivery through the commercial sector as a complementary mechanism. The NMSP aims to increase LLIN sales while decreasing untreated mosquito net sales. This survey aimed to track quantities, market share of different net categories, prices, and origins of mosquito nets in retail markets and to engage stakeholders to analyse market trends.

METHODS

This mixed-method mosquito net retail outlet survey was conducted in mid-2021 in six and in mid-2022 in eight regions. Field teams identified net-selling outlets in major urban and peri-urban markets and used snowball sampling to identify additional outlets. A structured questionnaire was used, and photos of available mosquito net products were taken. Key informant interviews were conducted with wholesalers and retailers. The relative market share of a product was calculated by using the mean of each sales category as frequency weights. Qualitative data analysis was undertaken by summarizing common themes and observations based on the research question.

RESULTS

A total of 394 and 1139 outlets were surveyed in 2021 and 2022, respectively. More than 96% of distributed brands in both years were untreated nets. The market share for untreated mosquito nets was 99.2% in 2021 and 88.3% in 2022. Bed net sales were seasonal, peaking in the rainy season and at the start of the school year. Leaked LLINs from the public sector comprised 0.3% of the market share in 2021 and 8.3% in 2022. Kigoma markets had the most significant frequency of leaked LLIN products. Legitimate LLINs were rare in 2021 (n = 2) and not found in 2022, despite the presence of a local LLIN manufacturer. A small number (n = 3) of untreated nets fabricated in China claiming to be LLINs were observed in 2022.

CONCLUSIONS

Despite NMCP's strategic approach to increasing retail market share for legitimate LLINs, significant challenges remain. Efforts are needed to change the current situation given the context of large-scale public sector distributions of LLINs, the higher consumer cost of LLINs, the lack of bed net varieties. Improvement of registration process is recommended.

An assessment of the pH changes and metal ions released into artificial saliva by fake orthodontic braces

BACKGROUND

This present study assesses changes in the pH as well as the metal ions that fake braces release into artificial saliva (AS) using a pH meter and inductively coupled plasma atomic emission spectroscopy (ICP-AES), respectively.

METHODS

Three sets of fake archwires (AWs) and brackets (Bs) as well as a set of controls were immersed in AS and placed in an incubator shaker at 50 rpm and 37°C. At Days 0, 1, 7, 14, 21, and 28, the pH of the AS medium was measured and 3.0 ml of AS was collected and stored at -20°C for elemental analysis.

RESULTS

Significant changes in pH were observed on Days 0, 1, 7, 14, 21, and 28 in the AS of the AW group. However, these changes were only observed in the B group on Days 0 and 7. The fake samples released a large quantity of sodium (Na), potassium (K), and calcium (Ca) ions, at concentrations exceeding 100 mg/L, post-28 days of immersion. The control and fake braces samples released other ions; such as lithium (Li), magnesium (Mg), barium (Ba), chromium (Cr), copper (Cu), lead (Pb), and aluminium (Al); at concentrations that did not exceed 10 mg/L.

CONCLUSIONS

The pH of the AS of all the samples increased post-incubation. Only 10 ions; namely, Na, Li, K, Mg, Ca, Ba, Cr, Cu, Pb, and Al; were detected in the AS.

Fentanyl, heroin, and methamphetamine-based counterfeit pills sold at tourist-oriented pharmacies in Mexico: An ethnographic and drug checking study

BACKGROUND

Fentanyl- and methamphetamine-based counterfeit prescription drugs have driven escalating overdose death rates in the US, however their presence in Mexico has not been assessed. Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018. In 2021-2022, study participants described the arrival of new, unusually potent tablets sold as ostensibly controlled substances, without a prescription, directly from pharmacies that cater to US tourists.

AIMS

To characterize the availability of counterfeit and authentic controlled substances at pharmacies in Northern Mexico available to English-speaking tourists without a prescription.

METHODS

We employed an iterative, exploratory, mixed methods design. Longitudinal ethnographic data was used to characterize tourist-oriented micro-neighborhoods and guide the selection of n=40 pharmacies in n=4 cities in Northern Mexico. In each pharmacy, samples of "oxycodone", "Xanax", and "Adderall" were sought as single pills, during English-language encounters, after which detailed ethnographic accounts were recorded. We employed immunoassay-based testing strips to check each pill for the presence of fentanyls, benzodiazepines, amphetamines, and methamphetamines. We used Fourier-Transform Infrared Spectroscopy to further characterize drug contents.

RESULTS

Of n=40 pharmacies, one or more of the requested controlled substances could be obtained with no prescription (as single pills or in bottles) at 28 (70.0%) and as single pills at 19 (47.5%). Counterfeit pills were obtained at 11 pharmacies (27.5%). Of n=45 samples sold as one-off controlled substances, 18 were counterfeit. 7 of 11 (63.6%) samples sold as "Adderall" contained methamphetamine, 8 of 27 (29.6%) samples sold as "Oxycodone" contained fentanyl, and 3 "Oxycodone" samples contained heroin. Pharmacies providing counterfeit drugs were uniformly located in tourist-serving micro-neighborhoods, and generally featured English-language advertisements for erectile dysfunction medications and "painkillers". Pharmacy employees occasionally expressed concern about overdose risk and provided harm reduction guidance.

DISCUSSION

The availability of fentanyl-, heroin-, and methamphetamine-based counterfeit medications in tourist-oriented independent pharmacies in Northern Mexico represents a public health risk, and occurs in the context of 1) the normalization of medical tourism as a response to rising unaffordability of healthcare in the US, 2) plummeting rates of opioid prescription in the US, affecting both chronic pain patients and the availability of legitimate pharmaceuticals on the unregulated market, 3) the rise of fentanyl-based counterfeit opioids as a key driver of the fourth, and deadliest-to-date, wave of the opioid crisis. It was not possible to distinguish counterfeit medications based on appearance of pills or geography of pharmacies, because identically-appearing authentic and counterfeit versions were often sold in close geographic proximity. Nevertheless, people who consume drugs may be more trusting of controlled substances purchased directly from pharmacies. Due to Mexico's limited opioid overdose surveillance infrastructure, the current death rate from these substances remains unknown.

Fake drugs, real concerns: Counterfeit HIV medications and community trust

Counterfeit medications infiltrate drug supply chains at various entry points. While scientific advancements continue to deter counterfeit medications, these imitation therapies still manage to circumvent national and international regulations to reach unsuspecting consumers. Certain manufacturers of human immunodeficiency virus (HIV) prevention and treatment medications within the United States recently encountered counterfeit versions of their therapies that in some instances contained antipsychotic and pain reliever products. People on HIV treatment or those taking HIV prevention therapies who consume counterfeit medications are at risk of having their HIV management strategies compromised or seroconverting from an HIV negative to an HIV positive status, respectively. The implicated manufacturers reportedly took legal actions against the discovered counterfeiters, alerted impacted pharmacies, and assisted them with removal of illegitimate drugs. However, communities' gradual awareness or lack thereof in regards to counterfeit HIV prevention and treatment medications is likely to result in speculation about how many consumers took real versus fake medications, contributing to consumer distrust. This commentary provides details of a stakeholder meeting that took place with one of the leading manufacturers of HIV treatment and prevention medications to query its responses to counterfeit medications identified among its available product supplies in pharmacies. This manuscript also recommends to manufacturers ways to augment their communication strategies to communities if similar medicinal breaches occurred in the future.

BBTCD: blockchain based traceability of counterfeited drugs

The supply chain is a complex network in healthcare that crosses organizational and geographical borders. The inherent complexity of such structures can introduce impurities inclusive of erroneous facts, lack of transparency, and restricted records provenance. In the healthcare business, counterfeit pills are one of the major reasons for the harmful impact on human health and also for financial losses. Thus, pharmaceutical supply chains and end-to-end tracking systems are the recent research in healthcare. In this paper, we propose blockchain based traceability of counterfeited drugs (BBTCD) that implements tracking of counterfeited drugs using smart contracts on the Ethereum blockchain. We propose a solution to fully decentralize the tracking in healthcare by storing BBTCD on IPFS (Inter Planetary File System) to provide transparency, cost-effectiveness.

Fake anabolic androgenic steroids on the black market - a systematic review and meta-analysis on qualitative and quantitative analytical results found within the literature

Objective

Supraphysiologic doses of anabolic androgenic steroids (AAS) are widely used to improve body image and sport performance goals. These substances can easily be acquired over the internet, leading to a substantial black market. We reviewed literature that assessed the quality and quantity of AAS found on the black market.

Methods

We searched PubMed/Medline, Embase and Google Scholar for articles published before March 2022. Additional hand searches were conducted to obtain studies not found in the primary literature search. Studies were included if they report on qualitative and/or quantitative analytical findings of AAS from the black market. Primary outcomes were proportions of counterfeit or substandard AAS. Eligible articles were extracted; quality appraisal was done using the ToxRTool for in-vitro studies. We used random-effects models to calculate the overall mean estimates for outcomes. The review protocol has been published and registered in INPLASY.

Results

Overall, 19 studies, which in total comprised 5,413 anabolic samples, met the inclusion criteria, and passed the quality appraisal from two WHO world regions that reported findings, the Americas and Europe. Most studies were nonclinical laboratory studies (95%) and provided samples seized by authorities (74%). In 18 articles, proportions of counterfeit substances and in eight articles, proportions of substandard substances were presented. The overall mean estimate for counterfeit anabolic steroids found on the black market was 36% (95% CI = 29, 43). An additional 37% (95% CI = 17, 63) were of substandard quality. We also demonstrate that these drugs could contain no active ingredient, or in another amount than that labeled, a wrong active ingredient, as well as not all or more active ingredients than were labeled. High heterogeneity among all analyses and significant differences between geographical subgroups were found.

Conclusion

With this systematic review and meta-analysis, we demonstrate that substantial mean proportions of black-market AAS are counterfeit and of substandard quality. These products pose a considerable individual and public health threat, and the very wide range in proportions of fake black-market AAS puts the user in a situation of unpredictable uncertainty. There is a great need for future prevention and harm-reduction programs to protect users from these substances.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13734-4.

Trends in counterfeit drugs and pharmaceuticals before and during COVID-19 pandemic

Counterfeit, fake, adulterated or falsified drugs and pharmaceuticals, could be branded or generic drugs, excipients and active substances (in drugs and vaccines), medical supplies and devices, etc, intended to pass as the original. Counterfeits are always inferior in terms of quality, safety and efficacy compared to the original pharmaceuticals, and subsequently, they pose an unpredictable risk to public health and lead to loss of confidence in medicines, healthcare providers, and health systems. In the decades before the outbreak of the COVID-19 pandemic, a constant trend of increased trafficking was reported. However, the pandemic created a combination of public health emergency, economic distress, and misinformation-driven panic that made problematic the access and supply of high quality essential medicines and health products, and pushed consumers and vendors even more towards counterfeit pharmaceuticals. This contribution aims to review the trends in counterfeit drugs and pharmaceuticals trafficking, the health impact of their use, as well as, measures and actions implemented to restrict their proliferation, before and during COVID-19 pandemic; the relative recommendations, the expressed perspectives and the existing limitations are thoroughly discussed.

The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations

BACKGROUND

The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.

METHODS

Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.

RESULTS

Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.

CONCLUSIONS

Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.

A Systematic Scoping Review on Social Strategies and Technological Solutions

Introduction

The counterfeit phenomenon is a largely under-reported issue, with potentially large burden for healthcare. The market for counterfeit drugs used in sexual medicine, most notably type 5 phosphodiesterase inhibitors (PDE5i), is rapidly growing.

Aims

To report the health risks associated with the use of counterfeit medications, the reasons driving their use, and the strategies enacted to contain this phenomenon.

Methods

A systematic scoping review of the literature regarding counterfeit PDE5i was carried between January and June 2021, then updated in August 2021.

Main Outcome Measure

We primarily aimed to clarify the main drivers for counterfeit PDE5i use, the health risks associated, and the currently available strategies to fight counterfeiters.

Results

One hundred thirty-one records were considered for the present scoping review. Production of fake PDE5i is highly lucrative and the lacking awareness of the potential health risks makes it a largely exploitable market by counterfeiters. Adulteration with other drugs, microbial contamination and unreliable dosages make counterfeit medications a cause of worry also outside of the sexual medicine scope. Several laboratory techniques have been devised to identify and quantify the presence of other compounds in counterfeit medications. Strategies aimed at improving awareness, providing antitampering packaging and producing non-falsifiable products, such as the orodispersible formulations, are also described.

Clinical implications

Improving our understanding of the PDE5i counterfeit phenomenon can be helpful to promote awareness of this issue and to improve patient care.

Strengths & Limitations

Despite the systematic approach, few clinical studies were retrieved, and data concerning the prevalence of counterfeit PDE5i use is not available on a global scale.

Conclusion

The counterfeit phenomenon is a steadily growing issue, with PDE5i being the most counterfeited medication with potentially large harmful effects on unaware consumers.

Sansone A, Cuzin B, and Jannini EA. Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions. Sex Med 2021;9:100437.

What agro-input dealers know, sell and say to smallholder farmers about pesticides: a mystery shopping and KAP analysis in Uganda

BACKGROUND

Pesticides can have negative effects on human and environmental health, especially when not handled as intended. In many countries, agro-input dealers sell pesticides to smallholder farmers and are supposed to provide recommendations on application and handling. This study investigates the role of agro-input dealers in transmitting safety information from chemical manufacturers to smallholder farmers, assesses the safety of their shops, what products they sell, and how agro-input dealers abide by laws and recommendations on best practices for preventing pesticide risk situations.

METHODS

Applying a mixed-methods approach, we studied agro-input dealers in Central and Western Uganda. Structured questionnaires were applied to understand agro-input dealers' knowledge, attitude and practices on pesticides (n = 402). Shop layout (n = 392) and sales interaction (n = 236) were assessed through observations. Actual behavior of agro-input dealers when selling pesticides was revealed through mystery shopping with local farmers buying pesticides (n = 94).

RESULTS

While 97.0% of agro-input dealers considered advising customers their responsibility, only 26.6% of mystery shoppers received any advice from agro-input dealers when buying pesticides. 53.2% of products purchased were officially recommended. Sales interactions focused mainly on product choice and price. Agro-input dealers showed limited understanding of labels and active ingredients. Moreover, 25.0% of shops were selling repackaged products, while 10.5% sold unmarked or unlabeled products. 90.1% of shops were lacking safety equipment. Pesticides of World Health Organization toxicity class I and II were sold most frequently. Awareness of health effects seemed to be high, although agro-input dealers showed incomplete hygiene practices and were lacking infrastructure. One reason for these findings might be that only 55.7% of agro-input dealers held a certificate of competency on safe handling of pesticides and even fewer (5.7%) were able to provide a government-approved up-to-date license.

CONCLUSION

The combination of interviews, mystery shopping and observations proved to be useful, allowing the comparison of stated and actual behavior. While agro-input dealers want to sell pesticides and provide the corresponding risk advice, their customers might receive neither the appropriate product nor sufficient advice on proper handling. In light of the expected increase in pesticide use, affordable, accessible and repeated pesticide training and shop inspections are indispensable.

Screening sexual performance enhancing compounds and their analogues in counterfeit and illicit erectile dysfunction drugs by high-performance liquid chromatography and liquid chromatography-tandem mass spectrometry

The growth of the counterfeit and illicit drugs market is attributable in part to phosphodiesterase type-5 inhibitor (PDE-5is) medications for erectile dysfunction (ED). PDE-5is and their analogues are being increasingly supplied as counterfeit and illicit drugs marketed to enhance sexual performance. Herein, we screened and confirmed a total of 181 such counterfeit and illicit drugs used to date to enhance sexual performance by high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Out of 181 samples, PDE-5is and their analogues were detected in 156 samples, with 49.4% containing two or more components in a single sample. Sildenafil, tadalafil, and miscellaneous group were detected a rates of 64.1%, 34.4%, and 1.5% times and concentrations of 0.04-496 mg/g, 0.02-147 mg/g, and 0.54-16.4 mg/g, respectively with multiple compound groups also detected in single samples. Overdosing on these drugs can lead to adverse effects, the toxicities of combined administrations have not been researched, and administering multiple components in a single sample can be fatal. We recommend that counterfeit and illicit drugs for enhancing sexual performance be continuously controlled and supervised for the protection of public health, and more studies into toxicity and side effects are required.

A simple, rapid, and robust "on-the-go" identity testing of biotherapeutics using FTIR spectroscopy

The stunning rise of biotherapeutics as successful treatments of complex and hard-to-treat diseases, in particular cancer, has necessitated the development of a rapid analytical method capable of differentiating these otherwise significantly similar antibody-based products. The existing methods for product identification pose significant drawbacks in terms of the consumption of time and labor. Here, we present an FTIR spectroscopy-based simple, rapid, and robust method that is capable of differentiating between the biotherapeutics (both innovator products and biosimilars). The proposed approach uses partial least-squares-discriminant analysis to pinpoint subtle differences in the FTIR spectra of the samples, enabling us to not only identify the product but also calculate its concentration. This FTIR-based method can be used to fulfill the identity testing requirement of a pharmaceutical drug in its final packaged form set by the US Food and Drug Administration. Along with this, identity testing can also be deployed at multiple steps in the manufacturing process and can also be used by the appropriate regulatory or government agency for tackling counterfeits of biotherapeutic products.

Rapid and accurate verification of drug identity, purity and quality by 1H-NMR using similarity calculations and differential NMR

The illegal trade in counterfeit and fake drugs is a worldwide multi-billion dollar industry, not only generating enormous economic losses, but health problems for the general population, through direct toxicity, treatment failure and the increased generation of antibiotic resistance. Techniques for high-throughput testing of suspect medicines are needed to face the challenges of the problem. In this study we show that with nuclear magnetic resonance spectroscopy (NMR) drug compliance can be verified in a few minutes, providing data on drug identity, purity and quality without the necessity to develop a specific methodology and using a direct extraction with deuterated solvent. The evaluation of the data is facilitated by similarity calculations and differential NMR spectroscopy. The viability and limitations of this method were assessed, with the application on five different drugs, namely sertraline hydrochloride, alprazolam, vitamin D₃, enalapril maleate and paracetamol, in which the individual dosage quantity of the active ingredient ranged from 750 mg down to 0.25 mg. The appropriate sample weight, solvent and internal standard were determined for each drug and quantification was carried out by choosing the most adequate NMR signals for each compound and the internal standard. With the method the accuracy of the quantification is somewhat sacrificed for increased speed in the analysis, but the measurements offer excellent precision and offer the possibility of external calibration. Spectral similarity calculations and differential NMR spectroscopy were used to compare different generic brands and detect eventual undeclared constituents and contaminants. In one brand of alprazolam tablets the undeclared constituent tristearin was found, while in paracetamol tablets the contaminant para-aminophenol was found at a level above the allowed by the legislation. The applicability and limitations of the method are discussed.

Analysis of biopharmaceutical formulations by Time Domain Nuclear Magnetic Resonance (TD-NMR) spectroscopy: A potential method for detection of counterfeit biologic pharmaceuticals

¹H Time-Domain Nuclear Magnetic Resonance (TD-NMR) is used to characterize solutions of antibodies that simulate biologic pharmaceutical formulations. The results from these measurements are compared with those from solutions in which the concentration or identity of the antibody has been altered. TD-NMR is shown to be very sensitive to differences in the amount of antibody in solution, with the ability to detect variations in as low as 2 mg/mL. It is therefore capable, by comparison with data from known formulations, of determining whether a particular sample is likely to be of an authentic biologic formulation. This method expands on the previous use of HPLC, UV/VIS, Near-IR and High-Resolution NMR to detect adulterated pharmaceutical materials. While the sensitivity of the method is high, it is a fingerprinting methodology, illustrating differences but not elucidating their origin. The extracted relaxation times reflect the combined effect of all solutes (antibody, buffer components, etc.) on the solvent (water).

The role of manufacturers in the implementation of global traceability standards in the supply chain to combat vaccine counterfeiting and enhance safety monitoring

The counterfeiting of vaccines is an increasing problem globally with the safety of persons vaccinated, the trust in vaccines generally and the associated reputation of vaccine manufacturers and regulatory agencies at risk. This risk is especially critical with the on-going development of COVID-19 vaccines. The ability to track and trace vaccines through the vaccine supply chain down to persons vaccinated has to be enhanced. In this context of traceability, the global immunization community has recently set the barcoding of the primary packaging of vaccines, specifically vaccine vials and pre-filled syringes, as a top priority. Emerging vaccine manufacturers are already engaged in investigating ways to incorporate barcoding in their labelling and packaging using GS1 international standards. A specific pilot taking place in Indonesia by the national vaccine manufacturer, Bio Farma, shows the innovation of barcoding on primary packaging already underway with a relatively modest level of investment and success at this stage. This article highlights the efforts of industry and governments on the value of traceability and introduction to 2D barcodes. Access to financial resources and support from the international immunization community would accelerate such innovations leading to enhanced security of the vaccine supply chain.

Scale validation for the identification of falsified hand sanitizer: public and regulatory authorities perspectives from United Arab Emirates

Background

Since the time of declaration of global pandemic of COVID-19 by World Health Organization (WHO), falsified hand sanitizers surfaced regularly in markets, posing possible harm to public due to unlisted inclusion of methanol. The current research is an attempt to develop and validate a tool to document falsified hand sanitizer in the UAE community.

Method

A descriptive cross-sectional community-based study was conducted among 1280 randomly selected participants. Respondents were sent a web-based electronic link to the survey via email. Content validity, factor analyses and known group validity were used to develop and validate a new scale to identify falsified hand sanitizer. Test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs) were used to assess the reliability of the scale. SPSS version 24 was used to conduct data analysis.

Results

A total of 1280 participants were enrolled in the study. The content validity index (CVI) was 0.83 with the final scale of 12 items. The Kaiser-Meyer-Olkin (KMO) value was 0.788, with the Bartlett test of sphericity achieving statistical significance (p < 0.001). Our factor analysis revealed a 3-component model. The 3-factor solution was confirmed by PCFA analysis and had associations with good fit values. The PCFA for NFI was 0.970, CFI 0.978, and TLI 0.967. All values were in excess of 0.95, with RMSEA values below 0.06 at 0.03; all of these values indicated a good model fit. The Cronbach’s alpha was good overall (0.867). All factors had a Cronbach’s alpha value in excess of 0.70. The instrument demonstrated that every item met the IIC correlation standard ≥0.40. The scale displayed good overall ICC statistics of 0.867 (95% CI 0.856–0.877) with statistical significance (p < 0.001). The scale’s test-retest reliability was assessed through correlation of the falsified hand sanitizer identification score of respondents at the two time points. The test-retest correlation coefficient was 0.770 (p value < 0.01). Participants with post-graduate education were more likely to identify the falsified hand sanitizer compared to those with high school education. (p < 0.001).

Conclusions

This study developed and validated a new scale for the measurement of falsified hand sanitizer. This is expected to improve and promote collaboration between the health regulators and the public and hereby encourage customer satisfaction and participation.

A focused netnographic study exploring experiences associated with counterfeit and contaminated anabolic-androgenic steroids

Background

A primary consequence of illicit drug markets and the absence of regulation is the variable quality or purity of the final product. Analysis of anabolic-androgenic steroid seizures shows that these products can contain adulterated products, product not included on the label, or product of unsatisfactory standard. While the potential negative effects of counterfeit anabolic-androgenic steroids (AAS) use is a recognised risk associated with use, no study has explored personal experiences associated with use. The aim of the present study was to use online discussion forums to investigate and explore the experiences associated with the purchase and consumption of counterfeit AAS among consumers.

Methods

An online search was conducted to identify online forums that discussed counterfeit or contaminated AAS; three were deemed suitable for the study. The primary source of data for this study was the ‘threads’ from these online forums, identified using search terms including ‘counterfeit’, ‘tampered’, and ‘fake’. Threads were thematically analysed for overall content, leading to the identification of themes.

Results

Data from 134 threads (2743 posts from 875 unique avatars) was included. Two main themes were identified from the analysis: (1) experiences with counterfeit product and (2) harms and benefits associated with counterfeit product.

Conclusions

The use of counterfeit or contaminated substances represents a public health concern. Those who report using performance and image enhancing drugs such as AAS for non-medical purposes report consuming these substances and experiencing harm as a result. Consumers take steps to limit coming into contact with counterfeit or contaminated product, though recognise that many of these have limitations. The implementation of accessible drug safety checking services may provide an opportunity to provide consumers with information to assist them with making healthier choices.

Developing anti-counterfeiting measures: The role of smart packaging

Counterfeiting of food and beverage products is rife and premium brands are often targeted by fraudsters. Such is the case with Scotch whisky, a global, reputable brand revered for its heritage and tradition. Using Scotch whisky as a case study, the aim of this paper is to review existing literature and industry information to determine the market and personal consequences of counterfeiting activities and consider the packaging related anti-counterfeiting measures that can be employed within a wider anti-counterfeiting strategy. A typology of counterfeiting activities is developed including: tear-down counterfeiting, product overruns, malicious activities and document counterfeiting. Anti-counterfeiting measures are used to deter, detect and control counterfeiting activities and different packaging related approaches include the use of smart covert and overt technology. Most smart packaging-related anti-counterfeit technologies are stand-alone systems and this presents a vulnerability. An integrated anti-counterfeiting measures strategy, employed by business, the supply chain and the government is required to reduce the risk of the sale of counterfeit food and beverage products.

Comparison of phosphodiesterase type V inhibitors use in eight European cities through analysis of urban wastewater

In this work a step forward in investigating the use of prescription drugs, namely erectile dysfunction products, at European level was taken by applying the wastewater-based epidemiology approach. 24-h composite samples of untreated wastewater were collected at the entrance of eight wastewater treatment plants serving the catchment within the cities of Bristol, Brussels, Castellón, Copenhagen, Milan, Oslo, Utrecht and Zurich. A validated analytical procedure with direct injection of filtered aliquots by liquid chromatography-tandem mass spectrometry was applied. The target list included the three active pharmaceutical ingredients (sildenafil, tadalafil and vardenafil) together with (bio)transformation products and other analogues. Only sildenafil and its two human urinary metabolites desmethyl- and desethylsildenafil were detected in the samples with concentrations reaching 60 ng L^-1. The concentrations were transformed into normalized measured loads and the estimated actual consumption of sildenafil was back-calculated from these loads. In addition, national prescription data from five countries was gathered in the form of the number of prescribed daily doses and transformed into predicted loads for comparison. This comparison resulted in the evidence of a different spatial trend across Europe. In Utrecht and Brussels, prescription data could only partly explain the total amount found in wastewater; whereas in Bristol, the comparison was in agreement; and in Milan and Oslo a lower amount was found in wastewater than expected from the prescription data. This study illustrates the potential of wastewater-based epidemiology to investigate the use of counterfeit medication and rogue online pharmacy sales.

Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

BACKGROUND

Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone.

DISCUSSION

Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made.

CONCLUSION

There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

Raman chemical imaging for spectroscopic screening and direct quantification of falsified drugs

Falsified drugs are a threat to the health of patients. The analytical control of such products contributes to the fight against this global issue. Raman chemical imaging is a method that relies on consecutive measurements at the surface of a sample, combining spectroscopy, microscopy and chemometrics. This article explores the capabilities of this analytical technique proposing an innovative methodology with spectroscopic screening for the identification of chemical compounds and the direct quantification of the active substance (without prior calibration). Two chemometric methods were used: Multivariate Curve Analysis - Alternate Least Squares for the qualitative analysis and Direct Classical Least Squares for the quantitative analysis. The methodology was optimized with samples prepared in the laboratory and validation parameters were studied. The methodology was then applied to real (authentic and falsified) samples of Viagra^® and Plavix^®. Despite the presence of fluorescence emission in some samples, the methodology succeeded in the detection of active pharmaceutical ingredients, and in the discrimination of three salts of clopidogrel (in generic formulations of Plavix^®). The quantitative deviation from the reference method ranged from -15% to +24% of the active substance content. This deviation may be considered to be acceptable since it is sufficient for assessing the risk to the health of patients and for quickly alerting the health authorities.

Detection of counterfeit brand spirits using 1H NMR fingerprints in comparison to sensory analysis

Beverage fraud involving counterfeiting of brand spirits is an increasing problem not only due to deception of the consumer but also because it poses health risks e.g. from possible methanol admixture. Suspicious spirit samples from Russia and Kenya were analysed using ¹H nuclear magnetic resonance (NMR) spectroscopy in comparison to authentic products. Using linear regression analysis of spectral integral values, 4 counterfeited samples from Russia and 2 from Kenya were easily identifiable with R² < 0.7. Sensory analysis using triangle test methodology confirmed significant taste differences between counterfeited and authentic samples but the assessors were unable to correctly identify the counterfeited product in the majority of cases. An important conclusion is that consumers cannot assumed to be self-responsible when consuming counterfeit alcohol because there is no general ability to organoleptically detect counterfeit alcohol.

Fighting falsified medicines: The analytical approach

Given the harm to human health, the fight against falsified medicines has become a priority issue that involves numerous actors. Analytical laboratories contribute by performing analyses to chemically characterise falsified samples and assess their hazards for patients. A wide range of techniques can be used to obtain individual information on the organic and inorganic composition, the presence of an active substance or impurities, or the crystalline arrangement of the formulation's compound. After a presentation of these individual techniques, this review puts forward a methodology to combine them. In order to illustrate this approach, examples from the scientific literature (products used for erectile dysfunction treatment, weight loss and malaria) are placed in the centre of the proposed methodology. Combining analytical techniques allows the analyst to conclude on the falsification of a sample, on its compliance in terms of pharmaceutical quality and finally on the safety for patients.

The dangers of sexual enhancement supplements and counterfeit drugs to "treat" erectile dysfunction

Counterfeit phosphodiesterase-5 inhibitors (PDE-5i) are an increasing problem. Already in widespread use, the market for PDE-5i is steadily growing as the population ages. Counterfeiters are taking advantage of this growing market by developing illicit and counterfeit PDE-5i products. Many factors are contributing to the rapid growth of the illicit market, such as the low risk of prosecution, potentially high financial reward, and ease of distribution via Internet pharmacies. Consumers of illicit PDE-5i often do not realize they are using counterfeit products and placing themselves at an unnecessary health risk. Others seek to bypass the legitimate healthcare system due to either embarrassment of the underlying condition or desire for cheaper alternatives. However, taking illicit PDE-5i may harm consumers directly, as many illicit products contain detrimental contaminants and inaccurate amounts of the active ingredient without the appropriate warnings. Bypassing the legitimate healthcare system also endangers consumers indirectly, as erectile dysfunction (ED) is often associated with other medical comorbidities that patients should be screened for. Furthermore, PDE-5i can have potentially dangerous interactions with other pharmaceuticals that are rarely warned against with counterfeit PDE-5i. This communication reviews the literature regarding counterfeit PDE-5i, and summarizes both the scope and dangers of the illicit PDE-5i market.

Traceability and Risk Analysis Strategies for Addressing Counterfeit Electronics in Supply Chains for Complex Systems

Within the microelectronics industry, there is a growing concern regarding the introduction of counterfeit electronic parts into the supply chain. Even though this problem is widespread, there have been limited attempts to implement risk-based approaches for testing and supply chain management. Supply chain risk management tends to focus on the highly visible disruptions of the supply chain instead of the covert entrance of counterfeits; thus counterfeit risk is difficult to mitigate. This article provides an overview of the complexities of the electronics supply chain, and highlights some gaps in risk assessment practices. In particular, this article calls for enhanced traceability capabilities to track and trace parts at risk through various stages of the supply chain. Placing the focus on risk-informed decision making through the following strategies is needed, including prioritization of high-risk parts, moving beyond certificates of conformance, incentivizing best supply chain management practices, adoption of industry standards, and design and management for supply chain resilience.

The diagnostic accuracy of the hand-held Raman spectrometer for the identification of anti-malarial drugs

Background

There is a need for accurate and field-applicable instruments for the evaluation of the quality of anti-malarial drugs. The aim of this study was to determine the diagnostic accuracy of the NanoRam^®, a handheld Raman spectrometer (RS), to identify anti-malarial drugs.

Methods

In total, 289 anti-malarial drugs collected in a randomized field survey in Gabon were evaluated. The samples were compared with authentic products as supplied by the official manufacturer. To determine the sensitivity and specificity of the handheld NanoRam^® spectrometer in the identification of anti-malarial drugs, a two-gate reversed-flow design was applied. The standards for reporting of diagnostic accuracy studies (STARD) were followed. The index test was the handheld RS. The reference test standards were thin layer chromatography and high performance liquid chromatography with ultraviolet photo diode array detection.

Results

The sensitivity [95 % confidence interval (95 % CI)] and specificity of the RS to correctly identify an anti-malarial drug were 100 % (95 % CI 94.9–100 %) and 96 % (95 % CI 92.3–99.0 %), respectively. The RS could not differentiate between different batches of the same product or different manufacturers of the same product. Intra-observer agreement for 289 samples was 100 %. The average time to conduct the RS was 15 s per sample compared to 45 min per sample for TLC.

Conclusion

The handheld RS holds promise as an easy-to-use, quick and field-applicable instrument for the evaluation of quality of anti-malarial drugs, potentially empowering pharmacists, drug inspectors and medical regulatory authorities.

Trial registration NTR4341 (Dutch Trial Registry)

Electronic supplementary material

The online version of this article (doi:10.1186/s12936-016-1212-y) contains supplementary material, which is available to authorized users.

The story of fake impact factor companies and how we detected them

Beginning about three years ago, the world of academic publishing has become infected by fake impact factors and misleading metrics that are launched by bogus companies. The misleading metrics and fake impact factors have damaged the prestige and reliability of scientific research and scholarly journals. This article presents the in-depth story of some of the main bogus impact factors, how they approached the academic world, and how the author identified them. Some names that they use are Universal Impact Factor (UIF), Global Impact Factor (GIF), and Citefactor, and there even is a fake Thomson Reuters Company.

Determination of counterfeit medicines by Raman spectroscopy: Systematic study based on a large set of model tablets

In the last decade, counterfeit pharmaceutical products have become a widespread issue for public health. Raman spectroscopy which is easy, non-destructive and information-rich is particularly suitable as screening method for fast characterization of chemicals and pharmaceuticals. Combined with chemometric techniques, it provides a powerful tool for the analysis and determination of counterfeit medicines. Here, for the first time, a systematic study of the benefits and limitations of Raman spectroscopy for the analysis of pharmaceutical samples on a large set of model tablets, varying with respect to chemical and physical properties, was performed. To discriminate between the different mixtures, a combination of dispersive Raman spectroscopy performing in backscattering mode and principal component analysis was used. The discrimination between samples with different coatings, a varying amount of active pharmaceutical ingredients and a diversity of excipients were possible. However, it was not possible to distinguish between variations of the press power, mixing quality and granulation. As a showcase, the change in Raman signals of commercial acetylsalicylic acid effervescent tablets due to five different storage conditions was monitored. It was possible to detect early small chemical changes caused by inappropriate storage conditions. These results demonstrate that Raman spectroscopy combined with multivariate data analysis provides a powerful methodology for the fast and easy characterization of genuine and counterfeit medicines.

Comparative dissolution study on counterfeit medicines of PDE-5 inhibitors

Counterfeit medicines are a growing problem in both developing and industrialised countries. In general the evaluation of these medicines is limited to the identification and the dosage of the active ingredients. In this study in vitro dissolution tests were conducted on two sets of counterfeit medicines containing PDE-5 inhibitors (sildenafil citrate and tadalafil). The dissolution profiles were statistically compared to the ones of the genuine products using the f₂-method and a comparison at each time point using the Cochran test.

The results showed low equivalences between counterfeit and genuine products as well as higher variations around the mean dissolution value at the different time points for the counterfeit products.