By Nkrumah Bankong-Obi
Counterfeit and contraband drugs litter the poorly regulated Nigerian drug industry, pushing the mortality rate higher, slowly
Dr. Jimpat Aiyelangbe was absolutely sure he was upholding the ethics of his profession when he tried to resuscitate Blessing, an asthmatic patient who was wheeled into his hospital’s emergency room. Dose after dose of a drug to stabilise the patient’s breathing failed to yield the desired result. Following a futile wait for a positive change in the patient’s condition, the physician decided to have a look at the pack of the medication he was administering. As it turned out, the drug was a counterfeit, an expert cloning of the original! Instantly, the doctor had to call for a different drug which helped save the patient.
Of course, Blessing was lucky. Bunmi Olayiwola was not as lucky, as her life was ultimately claimed by a fake drug unknowingly administered by a medical professional. The victim had complained at the clinic of pains and cough. A series of drugs were prescribed with the requisite dosage. About five days after treatment commenced, her health degenerated. Two days later, she passed on. A medical autopsy at the University of Lagos Teaching Hospital revealed that the medication clogged her vital systems, hence hastened the packing up of her internal organs.
These examples are indicative of the havoc wreaked on Nigerians by fake drugs in Nigeria. From malaria resistance to outright death, fake drugs are by all indications topping the charts as one of the silent killers in the country today. Across selected hospitals in the country, doctors agree for example, that cases of organ failure, resistance to malaria and typhoid fever and other illnesses are on the rise due largely to the use of sub-standard or counterfeit drugs by patients.
The deaths or sufferings resulting from drug-related illnesses may not happen directly or shortly after the intake of a counterfeit substance. Dr. Teslim Bello of the University of Lagos teaching Hospital, Idi Araba, Lagos gives an instance of how fake drugs can kill: “If somebody has an elevated blood pressure, it can damage the kidney, the heart’s blood vessels, it can cause a stroke. You treat this using the blood pressure medicine. The longer the blood pressure remains higher, the risk that the person will suffer organ damage like stroke and kidney disease. So, if a person takes a formulation or drug that doesn’t contain the active ingredients or doesn’t contain the appropriate dose, then the blood pressure will remain longer than it should and that will translate to harm to the person.”
Thus, fake drugs unless they are outright poisonous substances may directly or indirect but slowly make even simple cases such as malaria grow from mild to worse and could result to death, the consultant nephrologist said.
Isaac Aiyedimidun was an engineer with a private firm in Lagos for more than a decade and half. A few years ago, he came down with a health condition. At the clinic, he was given some drugs which he took judiciously. But this didn’t help. Before long, he approached another medical facility where he was diagnosed of kidney failure. When this reporter interviewed him at the St. Nicholas Hospital, Lagos, he was a shell of his old self. Evidently, while the former clinic which rightly found the source of his problem administered drugs to ameliorate the condition, the medication had no effect all. The engineer who had been on dialysis at the new hospital told this reporter that experts had said if he stopped dialysis for a week, he would be dead. His was not a case of misdiagnosis but a suspected lack of value in the initial treatment he received.
According to an in-house publication of the National Agency for Food Drug Administration and Control, NAFDAC, results from the World Health Organisation, WHO, quality of anti-malaria medicines in sub-Saharan Africa survey shows that 64 per cent of the malaria drugs in the market failed the test. Although NAFDAC says that this has fallen drastically, that claim is contestable.
0n 8 November, 2008 for example, a teething medication for infants made its way to the market from a pharmaceutical laboratory in Nigeria. Dozens of children died across the country. The court judgment in the “My Pikin” case which was given in the course of the investigation of this story, shows that although the medicine first went through checks by the regulatory agency, yet, the manufacturers added substances to the drug after production approval had been granted.
“Diethylene belongs to substances called glycol, with common characteristics. They include; diethylene glycol, ethylene glycol, propylene glycol and glycerol. The first two are sweet and deadly while the last two are sweet and harmless. Some dubious elements engaged in drug counterfeiting now sell the harmful substance diethylene glycol as glycerol and propylene,” an unnamed prosecution witness told the court. This was how those children became victims of drug counterfeiting, masterminded by a then Kaduna-based pharmaceutical company.
Multiple Death Traps: Fake Drug Peddlers’ Multiple Approaches
It has become customary to hear of interception of container loads of drugs at the airports, seaports and a few other places. Volume-wise, this is huge influx of fake medications into Nigeria. A medical practitioner who declined to be named said: “You already know that containers arrive here almost daily with fake drugs that are intercepted. But do you know that many more come without our knowledge?” Klieg lights flashed at different directions indicate that many routes provide uninhibited passage for drug counterfeiters. For example, a place like the abandoned mini-sea port project in Ukwa East, Abia State serves as a convenient entry point for smuggled commodities, including drugs. The hilly and riverine regions of the Obanliku, Etung and Ikom in Cross River State, this reporter found out, are safe passages for smugglers of drugs and other products into Nigeria.
A visit to a border route in Kano convinced this reporter that drugs may be finding their way into the Nigeria, regularly but in small quantities. A source who is familiar with the terrain said:“If these people bring in clothing, they bring food items and other things, what convinces you that they don’t bring drugs as well? They bring everything in here,” the resident who guided this reporter stressed.
While drug regulatory agencies bluster about the efforts they have made to checkmate the proliferation of counterfeit drugs in the country, small-time fakers are having a field day. Most times while NAFDAC, security agencies kick their heels at the ports, adulterators of drugs are busy at work in the country. Sporadic raids of places like Ariaria market in Aba, Onitsha, Sagamu may have yielded some fruit. But the real time small scale counterfeiter who plies his trade in dingy streets like Arochukwu Street, War Museum Road (where this reporter first witnessed cases of fake drugs and counterfeiting of other consumables, two years ago) remain in business producing panadol, paracetamol, capsules, with materials like powder, cassava flour and powdery glucose.
Here is how this reporter observed a trafficker at work. A woman sits under a mango tree in her compound which is isolated from other compounds. She brings in a basin-full of white cassava flour and containers of talcum powder– some empty, others filled with the real product. She then mixes the flour with the real powder and then begins the refilling process. With a bowl of the counterfeited product dispensed into containers, the middle aged woman brings on capsules shells and then begins to dish her illicit product into them. This pattern thrives, according to testimonies in many parts of the Eastern Nigeria.
It is not very different from what small-time counterfeiters do in Kano. For example, in some places, it was observed that expired products are re-labelled. In some instances, medical components like injection water are grossly compromised in the process of producing, as the makers bye-pass all hygienic process. A number of people who spoke to this medium expressed worry about the quality of medical products sourced locally because, as the respondents said, such products cannot be trusted. Ali Adamu, a pharmacist and member of the Pharmaceutical Society of Nigeria, gave an instance of how some health products could be adulterated: “there was a time we were given a tipoff in 2012 that in a village in Ungogo Local Government Area, a house was hired by some miscreant element who went and dug a well and they brought empty tubes of this water for injection which you and I use as water for injection. They filled these sachets with that well water. We discovered a gas cylinder, we found pliers, and we discovered empty containers, a tank where they put the water and labels.” Perhaps, this extends to other places outside of the coverage of this investigation.
In Sabon Gari area of Kano which is a den for hippies, TheNEWS found that it is not only illicit drugs that are produced. Prescription drugs are also counterfeited. A senior state government pharmaceutical regulatory official identified the area as a hub of fake drugs in the state. Upon a visit to the area last September, the magazine noticed groups of youths adulterating mixtures, some of them known drugs for treating illnesses. This category does not mass produce. Their aim is just for self-consumption but the effects, experts say, are severe on the long-run.
NAFDAC has shifted gear to using the reactionary technique like deployment of cutting edge technological equipment like the Mobile Authentication Service (to help potential buyers to ascertain the validity of a drug before buying), Truscan, Magic tray, Pentesta, Mini laboratory test kits, Black Eye and is upbeat that the war on fake drugs is being won. Small fake drug barons are however, busy stuffing the Nigerian market with drugs that are unfit for consumption. Their illicit trade is helped by the fact that their products reach the rural areas where technologies used by NAFDAC, findings show, are alien, where literacy level is poor and where access to good health facilities is grossly limited. Authorities at the agency spurned all entreaties for an interview. Even questions mailed to a senior official of the agency to whom our reporter was referred to, were never answered.
The Triangular Drug Markets: Open To Fake Drug peddlers
Drug trade in the country is said to operate in the form of a triangle – Lagos, Onitsha and Kano. Investigations toed this line. From Idumota drug market in Lagos to Onitsha through Kano, the triangle is populated by people who operate a similar business modus. From Idumota drug market in Lagos to the Onitsha Bridge Head market or Ochaogu and Abubakar Rimi Market – Yankura market, drugs sellers function the same way. It is common to see sellers in front of their shops hustling passers-by to patronise them.
Onitsha is particularly poorly policed against fake drugs peddlers, despite claims to the contrary. For example, our reporter transverse the market carrying two bags – a kit bag and a luggage carrier, to test if anyone would approach him to ask about the content of the bags. No one did, despite the fact that he went to selected shops to make inquiries about drugs. This happened despite the fact that the market is fenced with marked exit routes. At the Abubakar Rimi Market, Kano, eyes were raised, as the same method was tried perhaps because of the security situation in that part of the country. Even at that, sources told this magazine, the market enjoys the notoriety of being a choice destination for counterfeit and contraband drugs. Ali Adamu, Chairman, Kano State Taskforce on Fake and Counterfeit drugs confirmed this and gave instance of their discovery during raids at the market (see box interview).
Beside the possible intrusion of fake drugs into these markets, the hygienic condition therein is appalling. For instance, the Bridge Head market is bounded from the inner part by a timber market and building materials shops. The road leading to the market from Ochanja in the Fegge area of Onitsha is not tarred and when it rains such as it did on the day we visited, sanitation was quite poor. Inside the market, most of the buildings are uncompleted with cavernous openings. At the heart of the market, our reporter observed that the buildings backing the head bridge are in bad shape.
In Kano, the drug market is just a section in the main market. The roads adjoining the market are in poor shape. As at the time of this reporter’s visit, dust billowed as the approaching harmattan wind whirled around, bringing dust and particles into the complex. These anomalies contravene the approved health standard of a drug shop, hence, even good drugs when kept in such circumstances, and in temperature either below or above stipulated climatic or environmental conditions, could be compromised.
The growing ratio of these drug markets probably led to an outcry by the Pharmaceutical Society of Nigeria that these open drug markets be closed. The association’s president, Olumide Akintayo, said it is unacceptable in a situation where fake drugs are smuggled into the country and in a short time, such drugs get circulated to other parts of the country. “The government is aware of the channel through in which fake drugs are circulated and distributed nationwide and it must be ready to break this cartel. To do this, it must shut down the open drug markets, which are now more than 50 across the country. If it does not do this, what it means is that if an importer brings in N1bn worth of fake drugs this night, it will be all over the country by the next day through these open drug markets.”
The consequences of not doing this, he posited, is that this network of counterfeiters will be “chasing investors who want to increase Nigerians’ access to quality medicines. No serious investor will bring in billions to compete with quacks and counterfeiters. It must put a stop to the peculiar pharmacy practice in Nigeria.” It is left to be seen whether government will rise against these impostors by closing their outlets or allow them thrive as it is currently the case.
– This report was accomplished with funding and support by Ford Foundation/International Centre for Investigative Reporting, Abuja.