Since the lifting of subsidies on medical supplies and the loss of many of them, social media has been flooded with images of medicines amid crazy supply and demand in the black market. The Lebanese Pharmacists Association continues its warning campaign against counterfeit and expired medicines that spread illegally, describing them as "killer." Meanwhile, some black market traders speak of "noble" motives for serving patients. With the duality of the scene, there are questions that need to be answered: Is there exaggeration in the warnings about the spread of counterfeit drugs? What is the volume of smuggled drugs? How is legitimate medicine determined? And how can counterfeit drugs be recognized?
The registration of medicines in Lebanon is subject to an administrative sequence that considers the standards of the Technical Committee for Medicines at the Ministry of Health, which was established under decision 476/1. Therefore, all pharmaceutical products, whether locally manufactured or imported, must be registered with the Ministry of Health. Consequently, any medicine that enters Lebanese territory and is distributed without approval is considered illegal.
Lebanese law describes the counterfeiting or smuggling of medicines as a crime, with a focus on amending Article (92) of Law No. 367 published in 1994, which tightens penalties on acts involving smuggled, expired, unregistered, or prohibited drugs, with the person being punished with temporary detention and a fine. However, the crisis, according to those concerned in the health sector, has surpassed the issue of customs controls. “We do not have a problem with citizens bringing medicine for personal use as long as they come from licensed sources abroad,” says the president of the Pharmacists Association, Joe Saloum, but “the danger lies in large quantities of expired and counterfeit products reaching the Lebanese markets.” What is their impact?
It is common to say that counterfeit drugs do not contain any active ingredient. They often contain corn starch, potatoes, chalk, or water, but they may also include deadly and toxic products, or even be contaminated due to the poor conditions in which they are produced or stored, as explained by the World Health Organization in its report on counterfeit medicines published in 2018. It is difficult for citizens to verify the quality of medicines before purchasing them, possibly due to ignorance or lack of attention, especially if there is a necessity for them, such as securing cancer medication. However, contrary to what some may think, counterfeiting is not limited to expensive cancer drugs. Some seemingly simple medicines, like paracetamol, anti-inflammatory drugs, sedatives, and blood pressure medications, may also be counterfeit. There are also highly sensitive medicines regarding their spoilage rate that need to be stored under special conditions, like insulin injections and other medications that require refrigeration or are administered by injection.
**Black Market: Accusations Between the Ministry of Health and Traders**
One black market trader, a nurse working in a Beirut hospital, confirms to "Al-Qaws" that there is exaggeration in the warnings about the "invasion" of counterfeit and expired medicines, stressing that “the largest players in the black market usually have one or two boxes of drugs to distribute... we are helping people; what is happening in the country is the black market.” Saloum condemns this statement, but he has his own suspicions and questions about this issue in health institutions. “What about the huge quantities of subsidized medicine that were smuggled abroad and are now being sold in the markets by citizens in dollars?” the president asks, emphasizing that “it is time to open investigations into this file."
A relative of a cancer patient testifies about the chaos and nepotism in the Ministry of Health, which “we contacted a while ago to secure breast cancer medication, and the response was that it is out of stock. We tried to obtain it from Turkey, but the price in pharmacies there reached $1000, which we couldn’t afford. We went back and made our own contacts to mediate in the ministry, and a substitute was secured after we paid a large sum of money.”
To some extent, "collusion" with the black market for medicines is how some view the ministry’s relationship with what is happening. Dr. Ismail Sakr, head of the National Social Health Authority - Health is a Right and Dignity, emphasizes the need to open investigations into the smuggling of medicines from the Ministry of Health, noting that this is happening “in collusion with employees within the ministry,” something “documented” for a long time.
**Pharmacists Association: No Statistics... Just Social Media**
The Pharmacists Association does not possess any statistics on the number of counterfeit or expired medicines that enter the Lebanese market regularly, other than what reaches the association through social media and images of "street vendors" selling medicine on the streets. "Al-Qaws" tried to track electronic posts containing the term "Kyscali 200," which is a breast cancer medication that has been out of stock in Lebanese pharmacies for some time and is being traded in the black market. The results showed that there were 17 tweets mentioning this medication in the last 5 hours of the search. Perhaps the absence of a team to track the source of the medicines is one of the main reasons hindering efforts to curb the spread of counterfeit drugs.
According to a report published by the World Health Organization, tracing the origin of counterfeit medicines is often difficult but not impossible, as it requires diverse sources of information that include reports from the national authority responsible for drug regulation, law enforcement agencies, pharmaceutical companies, NGOs, geographically conducted studies, in addition to conducting studies on a sample of therapeutic treatments.
Lebanese law describes the counterfeiting or smuggling of medicines as a crime, emphasizing the penalties for any action involving smuggled, expired, unregistered, or prohibited medicines as stated in the amendment of Article (92) of Law No. 367 published on 1/8/1994, where the person is punished with temporary detention and a fine.
