Last week’s Tip discussed certain aspects of supply chain management. This week’s Tip continues that theme, with a particular focus on counterfeit medications. Counterfeit medications are not TYPICALLY a problem where it concerns the more “traditional” supply chains in the U.S. The problem is more prevalent in other countries; however, the fact that it is can be so problematic in other countries calls to question the practice of importation and re-importation. Additionally, it is widely known that some patients attempt to acquire drugs from specious sources, including pharmacies that are allegedly in Canada, but in reality could be based anywhere if operating solely online.

Rahman et al analyzed literature describing the health consequences of falsified medicines, focusing on mortality and morbidity, as well as the scale of the issue, the geographic extent, the medicines affected, and the harm caused at both the individual and population levels. Their review of 81 papers described 48 incidents in which falsified medicines caused patients to suffer serious adverse effects, injury, or death.  The distribution of incidents was examined according to the economic status of the countries involved, regional location in the world, therapeutic category of the medicines, number of incidents by year, number of victims by year, and characteristics of the falsified medicines. Among the 48 reported incidents, 27 (56.3%) occurred in developing countries and 21 (43.7%) in developed countries. The results of the review indicated that all types of medications have been targeted for falsification, and falsified medicines have had a serious impact globally. There were relatively few incidents in the U.S., but there were indeed a few of them, and among those several were more recent, including a report of Narco that had reportedly been adulterated with the addition of fentanyl and promethazine.²

Pharmacists and pharmacy managers must not only exert careful control over the supply chain of drugs to the extent possible, but also be aware that some patients might be receiving at least some of their medications through specious channels. Staff can be trained to look for red flags including questions from patients about online pharmacies from whom patients might already be acquiring or at least considering acquisition of drugs. Many of these suppliers will provide these patients with unsafe, adulterated products. This is especially the case for opioids and other drugs that are abused.

Additional information about Supply Chain Management in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

¹Rahman S, Yoshida N, Tsuboi H, et al. Review: The  health consequences of falsified medicines. Trop Med Int Health. 2018;  Oct 6. doi: 10.1111/tmi.13161.

²Vo KT, van Wijk XM, Lynch KL, Wu AH, Smollin CG. Counterfeit Norco poisoning outbreak San Francisco Bay Area, California, March 25 - April 5, 2016. MMWR Morb Mortal Wkly Rep. 2016; doi: 10.15585/mmwr.mm6516e1.