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Counterfeit drugs reach NHS supply chain

A BBC documentary discovers counterfeit medicines in the NHS supply chain and looks at the increase in drugs purchasing online

A BBC documentary has investigated the increasing problem of counterfeit medicines in the UK and even discovers fakes making their way into the NHS supply chain.

In Fake Medicines, part of the BBC's Fake Britain series, presenter Dominic Littlewood investigates just how easy it is to buy prescription-only medicines over the internet and looks at the often devastating effects that counterfeit medicines can bring.

Purchasing prescription-only medicines online
During the programme, Littlewood uses an online 'pharmacy' website to purchase a selection of prescription only medicines. He opts for Plavix, used to protect against heart attacks and strokes; Clomid, a potent fertility drug; Atorvastin, a generic version of cholesterol-lowering Lipitor; flu vaccine, Tamiflu; Reductil, a weight loss therapy; Propecia, for the treatment of hair loss in men and the erectile dysfunction treatment, Viagra.

After a few weeks various packages arrive. Shockingly, the Plavix comes with a free sample of Viagra – a combination that could be fatal in patients with a heart condition.

The drugs are taken to the London School of Pharmacy where they are analysed by Professor Tony Moffat. A chemical analysis shows the Viagra to be fake, but the Tamiflu, Reductil and Propecia are found to be real.

These prescription-only medicines have the potential to cause serious damage and could even be fatal if taken without medical supervision. The hair loss treatment, Propecia, for example, can cause infertility if handled by women.

The generic version of Lipitor, which should not be on the market as the drug is still under patent, is taken to manufacturer Pfizer for investigation. The tablets bought over the internet are found to contain far less of the active ingredient than the real product.

Lipitor works by lowering cholesterol levels, thereby reducing the risk of events such as a heart attack. If a patient is not receiving the full dose of the active ingredient, they are not receiving the protection they need.

Far more profitable than heroin
Talking about the increasing global counterfeit medicine market, Heidi Wright from the Royal Pharmaceutical Society explains that $1,000 invested in ingredients to produce heroin results in a profit of $3,000 – a 200 per cent profit margin, whereas $1,000 invested in ingredients to produce fake prescription drugs results in a profit of $30,000, or 2,000 per cent.

During the programme, viewers are shown footage of tatty, disorganised and non-sterile premises in South America where some of these counterfeit medicines are produced. We even see containers of boric acid (used as an insecticide) being used in the production process.

These backroom 'factories'' paint a very different picture to the 'shop front' websites with images of clinicians in white coats giving innocent users the impression of a professional, legitimate company.

"If consumers and patients and the public saw the back rooms, it is unlikely they would visit the front room," says Jim Thomson from European Alliance for Access to Safe Medicines (EAASM).

How are counterfeit medicines finding their way into the NHS supply chain?
Counterfeiting of prescription medicines is now so sophisticated that healthcare professionals and being fooled. Since 2004, there have been ten serious recalls of counterfeit medicines that have made their way into the NHS.

In June 2007, the Medicines and Healthcare products Regulatory Agency (MHRA) issued three recalls within days. The fake drugs in question were Zyprexa, used to treat the symptoms of schizophrenia, Cosodex, for prostate cancer, and Plavix, for stroke and heart conditions.

The MHRA seized around 40,000 packages of the drugs but estimates that there are still around 30,000 unaccounted for – some of which Phil Cottrell, security directory for sanofi-aventis (manufacturer of Plavix), believes will have been taken innocently by NHS patients.

Littlewood also meets Angela Allinson from Preston, whose eight-year-old daughter has type 1 diabetes and must inject insulin four times a day. Ms Allinson was shocked to discover she had been injecting her daughter with fake needles, supplied to her on the NHS, for two weeks.

"It never even crossed my mind that someone would counterfeit needles," says Ms Allinson.

In the UK, pharmacists and wholesalers aim to get the best price for medicine. It is perfectly legal for them to buy products from elsewhere in Europe, providing the drugs are repackaged and contain the patient information leaflet in English. This means that drugs could potentially be re-packed and exchanged several times across Europe before reaching the UK market.

Heidi Wright explains: "The NHS supply chain is actually quite complicated, so this makes it slightly easier for counterfeiters to infiltrate the medicines supply chain."

She goes on to explain that there is no definitive audit trail for medicines in the UK. In some European companies, it is a requirement that batch numbers are recorded on the way in and out of the country. This is not required in the UK for drugs for human use, but is a requirement for veterinary medicines.

Pharmacist Zafar Khan tells the programme he is very worried about the current counterfeit situation and would like to see an international clampdown. "These medicines can kill," he says.

Fake Medicines was aired on BBC1 on March 11, and is available to view via the BBC iPlayer

Unfortunately, the BBC's iPlayer is not accessible to users outside of the UK.

You can find out more about the work of the EAASM on the EAASM website

12th March 2010

From: Healthcare


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