The World Health Organization (WHO) has received reports of falsified medicines from all regions of the world, with 1 in 10 medical products in low- and middle-income countries estimated to be substandard or falsified. This problem is not a new one – counterfeit and substandard drugs have a long history, with the supply of falsified anti-malaria drugs dating back to the early 1600s.

Amidst a surge in counterfeit obesity medication, awareness of counterfeit medicines can protect you and the people around you. This article explores why counterfeit medicine present a big issue and gives you practical advice on how to reduce the risk of being exposed to them to protect your health.   

Medicines go through rigorous testing and approval processes to ensure they are safe for the public and treat a disease in the way they intend to. There are many health authorities that ensure each product goes through this process and are only distributed through licensed and legitimate methods (for example, prescription-only treatments).

Falsified and counterfeit products imitate real, approved medicines, but are deliberately mislabelled and avoid this authorisation process. It can be helpful to understand these different definitions:

• Counterfeit medicines: are made by someone other than the genuine manufacturer and do not comply with intellectual-property rights/infringe trademark law
• Falsified medicines: are medicines designed to mimic real, authorised medicines
• Substandard medicines: these are authorised medical products that fail to meet either their quality standards or specifications, or both. For example, if a genuine medicine is stolen, improperly stored and then resold

Falsified medicines may be sold online or other unauthorised platforms and often do not require a prescription or consultation with a healthcare professional to be bought. Depending on where the medication is obtained, there can also be a substantial price difference between the falsified and authentic medicines.

A well-designed counterfeit product will appear to be the same as the real, approved medicine. However, variations to the active ingredients – the part of the medicine that treats a condition – may lead to harm. These can include:

• Incorrect quantities of the genuine, active ingredient
• Untested dosage of the genuine, active ingredient. For example, the quantity or suggested frequency for taking the medicine has not been formally approved
• Different active ingredient
• Active ingredients that have been transported or stored unsafely

Due to the nature of these products being produced and distributed via unlicensed channels, you cannot be sure of the contents of a counterfeit medicine. Not only could taking these medicines result in not getting the correct treatment, but they could also expose you to toxic or harmful ingredients that, together, have potentially dangerous consequences for your health.

It can be a worrying thought to know that counterfeit medicines could cross your path. These are some top tips on how you can protect yourself from the counterfeit products:

1. Are you using a well-trusted source?
   Most importantly, you should only take medications prescribed by a healthcare professional and distributed from a licensed provider. Counterfeit products are often sold on websites which are not associated with the real manufacturer.⁴ Signs to look out for are unwanted pop-up adverts, spelling or format inconsistencies, unusual URLs and payment platforms
   
   
2. Does the packaging and medicine look like it usually does?
   Counterfeit products will often have spelling errors, instructions that are not in your language, unsealed packaging or changes in the appearance of the medicine itself, for example, the smell, taste or colour. These are all indicators that the medicine is not authentic
   
   
3. Is a valid prescription needed?
   Prescription medications should only be taken on the recommendation of a medical professional who knows your personal medical history, has considered the risks and benefits for you, and can provide you with information about any potential side effects. If the source of an online medication does not need confirmation of a prescription, it is likely to be untrustworthy

If you have any suspicions that a medicine is not authentic, do not purchase or take it, and speak to your doctor, nurse or pharmacist.

Countries have different regulation and approval processes, which can lead to certain medicines being available in some countries and not others - even if the demand for a product is high. This creates an opportunity for counterfeit medication to fill these shortages and some people might be enticed by the promise of an online alternative, especially if they do not fully realise the risks of taking them.

Prescription medications that require approval from a healthcare professional to be distributed are a target for those making counterfeit medicine. Strict measures that require a medicine to be distributed by prescription only are in place to keep you safe, but they create an opportunity for counterfeit medication to target those who might not need them.

You should not take any treatment that hasn’t been discussed with your doctor. If you find yourself struggling to find a trusted source for a medication you need, it is best to speak to your doctor who can help you to decide the best course of action which protects your health and safety.