Cambodia is awash with counterfeit and out-of-date drugs, and taking precautions such as checking for authentic packaging and security holograms may not be enough to ensure that you get what you pay for at the pharmacy.
Philip Passmore, director of Pharmaceutical Services Management International Pty Ltd and a consultant for the World Health Organization, said fake drugs are often hard to detect because counterfeiters use sophisticated methods to distribute their drugs.
“Counterfeiting is done to dupe and fool the public,” he said. “Often with counterfeiting you cannot look at it and clearly say where it’s coming from.”
One category of drugs that has been targeted by counterfeiters is malaria medications.
A 2003 report by the National Center for Parasitology, Entomology and Malaria Control said “the use of counterfeit drugs may result in mortality of patients who would otherwise have survived their illness if available treatment had been given.”
The study began in May 2003 and covered Pursat, Battambang, Pailin and Preah Vihear provinces. A total of 351 out of 451 samples were purchased from unlicensed drug outlets, and 355 were not registered at the Department of Drug and Food at the Ministry of Health. Overall, 122, or 27 percent of the samples, were found to be fake and all were unregistered.
Dr Lon Chan Thap, with the senior technical bureau at the NCPEMC, said his office had investigated a company called Brainy Pharmaceutical which manufactured counterfeit quinine and tetracycline, both used to treat malaria. The label said the drugs were made in Thailand, but when the Thai Food and Drug Administration was contacted, it said no company by that name was registered.
“We don’t know where the company came from. [The label] had no address,” Lon Chan Thap said. “It’s a big problem with fake drugs. We cannot find the source of the drugs.”
Reiko Tsuyuoka, a malaria control scientist at the WHO, said one example of a counterfeit drug that is difficult to detect is artesunate tablets. Counterfeits of the drug have holograms on the box and the back of the pill package that are almost indistinguishable from those on authentic packages.
“It’s so good that it even fools some of the drug sellers,” Passmore said. “Imagine a product like that getting into the legitimate market.”
Dr Chroeng Sokhan, Deputy Director of the Department of Drug and Food, said a survey done in 2001 showed that 13 percent of drugs sold in both legal and illegal pharmacies are counterfeit.
“Usually we can never find the sources…. Everything is fake, including the label, address, origin, so it’s difficult to find,” Chroeng Sokhan said. “If you want to arrest people, only supplier and broker—but real producer can never be found.”
Cambodian authorities have so far made no arrests of counterfeit drug sellers, Chroeng Sokhan said.
In 2003, the Thai FDA confirmed that 17 drug companies with Thai labels selling products in Cambodia were not registered in Thailand. No pharmacies selling these products were shut down.
“So far no pharmacies shut down because there are a lot. We just warn them that these products are fake,” Chroeng Sokhan said.
The Cambodian drug and food department has given pharmacies six months to sell medicines with stickers that tell consumers whether the products are registered. If they do not comply, they will be fined, Chroeng Sokhan said.
The NCPEMC is also actively working to fight counterfeits through rapid alert systems. In Battambang, for example, a television spot that was aired about the danger of using fake drugs was “very effective” in alerting the public, Lon Chan Thap said.
Passmore said the WHO is working to make better, more comprehensive inspections and to make drug sellers more aware of their responsibility for drug quality.
Passmore advises those who have to buy medication to ask a lot of questions and to ask the pharmacis, “Can you guarantee this product?” He added that people who are regularly on medication should be familiar with the effects and should report any irregularities.