Strategies and Systems-Level Interventions to Combat or Prevent Drug Counterfeiting: A Systematic Review of Evidence Beyond Effectiveness

Abstract

BackgroundA recent systematic review suggested that drug registrations and onsite quality inspections may be effective in reducing the prevalence of counterfeit and substandard drugs. However, simply replicating the most effective interventions is problematic, as it denotes implementing the intervention without further adaptation.ObjectiveThe aim was to systematically review the evidence beyond effectiveness for systems-level interventions to combat or prevent drug counterfeiting.MethodsWe conducted an extensive search, including an electronic search of 14 databases. We included studies examining the efficiency, feasibility, reliability, and economic outcomes of the interventions, as well as barriers and facilitators to their implementation. Two reviewers selected eligible studies and abstracted data in duplicate and independently. We synthesized the results narratively, stratified by type of intervention.ResultsOf 10,220 captured citations, 19 met our inclusion criteria. The findings suggest that the following may strengthen regulatory measures (e.g., registration): minimizing drug diversion, enhancing lines of communications, ensuring feedback on drug quality, and promoting strict licensing criteria. There is evidence that onsite quality surveillance and inspection systems may be efficient and cost-effective for preliminary testing of large samples of drugs. Laws and legislation need to be specific to counterfeit drugs, include firm penalties, address online purchasing of drugs, and be complemented by education of judges and lawyers. Public awareness and education should rely on multiple platforms and comprehensive and dedicated content. While product authentication technologies may be efficient and reliable in detecting counterfeit drugs in the supply chain, they require a strong information system infrastructure. As for pharmacovigilance systems, it is critical to tackle the issue of underreporting, to enhance their chances of success.ConclusionSeveral factors are critical to the successful design and implementation of systems-level interventions to combat or prevent drug counterfeiting. Policymakers need to take these into consideration to ensure success of these interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s40290-016-0156-4) contains supplementary material, which is available to authorized users.

Public and pharmacist perceptions towards counterfeit medicine in Lebanon using focus groups

“…13 Furthermore, participants stated that the shortage of medicine increases the demand for cheaper medicine that are highly likely to be counterfeits, which is supported by a number of studies. 1,7,10,36 In Poland, people who had low monthly income found the low cost of CFM attractive, and consciously bought them due to their availability and low cost, increasing the demand for CFM.…”

“…10 Identifying the appropriate interventions required for the educational, managerial and regulatory programs may lead to the development of beneficial interventions. 36 Additionally, pharmacists' awareness and CFM education can play a key role in educating and counselling patients about CFM that can empower the public by decreasing their vulnerability towards CFM, improving detection and reporting of CFM, thus reducing their availability/use.…”

Risks Associated with International Trading of Medicines by Non-Licensed Entities and Non-Professionals

“…What is really said here is that the ight against illegal trading of medicines as well as the production and sale of drugs of abuse should be a top priority for ministries of health, inances and justice of nations of the world [140,166]. The belief that current and existing national and international interventions suice to handle this problem is clearly contradicted by the facts on the grounds.…”

Investigation of the Quality of Antibiotics-Based Amoxicillin for Monitoring of Some Different Medicine Markets of Democratic Republic of Congo

“…However, if governments adopt to have a unique centre of labelling and packaging, these technologies would be useful to detect fake in generic medicines. In any case, the quality control of the drugs at the level of the distribution points (pharmaceutical wholesaler, medical center and pharmacy) is necessary to evaluate the quality of the drugs consumed by the population and thus to apprehend the tracks of the solutions to fight against poor quality drugs [19] [20].…”