Health sector in peril as adulterated drugs rampant

The deaths of three children who had anaesthesia for cochlear implants at Bangabandhu Sheikh Mujib Medical University (BSMMU) in December and January raised suspicions about the drug administered for the procedure. The hospital administration then sent samples of the halothane used in the anaesthesia to the laboratory for testing.

The test confirmed adulteration of halothane. 

Following this discovery, the health ministry issued several instructions, including using isoflurane or sevoflurane instead of halothane at all public and private hospitals across the country.

The adulteration of a critical drug like halothane reflects the current state of the country's medicine market, healthcare professionals said. 

While efforts have been made to address issues with halothane, there has not been enough focus on the adulteration of other drugs in the market, they added.

Take the instance of albumin injection, used for treating liver cirrhosis. In November last year, the authorities arrested a manufacturer of fake albumin. Doctors are aware of the availability of counterfeit versions of this medication, leading many to refrain from its use. 

A few months ago at Sylhet MAG Osmani Medical College, a patient with liver cirrhosis died after receiving an albumin injection. Other patients too were admitted to the ICU due to complications from the drug. Later, doctors at the hospital decided not to use albumin medicine.

Dr Kabir Ahmed, assistant registrar at the hospital, explained that albumin is primarily used for liver cirrhosis, improving patients with watery livers. It is occasionally used for kidney or other diseases, but it is not widely discussed like halothane due to fewer candidates for the drug. 

Over the past 5-6 months, adulterated albumin has become more common, he said. When poor patients purchase this medicine for Tk7,000-Tk8,000 and suffer adverse reactions, they blame the doctors. 

"Therefore, we have stopped using this drug, leading to increased patient suffering," he added.

Dr Chanchal Chowdhury, assistant professor, Department of Gastroenterology, BSMMU, said patients experience various reactions to adulterated albumin, with some requiring ICU admission. They now only use albumin from reputable drug makers. 

A doctor recently posted on Facebook, "Fake albumin, fake pethidine, fake halothane... and when the patient dies, it's all the doctor's fault!!" 

The doctor said he had not seen the authorities conducting any campaign against these counterfeit drugs.

Antibiotic made of flour 

The law enforcement authorities recently seized counterfeit antibiotics that were specifically designed to mimic high-demand but scarce antibiotics in the market. These fake drugs were packaged to appear genuine, but inside the packaging, they contained capsules or tablets made of flour.

On 31 March, police confiscated 4,96,300 fake antibiotic tablets from Dhaka and Barishal, valued at approximately Tk2 crore. Five individuals were apprehended during this operation.

At a press conference, police officials disclosed that the gang operated by setting up factories in Savar and Cumilla, where they manufactured these tablets. The fake drugs were then stored in Barishal before being distributed to various districts of the country through courier services. This criminal operation has been going on for the past 8-10 years.

Although law enforcement agencies occasionally arrest individuals involved in manufacturing these counterfeit drugs, they often resume their illegal activities shortly after being released on bail, thanks to the influence of the fake drug syndicate.

'Lack of will in stopping fake drugs'

Dr Muniruddin Ahmed, former professor, Faculty of Pharmacy, University of Dhaka, told TBS that due to the lack of will of the authorities, fake medicines are rampant in the market. "If the police want, they catch counterfeiters within an hour."

He said the Directorate General of Drug Administration (DGDA) lacks the manpower to oversee the numerous pharmacies in the country. Besides, there is an absence of drug specialists or pharmacists in significant positions within the Drug Administration.

"Dishonest people tamper with medicines without fear of consequences because there are examples of counterfeiters going unpunished even when evidence linked fake paracetamol to child deaths," he added. 

What authorities are doing

Bangladesh has the "Drug and Cosmetics Act 2022" , which imposes a maximum penalty of 10 years in prison and a fine of Tk10 lakh for manufacturing adulterated drugs.

According to the DGDA, in 2023, it conducted raids through 1,696 mobile courts, 8 drug courts, and 447 magistrate courts, resulting in fines totalling Tk1.73 crore. 

However, there was no information available regarding imprisonment for manufacturing adulterated drugs.

Regarding this issue, Health Minister Dr Samanta Lal Sen informed TBS that it is the responsibility of the Directorate General of Drug Administration (DGDA) to monitor and address concerns related to adulterated drugs. 

"I have instructed them [DGDA] to take strict action in this regard," the minister added.

Md Salah Uddin, director at DGDA, said halothane is not available in drug stores and hospitals procure it through company agents. 

"As it's not sold in pharmacies, we were unaware of counterfeit versions," he added. "We have instructed field officials to check hospitals for fake halothane, and daily raids have been ongoing since 27 March, but no counterfeits have been found yet."

He said post-market surveillance is conducted to find fake drugs at the field level. "However, manpower shortage remains a challenge as only one or two officers are working at this level."