Until recently, buying most drugs in Lebanon was as easy as buying chewing gum. Even without showing a prescription, you could order a drug by phone and get it delivered directly to your door. This changed a few months ago, however, when the country's minister of health banned pharmacies from running these home drug delivery services. The country is getting tough on pharmacies, in particular those that sell fake drugs.

In late January, Lebanon's Minister of Public Health Mohammed Jawad Khalifeh announced the government was temporarily shutting down nine pharmacies and four drug warehouses for two weeks. According to officials, these retailers and distributors were involved in selling counterfeit copies of Plavix (clopidogrel bisulfate), an anticoagulant used by people who have experienced a heart attack or stroke, and manufactured by Sanofi-Aventis. The fake lot contained only 40% of the active ingredient compared to normal pills, a percentage low enough to pose a grave problem for patients, according to the minister.

According to Ismail Sukarieh, a former member of Lebanon's parliament and the head of the National Association for Social Health, a nongovernmental organization focusing on health and pharmaceutical consumer rights, “30% to 40% of all drugs on the Lebanese market are either counterfeit or were withdrawn from the world market but still available in Lebanon.”

On a mission: Mohammed Jawad Khalifeh. Credit: Newscom

However, the head of the Order of Pharmacists of Lebanon, Ziad Nassour, rejects these numbers, saying that “no one can actually know the size of counterfeit, and Lebanon has been brave enough to acknowledge this problem.”

The ministry of health emphasizes the role of pharmacists in preventing the spread and promotion of counterfeit drugs. But experts disagree as to whether it is the responsibility of pharmacies to check that their drugs are not counterfeit versions. “It is one of pharmacists' responsibilities to abide by the law in buying the drugs from approved agents” says Nassour, “but it is the up to the authorities to protect the pharmacists from becoming drug brokers,” he stressed.

According to the ministry, this can be done by committing to purchasing medicines directly from approved importer agents or manufacturers and by sticking to the price list set by the ministry. Sukarieh points out that not all will follow these guidelines, as “some pharmacists are looking for quick profit.”

“Another problem appears when a national distributor warehouse buys drugs from unlicensed parties. This is not the pharmacists' responsibility,” Nassour adds.

According to Fady Koussa, the head of the regulatory department at Sanofi-Aventis Near East, in the case of the January crackdown, “this time, the hologram of the Lebanese Pharmaceutical Importers Association as well as the security label of the manufacturer on the Plavix boxes, which should guarantee it genuineness, had been forged!” Koussa adds, “in this case, it was difficult even to experts to differentiate between the genuine and fake drugs.” To distinguish the fake lot, the pharmaceutical company cooperated with the health ministry by bringing in special electronic detectors from France to do a full inspection of pharmacies.

Nassour notes that “so far, the investigations show that the pharmacists concerned had not promoted fake drugs, but bought them from the wrong places. This is a mistake, and they will be accountable for that.” Lebanese law considers fraud in pharmaceutical products only a felony, with a sentence ranging from 10 million to 50 million Lebanese liras ($6,600–$33,000) and from one to three years of prison. Given the threat of fake drugs, Nassour concludes that there should be an amendment to the law to give tougher sentences for counterfeiting and consider it as attempted murder.