Counterfeit medicines kill: drawing the public's attention to the dramatic and dangerous increase in counterfeit drugs on the global market is the aim of this year's International Nurses' Day theme.

Countering the worldwide threat of counterfeit medicines is the International Council of Nurses' (ICN) focus for this year's International Nurses Day, May 12. Counterfeit medicines, says ICN, have killed and injured thousands of people around the world, particularly in developing countries.

NZNO supports this campaign, but has decided to modify the patient safety theme to fit New Zealand's situation (see editorial, p2). It notes that there is no evidence of counterfeit medicines being a major problem in this country.

According to information supplied by the ICN, counterfeit medicines make up more than ten percent of the global medicines' market and are found in both developed and developing countries. The World Health Organisation (WHO) estimates that up to 25 percent of the medicines used in developing countries are counterfeit or substandard, particularly those sold on the street. Annual earnings from counterfeit medicines are estimated to be over US$32 billion globally.

"In developing countries, medicines that are commonly found to be counterfeit are those used to treat life-threatening conditions such as malaria, tuberculosis (TB) and HIV/AIDS," said ICN president Christine Hancock. "Cough syrups are commonly counterfeited in India. In wealthier countries, expensive lifestyle medicines such as drugs to combat erectile dysfunction, hormones and steroids, and antihistamines appear to be the most likely to be counterfeited."

Counterfeit medicines can kill. In 1992, 233 Bangladeshi children died after taking a paracetamol-based syrup that was tainted with antifreeze. In 1995, 2500 children in Niger died after taking a fake meningitis vaccination. Of the one million deaths that occur from malaria annually, as many as 200,000 would be avoidable if the medicines available were effective, of good quality and used correctly.

ICN intends that its IND theme--Nurses for Patient Safety: Targetting Counterfeit and Substandard Medicines--will become the centrepiece of a multi-sector campaign aiming to raise awareness of the increasing availability of counterfeit and substandard drugs; provide tools to identify counterfeit drugs and to report any suspicious medicines; and encourage nurses and other health professionals to lobby governments and regulatory authorities for appropriate legislation, drug regulation and law enforcement against counterfeit drugs.

ICN calls on nurses and national nursing associations to:

* look out for counterfeit and substandard medications;

* enquire about any doubtful medications; and

* denounce counterfeit and substandard medications to the appropriate authorities.

Nurses should also monitor drug effects and side effects, and be vigilant for signs of counterfeiting, such as improper packaging and labelling. "Nurses are in a good position to educate the public about the dangers of buying medicines through the Internet or on the streets from unauthorised sources," said Hancock. "They should lobby governments and pharmaceutical companies to set fair prices for medicines, as the high cost of medicines in developing countries makes them unaffordable to large sectors of the population. This increases the risk of counterfeiting.

"When nurses are dispensing medicines, they should took out for products that are not intact, that have been altered, damaged or that have unsealed packaging. Some of the main consequences of counterfeit medicines include treatment failures, erosion of public confidence in health care, prolonged illness, unexpected side effects, antimicrobial resistance, and even death."

According to a WHO definition, a counterfeit medicine is one which is deliberately and fraudulently mislabelled with respect to identify and/or source. It may include products with the correct ingredients but fake packaging, with the wrong ingredients, without active ingredients or with insufficient active ingredients. Counterfeit products may also contain high levels of impurities, contaminants and even toxic substances. A substandard drug is a genuine medicine produced by legitimate manufacturers that fails to meet quality specifications and standards.

Counterfeit medicines are among the main causes of antimicrobial resistance in infectious diseases such as TB. For example, counterfeit antimicrobials, with deliberately reduced amounts of the active ingredient, can turn a TB case that could be cured in three months at a cost of US$11 into a multi-drug resistant TB that takes two years to treat and is over 100 times more expensive than the first-line drugs used to treat non-resistant forms. It is estimated that five percent of all antibiotics sow globally are fake drugs that claim the lives of victims worldwide.

Epicentres of counterfeit drug production are China, Nigeria and the former Soviet Republics, according to pharmaceutical companies. Other sources include Egypt, Pakistan, India and Indonesia. ICN warns that the Internet has extended the reach of those seeking to sell counterfeit drugs. This now means that anyone in the world is a potential victim. Viagra, a drug used to correct erectile dysfunction, is reportedly the most counterfeited drug for sale on the Internet. Nurses can advise patients not to purchase medicines off the Internet where there is no guarantee that the product is authentic, says ICN.

For further information, see the ICN website: www.icn.ch.