By Adeola Bakare

In bustling cities like Lagos, Abuja, Port Harcourt, and Kano, a silent public health emergency is unfolding—one that lurks behind pharmacy counters, across hospital wards, and inside medicine cabinets. It is not a virus or a new disease. It is something more familiar but just as deadly: fake and substandard drugs.

While the term counterfeit medicine is often associated with intellectual property crimes or smuggling rings, its real impact is deeply human and tragically overlooked—it directly compromises patient safety. In Nigeria’s urban healthcare landscape, where millions rely on prescription and over-the-counter medication daily, the threat of unsafe pharmaceuticals is not only real but pervasive.

When treatment becomes a threat
Consider this: A young woman diagnosed with typhoid fever visits a reputable clinic in Abuja. She is prescribed antibiotics, purchases them from a nearby pharmacy, and begins treatment. Days later, her condition deteriorates. What she didn’t know—and what her doctor couldn’t immediately suspect—was that the medication she received contained only trace amounts of the active ingredient. She was essentially taking a placebo. Unfortunately, her story isn’t rare.

According to the World Health Organisation, WHO, substandard and falsified medical products are most prevalent in low- and middle-income countries, accounting for 1 in 10 medical products. In Nigeria, a 2018 report by NAFDAC, National Agency for Food and Drug Administration and Control, estimated that 15-17 per cent of drugs in circulation were either fake or substandard—a staggering number with grave implications for public health.

Urban irony
Urban centers, despite their better infrastructure and access to healthcare, are not spared. In fact, they may be more vulnerable due to high demand for medication in dense populations; thriving informal drug markets where unregulated vendors compete with licensed pharmacies; digital pharmacies and online drug sales, which are often difficult to trace or regulate; overburdened health facilities that unintentionally source low-cost, unverified medicines to meet demand.
These factors form a toxic mix—one that undermines not just treatment outcomes, but patient trust and safety.

Patient safety
The global conversation on patient safety often revolves around surgical errors, infections, or misdiagnoses. However, pharmaceutical integrity remains a critically under-discussed pillar of safe healthcare delivery, especially in Nigeria.
When a patient takes a counterfeit drug: their illness may worsen, leading to unnecessary hospitalization or death; drug resistance can emerge, especially with substandard antibiotics; additional costs are incurred—economically burdening families and the healthcare system; clinician trust is eroded, making it difficult to assess treatment failure accurately; patient safety isn’t just about what happens in the operating room or on the hospital bed—it extends to every pill swallowed in good faith.

Systemic gaps
Despite efforts by regulatory bodies like NAFDAC and PCN (Pharmacists Council of Nigeria), several challenges persist: inconsistent enforcement of pharmaceutical regulations; gaps in drug supply chain monitoring, especially at the point of retail; corruption and counterfeit infiltration within some licensed establishments; public ignorance, where patients unknowingly purchase from unlicensed vendors; limited consumer tools for verifying drug authenticity; recent technological innovations like the Mobile Authentication Service (MAS)—which allows consumers to verify drugs via SMS—have helped, but awareness and usage remain low.

What can be done?
Strengthen Enforcement and Surveillance: Regulatory bodies must adopt real-time supply chain tracking technologies and increase on-the-ground inspections in urban pharmacies.

Public Education Campaigns: Patients need to understand the risks of buying from unlicensed sources and be empowered to ask questions and verify their medications.
Healthcare Provider Training: Doctors and pharmacists must be trained to recognize signs of drug ineffectiveness that may indicate substandard medicines.
Support Local Manufacturing: Promoting locally produced, regulated drugs can reduce reliance on imports and close gaps that counterfeiters exploit.

Expand Patient Safety Frameworks: Hospitals and clinics must include pharmaceutical integrity checks as part of broader patient safety protocols.

Prescription
Patient safety must go beyond prescription. The fight against counterfeit and substandard drugs in Nigeria cannot be left solely to regulators or law enforcement. It must become a core concern for healthcare providers, patients, and policymakers alike. If a patient cannot trust that their medication is what it claims to be, true patient safety will remain out of reach.

To protect the health of Nigerians, especially in our cities, we must begin to treat drug quality not as a pharmaceutical issue—but as a life-or-death matter of patient safety.

Bakare, a pharmacist and patient safety advocate, writes from the US