The World Health Organisation (WHO) defines a medication as any substance or composition that presents curative or preventive properties for human or animal diseases and includes any product that can be administered for medical diagnosis, restoration, correction, or modification of organic functions. The sale of unregulated prescribed medications on the streets remains an enduring challenge in healthcare systems worldwide.
Street-sold prescription drugs are drugs obtained illegally on the streets without their validity being controlled by a regulatory body or without the involvement of an authorized healthcare professional (pharmacist). The intersection of limited access to affordable healthcare and the unregulated drug market poses significant public health challenges in certain regions.
This article will focus on the problem of street-sold drugs, its causes, consequences, and potential solutions in the paragraphs that follow.
In some areas, people consume illegally sold drugs due to their addictive nature, like nicotine, which is prevalent in areas with high addiction rates, such as Colombia and Mexico. In developing countries like Cameroon, Nigeria, and the Congo, people use essential medications such as antipyretics (Paracetamol), painkillers (aspirin), antimalarials (Artemether), and antibiotics (amoxicillin) illicitly due to limited access to affordable healthcare (same in conflict zones).
People turn to illicit drugs because of the lack of affordable healthcare in certain areas of developing countries, coupled with the poor road conditions. This makes buying drugs in local markets, where they are abundant there due to the weakness of national pharmaceutical regulatory authorities, an easier option.
Again, some tribes and religious beliefs don’t accept the use of modern medicine, let alone drugs sold on the streets. Additionally, financial constraints lead individuals to illicit drugs because of their cheap cost, and illiteracy causes people to buy illicit drugs without being aware of their dangers.
Teenagers mostly purchase narcotics due to peer pressure, a desire to feel bold, and addiction. Illicit drugs obtained from street vendors may lead to risks and consequences like the inability to attain complete treatment as the drug may be counterfeit or stored in poor conditions, which may destroy the active ingredient (street vendors do not have extensive knowledge of drug interactions) and increase healthcare costs.
Also, misusing of antibiotics leads to resistance; antibiotic resistance is the result of not taking the prescribed dose of an antibiotic as required, as in the case of amoxicillin, which acts on both gram-positive and gram-negative bacteria by destroying their cell wall (the peptidoglycan layer). If the appropriate dosage isn’t used, exposing the bacteria to the drug without putting enough in to kill it causes the bacteria to develop adaptor mechanisms to protect itself so that if it is exposed to the drug another time, it won’t be killed so easily.
Constant exposure of the drug to certain microorganisms could lead to reduced effectiveness due to changes developed by the organism itself.
A bacterium can acquire resistance by either modifying its DNA during cell replication, referred to as mutation, or by inserting the organism’s gene into its own, becoming part of the bacteria’s genetic material and thus becoming resistant to the drug. Therefore, upon the introduction of the drug again, only non-resistant organisms are affected, while resistant bacteria remain unaffected and preferentially proliferate. Each organism acquires resistance differently, depending on its type. For instance, the resistance mechanisms of Beta-lactams differ depending on the type of bacteria. For Gram-negative bacteria, it is modified in a way to produce Beta-lactamases, while in Gram-positive bacteria, resistance is achieved by modifying its target site, the penicillin-binding proteins1. This is one of the reasons patients, after misusing an antibiotic, complain later that it is not effective anymore.
Drug interactions can occur. Drug interactions are when two or more drugs react with each other or with foods, beverages, or medical conditions. Drug interactions can affect the effectiveness, safety, or side effects of the drugs involved. Drug interactions can be pharmacodynamic when the drugs act at the same or similar receptor site or pharmacokinetic when the drugs affect each other’s absorption, distribution, metabolism, or excretion2.
Food-drug interactions: it is how food reacts with drugs. Example: milk (dairy products) and antibiotics3. Drug-drug interaction is how one drug would affect the activity of another drug. Such as warfarin. Drug-condition interaction: your medical conditions can affect the way a drug works or lead to side effects. For example, taking a nasal decongestant like pseudoephedrine if you have high blood pressure may worsen your high blood pressure, aspirin, and peptic ulcers.
These consequences can remove the public’s trust in health care systems, professionals, providers, and national medicine regulators.
Most vulnerable communities to the use of street sold medication are located in rural areas of developing countries and conflict zones around the world.
To reduce the consumption of street-sold drugs, public awareness strategies should focus on the following approaches:
Firstly, engage religious or community leaders: In rural areas of developing countries and conflict zones, it is crucial to involve leaders who already understand the problem. These leaders should be trusted by the community and able to participate in sensitization campaigns. If necessary, they should also be proficient in the local language to effectively communicate with the population.
Secondly, prioritize results over mere discussion: Rather than relying solely on talk, it is essential to encourage action. Those who are receptive to advice from health professionals can significantly improve their lives by receiving complete treatments for their diseases. Additionally, others can benefit from health professionals’ guidance, leading to overall better health. This positive impact can extend to their close friends and family members.
Use targeted awareness methods: In rural areas, consider using radio stations for those who cannot read. For literate individuals, distribute printed leaflets in languages they understand. These materials should emphasize staying away from street-sold drugs and provide examples of essential medications commonly used in daily life.
Also, use of multimedia platforms: Creating pamphlets and short animated videos to sensitize the population. These materials can be shared on popular platforms like WhatsApp, Facebook, and TikTok. By breaking down complex drug-related information into simpler forms, we can enhance understanding and encourage informed decision-making.
Again addressing misconceptions: Sensibilization efforts should combat the misconception that patients with symptoms similar to those of a friend should receive the same medication without seeking professional advice.
Pharmacists are drug experts who understand the biochemical make-up of medicine, how they work, side effects, interactions, and efficacy. Community pharmacists play a very important role in educating the public about the dangers of street-sold medications. The first point of contact, they provide reliable information and advice for consumers and patients4, the trust that patients place in their pharmacists enhances medication adherence rational drug usage (the main reason for which patients prefer street-sold drugs).
The trust between pharmacist and patient is strengthened in the following ways; pharmacist keep professional secrets, rationalize drug use to avoid unnecessary poly-pharmacy and unnecessary drug cost, pharmacist exhibit gentleness patience in counselling patients in detail about how the medication is to be taken.
Again, modalities of recourse to a pharmacist is made easy with advice and support from a pharmacist. This support can be done through medication reviews, phone calls, and in-person visits. Pharmacies in vulnerable communities could be made more accessible.
Pharmacists dispensing proper medication, giving appropriate dosage information, and being able to catch potential drug interactions are also responsibilities of a pharmacist. These actions prevent death or the acquisition of new diseases and increasing the cost of treatment. Factors, such as dosage information, help the patient take the appropriate dose, helping the patient stay in the therapeutic window for optimal therapy.
Law enforcement attempts to disrupt illicit drug markets in numerous ways, These attempts include to control or reduce the illicit supply or distribution of drugs, interfere with the activities of drug market participants, or arrest and convict some of these participants. Each type of illicit drug market disruption is triggered differently, requires different kinds of resources and strategies, and involves a different level of law enforcement intervention. However, much of law enforcement is local, and, not surprisingly, many law enforcement disruption programs focus on local drug markets, most often street level, open-air drug markets. To combat the use of illicit drugs, government policies and regulations could be implemented, such as; Drug supply disruption approaches involve; disruption of drug availability and prices, mostly through drug seizures; disruption of drug production; disruption of drug trafficking (importation and exportation); disruption of the supply of counterfeit and contraband pharmaceuticals; and, disruption of cyber drug markets.
Despite countless national and international efforts to interdict drugs, disrupt the drug supply chain and limit the availability of drugs on illicit markets, drugs have remained plentifully available nearly everywhere on illicit markets.
Also, space-based disruption strategies aim to reduce the selling of illicit drugs, which consist of local space-based disruption strategies focused on the bottom end of drug markets, the street level which include, disturbing established markets, thereby reducing public disorder, as well as interrupting supply and thereby driving up drug prices and increasing the time drug users must spend searching for drugs. Police crackdowns, high visibility policing, and problem-oriented policing, among others.
Again, disruption strategies targeting illicit drug market participants (three variations of that strategy are identified): disruption strategies that focus on drug users; law enforcement strategies to disrupt illicit drug markets disruption strategies that focus on participants in local drug markets, including by using a focused-deterrence approach; and strategies that focus on disrupting the criminal organizations and networks involved in an illicit drug market by focusing on key individuals.
The latter includes surveillance, the infiltration of criminal organizations to arrest and convict their leaders, and strategic attempts to identify the vulnerabilities of the criminal networks and target individuals that play a key operational role in them.
The fact that criminal organizations tend to have the ability to recover and pursue their criminal activities after a disruption suggests that isolated law enforcement disruption activities of that nature are likely to remain unsuccessful at reducing the activities of criminal networks5.
Furthermore, the strengthening of legislative texts and punishment of violators of legislative texts and regulations relating to drugs and the practice of pharmacy are essential.
Additionally, UNODC, in reinforcement of strategies already in place, supports Member States in practically implementing international drug policy commitments and leads the follow-up process with the Commission on Narcotic Drugs, keeping in mind the 2024 progress review.
Partnering with United Nations entities, academia, relevant national and regional institutions to foster a coherent position, UNODC will strengthen national data collection capacity as well as monitoring and analysis of the world drug problem. This will facilitate the development of evidence-based, human rights-compliant, and gender-sensitive policies and programs5.
International collaborations to combat street-sold drugs are as follows: Collaboration between national, regional, and international law enforcement with various international organizations involved in the fight like Interpol to improve global operations against drug trafficking and gain assistance in ongoing investigations; Criminal analysis of intelligence on drug trafficking routes, comprehensive training for police worldwide to better tackle drug trafficking6.
Also, coordinated policy initiatives and information sharing can strengthen the fight against this public health threat.
In conclusion, the global challenge of street-sold prescribed medications presents a complex and multifaceted problem that requires a coordinated effort from all international and national organizations, healthcare professionals, and patients.
Education about the risks associated with purchasing prescription drugs from unauthorized sources and implementation of measures to protect public health can help us move towards safer practices for obtaining medications, prevent harm, and attain optimal therapy. Moving forward, it will be crucial to continue raising awareness, strengthen regulations, and support public health initiatives to address this issue.
Bibliographic References
- Omairi R, Krayem M, Khaled S, Salla M, El Khati S. Antibiotic residues in milk and milk products: a momentous challenge for the pharmaceutical industry and medicine World J Pharmacol 2022; 11(4): 48-45
- “Drug Interaction Checker Quickly Check Your Meds.” Drugs.com,
- The Pharmaceutical Journal, PJ, 19 July 2014, Vol 293, No 7819;293(7819)::DOI:10.1211/PJ.2021.1.69976, Last updated 18 March 2021 17:16
- Agomo C.O. The role of community pharmacists in public health: A scoping review of the literature. J. Pharm. Health Serv. Res. 2012;3:25–33
- Dandurand, Yvon. “Law Enforcement Strategies to Disrupt Illicit Drug Markets 1-2 Review of the Literature.” ResearchGate, Nov. 2021,
- “UNODC Strategy 2021-2025.” United Nations : Office on Drugs and Crime, www.unodc.org/unodc/en/strategy/full-strategy.html.
- Our Role in Fighting Drug Trafficking. www.interpol.int/en/Crimes/Drug-trafficking/Our-role-in-fighting-drug-trafficking.
- https://medlineplus.gov/drugreactions.html
- World health organisation (WHO). “Substandard and falsifies medical product”.2019
- Kumar B, Baldi A. The Challenge of Counterfeit Drugs: A Comprehensive Review on Prevalence, Detection and Preventive Measures. Curr Drug Saf. 2016;11(2):112-20. doi: 10.2174/1574886310666151014114633. PMID: 26463250.