By Ayodamola Owoseye
With a doctor’s prescription in hand, the reporter walked into a pharmacy to buy some antibiotics.
Just as she was about to pay, she checked the expiry date on the package and found that the drug was about two months out of date.
Apologising profusely, the seller immediately tried to convince the reporter that the drug could still be used as it was yet to lose its potency.
He explained that drugs retain potency six months after the indicated expiration dates.
The reporter requested for any of the prescribed drugs that was yet to expire but all the stock of that prescription on the shelf were expired.
Doing a quick eye count, she realised there were more than six packs of that expired drug on the shelf.
Unlike the reporter, Yinka Taiwo did not check the expiry date on the drug she bought to treat a “splitting headache.”
“I was having this splitting headache, body pain and feeling feverish,” Ms Taiwo recalled.
“I walked into a pharmacy in Abeokuta and bought paracetamol, anti-malaria drug, and multivitamins.
“I immediately started using the drugs. It was my friend that saw that the date on the paracetamol and multivitamin drug was expired. We went back to the pharmacy but the pharmacist said he would only change the drugs, not refund my money. But I was adamant as I no longer trusted the pharmacy.”
In a bid to assess the extent to which expired medicines are sold in Nigeria, PREMIUM TIMES, using one of its social media platforms, conducted a survey. The result was alarming.
It showed there are lots of expired drugs sold from the shelves of pharmacies and chemists. It also indicated that a Nigerian at one time or the other had bought expired drugs at pharmacies or drug stores across the country.
Also, it was noted that many Nigerians are concerned about the standard of drugs sold in the country.
Most of the people who commented complained that drugs sellers alter the expiry dates on the drugs.
The Nigerian health authorities had mainly focused on the fight against fake and substandard drugs. But Nigerians also want the agencies in charge of drug monitoring and control to look into the widespread sale of expired drugs across the country.
Bidemi Bello bought an expired drug at a popular drug store in Oyo town.
“I bought an expired drug at Shekinnah Pharmacy in Oyo town. I discovered alterations of the expiry date and I called the seller’s attention but she was adamant.
Therefore, we ended up at Durbar police station,” she said.
Another Nigerian, Barimon Iyeleema, from Port Harcourt, said he discovered that the drug had expired before making payment.
“I called the seller’s attention immediately and she apologised and gave me another one.
But I pretended that the drug was too expensive and left without buying anything again.
“I stopped patronising that pharmacy as I cannot guarantee the standard of the drugs sold there,” he said.
Omeiza Ajayi was treated with an expired injection at a specialist hospital in Kogi State, years ago.
He said the injection solvent used to dissolve the injection solute (powder) had already expired two months earlier.
He said he had taken the injection for three days before checking the expiry date on one of the used bottles.
“It was then that I discovered that the product was expired. I complained, but the hospital told me that when a product expires, it can still be used within six months after the expiration date.
Another Nigerian, Ajibo Diamond, said he bought some anti-malaria tablets in 2018 in Akwa Ibom. The manufacturer’s date stated the drug would expire in 2021. I threw it away.”
Murtala Musa said he sent someone with the prescription to buy nystatin suspension for his chid. But on reading the label of the drugs, he realised that the expiry date was altered.
“I took it back to the man but he refused accepting it until I threatened him with legal action,” he said.
Maikano Abdullahi said he once bought some drugs with a friend at Kasuwan Barcci in Kaduna. They also noticed that the expiry dates were all altered.
However, Mr Abdullahi said the Nigerian authorities were right to be more concerned with fake drugs. For the expiry dates, he said the drug dealership pharmacies should know how to manage their drugs before they expire.
How expired are expired drugs?
The big questions are: Do pills expire and when should they be removed from the shelf? And what happens when expired drugs are ingested?
Drug expiration is the date after which a drug might not be suitable for use as manufactured. This is also referred to as the shelf life of a drug. Consumers can determine the shelf life for a drug by checking its pharmaceutical packaging for expiration date.
While the World Health Organsiation says “it is recommended not to use expired drugs at all”, some argue that the drugs are still safe for consumption.
WHO said expired stockpiles present serious problems with serious implications. It said expires drugs imply financial losses because they should no longer be distributed and must be discarded.
The UN health agency said expired drugs must be disposed of safely without harming people and the environment.
“Pharmaceutical products may lose their potency in the degradation process. Physical changes may also lead to reduced absorption, rendering the product less effective. The manufacturer of a pharmaceutical product can only be held responsible for any harmful effect of the product within its shelf life and only if the product was transported and stored under conditions recommended by the manufacturer”, it said.
Also, the Food and Drug Administration said expired medical products can be less effective or risky due to a change in chemical composition or a decrease in strength.
“Certain expired medications are at risk of bacterial growth and sub-potent antibiotics can fail to treat infections, leading to more serious illnesses and antibiotic resistance.” it said.
However, a report by the Harvard Health Publishing – Harvard Medical School said most times, expiration dates on drugs do not necessarily mean that the drugs are no longer fit for consumption.
Quoting a column published in Psychopharmacology Today, it said, “it turns out that expiration date on drugs does stand for something, but probably not what you think it does.”
It explained that due to a law passed in 1979, drug manufacturers were required to stamp an expiration date on their product.
The expiration date is that which the manufacturers can still guarantee the full potency and safety of their product.
The report, however, said a research conducted by the FDA for the military, found out that 90 per cent of more than 100 drugs, both prescription and over the counter, were perfectly good for use even 15 years after expiration date.
“The expiration date does not really indicate a point at which the medication is no longer effective or has become unsafe to use. Nevertheless, a rare exception to this may be tetracycline, but the report on this is controversial among researchers,” it stated.
The report, however, agreed that the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date.
This it said exclude drugs like nitroglycerin, insulin, and liquid antibiotics.
The National General Secretary, Pharmaceutical Society of Nigeria, Emeka Duru, said, “for most people who sell expired drugs in their stores, it is not intentional.”
Mr Duru said the sale of expired drugs cannot always be ruled out especially in large drug stores. He said it is advisable for pharmacists to check their stocks from time to time. “But no matter how they try, they might still miss out on some,” he said.
“I don’t think any pharmacist would like to sell expired drugs. No matter how you try, one way or the other, there might be cases of expired drugs especially in big pharmacies where they have lots of drugs on the shelf.
“It is not that it is intentional. It is either they forgot or sometimes the drugs might be rare drugs which the pharmacy bought for keep in case it is demanded and this can make them forget until there is a demand for it,” he said.
Mr Duru, however, said he was not justifying the sales of expired drugs.
“The sale of expired drug is not good or the agreed norm and the association do not support that.
“It is conventional, when you make a drug, you write expiry date. But that does not mean that the drug has become dangerous or has side effect when expired.”
He said a problem expired drug might have is that the potency might reduce.
He explained that if the potency of the drug is supposed to be 100 per cent, after six months of expiration, or longer, the potency can drop to 75 or 65 per cent, “and that is unacceptable.
“This is because a drug must achieves 100 per cent potency for it to do the right work that it is dedicated for. It is not that it has become dangerous and that when it is taken it becomes poisonous,” he said.
Mr Duru added that the best way to fight the sale of expired drugs in the country is by creating awareness among the people.
He advised Nigerians to always purchase their drugs from registered pharmacists, and not patent medicine stores.
He also encouraged patients or individuals to check the expiry date and observe the colour of the drug they are buying He explained that a drug that is said to expire in 2022 indeed can expire in 2019 because of the storage or hazard of the element of nature on the drug.
“Therefore, we press people that when you buy a drug, before you use it look at the colour of the drug and do a thoroughly physical examination. You know the size of paracetamol by experience and if you noticed that the size has become small, that is degradation and you are not expected to consume it.
“We will encourage and advise individuals and patients when they buy drugs, check the expiry date, make physical observations and ensure that the drug specification meets what the drug should be like.”
Mr Duru said whenever an expired drug is bought; it is the duty of a pharmacist to replace it with a good one.
“A drug that expires is not just about the date. It is about the wholesomeness. If a drug is meant to be yellow, and it currently blue, pink or black; automatically, your mind will tell you there is something wrong and you assume the drug is not wholesome. As such, the drug should be treated as expired,” he said.
According to Mr Duru, there is a mechanism in place for the disposal of expired drugs in Nigeria.
He said there is a central collection point for expired drugs, where expired drugs are collected from pharmacies and disposed of.
He also added that the National Agency for Food and Drug Administration and Control (NAFDAC) helps with the collection and disposal of expired drugs.
‘Expired drugs are counterfeit’
The NAFDAC spokesperson, Abubakar Jimoh, said the agency is trying its best to curtail the sale of counterfeit drugs in the country.
Mr Jimoh said expired drugs can be regarded as counterfeits because they are not fit for consumption.
He advised Nigerians to speak up anytime they buy expired or counterfeit products, adding that NAFDAC needs to work with Nigerians in terms of intelligence gathering.
“We need Nigerians to work with us in terms of intelligence gathering as the country is very big and we do not have enough manpower to carry out the necessary intelligence duty,” said Mr Jimoh.
“That, however, does not mean that people should be selling counterfeit or substandard drugs.
“Over the years, NAFDAC has done its best to curtail it. we are working and trying to stem the tide. we are approaching it from the enforcement terms, we seize, arrest peddlers and sometimes we take them to court, he said.
Mr Jimoh explained how NAFDAC handles the disposal of seized drugs in Nigeria.
“We have warehouse across the country where we store seized drugs,” he said.
“We dispose them either through crushing or burning. We often time are careful with the burning of these drugs because we do not wait it to get into the environment. This can have an hazardous effect. so we go into the far bust to burn. This is because we do not have an incinerators although the government has promised to build some for the agency.”