One in four Cape Verdeans purchase drugs through illicit means. This and other data from the 2012 Pharmaceutical and Food Products Regulatory Agency (ARFA) study help to understand why, only between August and September this year, authorities seized more than 98,000 tablets at Praia airport.
It is not known for sure how many medicines a year enter illegally in the country. ARFA, which has the responsibility of approving any drug that enters and circulates in the country and which, together with the National Police (PN) and the General Inspection of Economic Activities (IGAE), the team that supervises the entry of drugs does not have the numbers. It is only known from the study carried out in 2012 that a quarter of Cape Verdeans admit that they buy medicines outside their own regulated areas.
The study, an ARFA initiative that had 1528 individuals in Santiago and 2206 individuals nationwide (65.9% female and with a mean age of 40.2 years), had the objective of collecting “real data “On the illicit purchase of medicines, on the proportion of the population that consumes drugs from the illegal circuit, on the geography of the illicit sale of medicines at national level, on the best-selling medicines and on identifying the reasons for purchasing those products in the illegal circuit .
The survey showed that the practice has a higher occurrence on the island of Santiago (35.4%, followed by the island of Maio with 31.8%, São Vicente with 24.2% and Brava island with 15.8% %). At county level, the greatest weight of this informal market is found in the municipality of Praia (38.9%).
In his PhD thesis – “A Pharmacovigilance Model Proposal for Cape Verde”, defended in 2016 at the Faculty of Pharmacy of the University of Lisbon – Djamila Reis, Chairman of the Board of Directors of ARFA, points out that, worldwide, the market is estimated at more than € 55 billion per year, “the proportion of which varies between countries with an estimate of between 1% and 60% depending on the regulatory and control capacity of the distribution system.” Between 2000 and 2006, this market will have increased by 800%, with authorities estimating around 800,000 deaths caused by these drugs sold illegally during this period.
The researcher warns that “in developing countries, characterized by greater problems of access to the drug, equity in access, coupled with the weaknesses of regulatory systems, the escalation of the illegal market is becoming dramatic”, which has a strong repercussion on health of the population and also in the economy.
“It is demand that makes the market,” says Ester Gonçalves, director of Pharmaceutical Regulation who admits that the regulator does not yet have a general notion of the amount of drugs that enter illegally in Cape Verde but advances with the names of the most frequently seized (37.92), ibuprofen, with a relative weight of 27.25% and amoxicillin, representing 13.79% of the total sales, of total sales. Another common occurrence in listed seizures, which also includes drugs for dermal use, is Sildenafil (a generic of the Viagra family).
Demand makes the market. And when those who seek find, it is perceived that not everything that is sold in the clandestine market falls into the hands of the supervisory authorities. Example: Cytotec (Misoprostol). A prescription drug for stomach diseases, it is widely used in the country as an abortifacient by women who, according to the 2013 study, bypass direct recourse to the public health service to stop unwanted pregnancies.
The number of women entering the public health service in an abortion process intentionally provoked by the drug, proves that the drug – which is not on the list of authorized sales drugs in the country – clandestinely enters Cape Verde and circulates on the streets. But much more hidden than other drugs sold on the illicit market.
“We have already made inroads, together with the police authorities and the IGAE, for commercial establishments and markets where we seized illicitly sold drugs but Cytotec is not found among these drugs. That is, it is sold even more clandestinely. And we know that it is sold for certain purposes because then there are the cases of women who enter the health services with complications due to the use of Cytotec as an abortifacient, “says the young director of Pharmaceutical Regulation.
Demand makes the market, and the market defines the price. The clandestinity of the drug makes it one of the most expensive in the illegal sales circuit. A box with 60 of these tablets manufactured to treat stomach ulcers is sold legally in Portuguese pharmacies for 20 euros (just over 2000 escudos). In the Cape Verdean clandestine market one Cytotec tablet is sold for 1500 escudos. A profit of about 90,000 escudos per box sold.
This information is advanced by a pharmacist with long years of professional experience who prefers anonymity to tell us what she knows about counterfeiting and illicit drug sales.
She is “surprised and happy” with the news of the recent arrests made by the authorities. “So the customs services have started to act in this direction,” he says. Surprised also because “I was aware that this illegal selling of pills had subsided. In the old days we saw a lot of trays on the street; now no longer. ”
In the decades that already leads in the sector says he has already seen everything. Venders in the market with cartons of pills in sight that try to hide when they perceive their curiosity, clients of the pharmacy that drives that appear with medicines that bring or receive from the United States – Centrum and other food and energy supplements and multivitamins, especially – and of Europe (most of the time Tylinol) and even in an unusual episode in which the patient who needed the medicine died. They tried to sell him insulin, a medicine that requires constantly controlled refrigeration conditions.
“Obviously we do not. What we sell are medicines that were previously monitored, which had a transport in ideal conditions of temperature, humidity, well maintained. Everything we sell has to have the seal of Emprofac or another distributor, “he says.
The head of pharmacy explains that the importation of medicines in Cape Verde is centralized. Everything that is legal enters Cape Verde in two ways: via Emprofac or through the international aid offered to the country through the Ministry of Health.
They illegally enter through airports and ports. And at least in the case of so-called “men’s coffee” (a powder quite popular in African countries for its alleged effects similar to Viagra), our interviewee points to rabidants as the major “importers” and sellers of the substance, regularly among those seized by authorities. This is when the drug is legally available in pharmacies with a prescription. There, the number of users who buy it is low.
“Maintaining the quality of a drug is key. A paracetamol adulterated by bad conditions of conservation can transform itself into something else and not have the desired effects, or until having another effect, become something toxic. No wonder we spend so much money on electricity to have the air conditioning at the right temperature in the pharmacy, “insists the drug specialist, who reminds the risks of self-medication the danger of increasing resistance to antibiotics.
The poll conducted by the regulatory agency brought the worrying revelation that most respondents were aware of the risks involved in buying illegal drugs. The reason given for this risk behavior by the majority of respondents is related to proximity and quantity. That is, they replied that having the possibility to buy the medicines in places closer to the health structure of their region and in smaller quantity (not having to pay the price of a complete package when what they need are only a few tablets, for example) was a reason to opt for the clandestine market.
Maybe that’s why some pharmacies also end up selling medicines for units of tablets. It is our pharmaceutical interviewee who confirms it, saying that she knows about this procedure in pharmacies in the interior of Santiago.
As already mentioned, in addition to the potential for counter-reaction to occur, the use of contraband drugs often results in increased health care expenditures due to delay in the correct treatment and probable need for ancillary intervention.
The way to get around this is through enforcement and repressive actions by the authorities, but mainly by the information and education of the population. Because, as Ester Gonçalves said, it’s the demand that makes the market. And this is what the recommendations of the study say: bet on a campaign of communication and information of the population in order to know the risks that run.
And this is what ARFA has been doing in recent years, according to the director of Pharmaceutical Regulation. Brochures, information leaflets and TV programs were produced, but also the training of the PN and IGAE agents was promoted, as well as the increase in supervision and coordination between these different entities, which is now bearing fruit, as exemplified by the apprehensions that in recent years years have been occurring.
Finally, legislation also deserves attention. “At that time we have some regulations in public consultation. For example, the decree-law that establishes the price of medicines [Decree-Law No. 22/2009] is under review, “explains the ARFA technique.
On the other hand, and as already mentioned, the chairman of the ARFA board of directors has produced a doctoral thesis proposing a model of pharmacovigilance system adapted to the conditions of Cape Verde, a model in which the repetition of the (then unpublished) study the purchase of counterfeit and illicit drugs is suggested.
Six years ago, the current situation of the illicit drug market is of interest. That is, whether the inspection, information campaign and other measures introduced have had an effect.
Text originally published in the printed edition of theExpresso of the Islands nº 877 of 19 of September of 2018.