Counterfeit and Substandard Medicines: How to Spot Them

What this article covers

What are substandard and falsified medicines, and why do they differ?
Why is the Arab region more exposed to this problem?
How to check a medicine's packaging before you use it
Safe and risky ways to buy medicines
Which medicines are most commonly falsified in this region?
What to do if you suspect a medicine is fake
Buying medicines online: a risk that deserves its own heading
How to choose a trustworthy pharmacy

What are substandard and falsified medicines, and why do they differ?

The World Health Organization draws a clear line between two types of problem medical product. Substandard medicines are manufactured by a licensed producer but fail to meet the quality specifications they are supposed to meet, for example an antibiotic tablet that contains only 60 percent of the stated active ingredient. Falsified medicines are presented as a known product but are manufactured by an unlicensed party with deliberate intent to deceive.

Both types are dangerous, but for different reasons. A substandard medicine may fail to treat the infection or condition because its effective dose is too low, which in the case of antibiotics can actively promote antimicrobial resistance, a serious regional and global problem. A falsified medicine may contain entirely unrelated substances, chemical contaminants, or biological material that causes direct harm.

A 2025 study in BMJ Global Health covering patients and health professionals in Jordan found that a meaningful proportion of respondents reported personal experience with a medicine they suspected was not authentic. The study confirms that this is not a theoretical concern but one that affects real people in countries close to us.

In areas affected by conflict or where formal regulatory systems have weakened, such as parts of Syria, Yemen and Libya, the risk increases sharply as normal supply chains collapse and informal suppliers fill the gap. But it is worth noting that online channels and informal social-media sales mean that even countries with stronger regulatory systems face exposure to poor-quality products from outside their borders. Personal vigilance matters regardless of where you live.

The difference between substandard and falsified medicines

Type	Definition	Main risk
Substandard	Made by a licensed manufacturer but fails quality standards	Low dose, treatment failure, antibiotic resistance
Falsified	Presented as a known medicine but made to deceive	Wrong or harmful ingredients
Unregistered	Has not passed regulatory review in the country	No guarantee of safety or effectiveness

Why is the Arab region more exposed to this problem?

A 2013 survey of pharmacovigilance systems across 13 Arabic-speaking countries published in Drug Safety found significant gaps in adverse event reporting and medicine surveillance in most of them. These gaps mean that many substandard products are never discovered or reported, allowing them to circulate undetected. A weak regulatory environment is the ideal setting for poor-quality products to thrive.

Several factors increase the risk in this region: limited capacity in national drug regulatory authorities in some countries, porous or poorly monitored borders that allow smuggled goods to enter, and the high cost of original branded medicines which pushes some buyers toward cheaper sources of uncertain origin.

Informal pharmacies that sell medicines without a prescription also play a role, because they often source outside the regulated supply chain. When you buy a medicine from an unlicensed seller, there is no chain of custody and no guarantee of product integrity.

How to check a medicine's packaging before you use it

Careful inspection of packaging will not catch every falsified product, but it catches many of the less sophisticated ones. Start with the print quality on the box: is it sharp, clear and free of spelling mistakes? Original medicines are printed to a high industrial standard, and fakes often have blurred fonts, off-register colours or misaligned text.

Check the expiry date and manufacturing date: are they printed clearly and in a way that cannot be easily rubbed off? Are they consistent with each other and with the expected shelf life of the product? Also check the batch number (Lot number): it should appear on both the outer box and the inner packaging, and they should match.

Look at the tablets or capsules themselves: are they uniform in size, shape and colour? Any variation within a single blister pack is unusual and worth questioning. An unfamiliar smell, or a different taste in a medicine you have taken for a long time, are also signals to stop and ask before continuing.

A 2021 study in the American Journal of Tropical Medicine and Hygiene evaluated systematic visual inspection as a field method for identifying suspect medicines and found that a structured visual check of packaging is a meaningful first filter that can flag products requiring further laboratory analysis. What you can detect with your own eyes is a genuinely useful first line of defence.

Checking your medicine before use: practical steps

1Examine box printing: clear, sharp and free of spelling errors
2Check expiry and manufacture dates: clearly printed, not handwritten
3Verify the batch number appears on both outer box and inner packaging
4Inspect tablets or capsules: uniform size, shape and colour throughout
5Read the package leaflet: must be present, legible and in a language you understand
6Ask yourself: is the price significantly lower than you would normally expect?

Safe and risky ways to buy medicines

A licensed, registered pharmacy is the safest place to buy your medicines. A licensed pharmacy sources from approved distributors, is subject to periodic inspection by health authorities, and keeps records of its supply chain. While this does not eliminate all risk in every country, it reduces it dramatically.

Street markets, informal wholesalers and general convenience stores have none of this oversight. Buying medicine from a grocer or an informal trader increases the risk of receiving a product of unknown origin.

Online purchasing carries by far the highest risk. A 2022 surveillance study published in Scientific Reports covering 13 low- and middle-income countries found that a significant proportion of medicines purchased from informal non-pharmacy sources were substandard or falsified. Social media advertisements and unfamiliar websites selling weight-loss drugs, performance enhancers or health supplements represent very high-risk channels, and the WHO has flagged these categories as consistently problematic globally.

Which medicines are most commonly falsified in this region?

Not all medicines are targeted equally. The most commonly falsified products are those with high demand, high price, or both. In the Arab world, the most commonly targeted categories include antimalarials and tuberculosis treatments in affected areas, widely used antibiotics, cardiovascular medicines including antihypertensives, thyroid hormone replacement, and medicines for erectile dysfunction.

Weight-loss products, herbal supplements and immune-boosting preparations sold outside formal pharmacy channels represent another high-risk category. Many of these were never tested in clinical trials, some carry unproven or outright false medical claims, and regulatory oversight of this segment is weak in many countries.

Biological medicines including insulin, rheumatology biologics and expensive treatments for chronic diseases are increasingly targeted as their prices rise. A patient searching for a cheaper alternative to a costly medicine is the profile most likely to encounter a falsified product, and the one whose health is most at risk from receiving a compromised version.

What to do if you suspect a medicine is fake

First step: do not use the medicine if you have serious doubts about it. The risk of a falsified product almost always outweighs the risk of a short delay in starting treatment. Keep the packaging intact, including all the packaging and the batch number, because this is evidence when you report.

Speak to your pharmacist or doctor directly and describe what you noticed. They are equipped to assess the product and help you obtain a verified alternative. In several Arab countries, the national food and drug authority operates a reporting hotline for suspect medicines. These reports are not just paperwork: they help authorities identify patterns and take action against suppliers.

The World Health Organization operates a global reporting system for substandard and falsified products called RAS-SF, which receives reports via its regional offices. Reporting is not only protecting yourself; it is a contribution to the safety of everyone around you who might encounter the same batch.

Unusual side effects that you have not experienced before on the same medicine, or a sense that the medicine is controlling your symptoms less well than it used to, are worth mentioning to your doctor as a possible signal of quality change. Doctors in the region are more aware of this issue than is often assumed, and naming it directly as a possibility will help your doctor investigate properly.

Buying medicines online: a risk that deserves its own heading

Online pharmacies have expanded rapidly across the Arab world in recent years, and some are licensed and reliable. However, a significant proportion operate outside any regulatory framework. An advertisement for a medicine on a social media platform at an attractive price is not any kind of guarantee that the product is genuine or safe.

A 2011 survey of pharmaceutical wholesalers in developing countries published in BMC Health Services Research found that awareness of counterfeit medicine risks was low even among supply-chain professionals, suggesting that the ordinary consumer faces a significantly higher risk than commonly understood. If even trained wholesalers could be deceived, the unaided consumer buying online is more vulnerable still.

The practical rule: if you are not certain that an online pharmacy is licensed by your country's health authority, do not buy from it. A medicine of unknown origin and unknown storage history can harm you more than it helps. For over-the-counter items such as cold remedies, supplements and painkillers, purchase only from known, named pharmacies.

A quick practical check: most national drug authorities in the Arab world publish lists of licensed online pharmacies on their websites. In Saudi Arabia, SFDA maintains a searchable register. If a site selling medicines cannot be verified against such a register in two minutes, that is reason enough not to buy from it.

How to choose a trustworthy pharmacy

A trustworthy pharmacy has a qualified pharmacist present who you can ask questions of, displays its licence visibly, sells medicines in sealed original packaging, and will hand you your prescription and return it to you rather than keeping it. If a pharmacy sells you a medicine that has been split from its original packaging, or refuses to name its supplier, these are negative signs worth taking seriously.

Building a relationship with a pharmacist you know by name is genuinely protective over the long term. A familiar pharmacist knows your medication history and can flag it if a particular batch of a medicine looks different from previous ones. That kind of ongoing familiarity catches problems that a one-off inspection of the box never could.

If you have moved to a new neighbourhood or country, take the time to identify licensed pharmacies near you before you need one urgently. Finding a good pharmacy when you are healthy and can ask careful questions is far easier than searching under the pressure of illness.

The Sihtak app lets you keep a record of your regular medicines, their correct names and the pharmacies where you buy them, so you always have a reference to check against when a purchase looks different from what you expect. The app is an organisational tool and does not replace a pharmacist's assessment of any specific product.

Frequently asked questions

How can I tell if a medicine I bought is fake?

There is no foolproof method with the naked eye, but warning signs include poor print quality on the box, spelling mistakes, variation in the size or colour of tablets, a price far below what you normally pay, and a sense that the medicine is less effective than usual. If you have any concern, stop using it and speak to your pharmacist before continuing.

Are generic medicines more likely to be falsified than branded ones?

No. Falsification targets both branded and generic medicines. A generic medicine produced by a licensed manufacturer to quality standards is safe and therapeutically equivalent to the original. The key variable is the manufacturer and the pharmacy you buy from, not whether the medicine is branded or generic.

Are smuggled medicines always counterfeit?

Not always fake, but always unknown. A genuine medicine that travelled through an uncontrolled supply chain may have been exposed to heat, humidity or contamination that rendered it ineffective or harmful, even if it appears normal. The risk is unquantifiable, which is itself the problem.

Are herbal supplements safe because they are natural?

Being natural is not a safety guarantee. Many supplements sold in the region have never been tested in clinical trials, and some contain undisclosed pharmaceutical ingredients or contaminants. Buy supplements only from licensed pharmacies, and tell your doctor if you are taking them alongside prescribed medicines, because interactions are possible.

How do I report a suspect medicine in my country?

Contact your national food and drug authority directly. In Jordan this is JFDA, in Saudi Arabia it is SFDA, and most Arab countries have an equivalent body. Keep the packaging, batch number, and purchase details as evidence. Your report can trigger an investigation that protects many others from the same batch.

Is buying via pharmacy delivery apps safe?

It depends on whether the partner pharmacy is licensed and named. Apps that work with specific licensed pharmacies and deliver medicines in sealed original packaging are generally safe. Apps or websites that offer medicines at opaque prices without identifying the partner pharmacy require significant caution.

Can I check whether a medicine is registered before I buy it?

In some Arab countries yes, through the website of the national regulatory authority. Jordan's JFDA and Saudi Arabia's SFDA both maintain searchable online registers. In countries where the database is not consistently updated, the register is less reliable, but checking it is still a worthwhile step before buying an unfamiliar product.

Sources

This content is for health education only and is not a substitute for medical advice. If you have symptoms that worry you, see your doctor.