People in the Ivorian commercial capital, Abidjan, can be seen leaving the doctor’s office, prescription in hand, heading not to the pharmacy but to Roxy market in the Adjame neighbourhood, where the same medicines can be had for a fraction of the price.

That is a problem, according to health officials who recently launched a campaign to stem the uncontrolled sale of prescription drugs.

“When people buy medicines in the streets it poses many problems, including inappropriate medicines for the condition, incorrect dosage, lack of knowledge of interactions with other medicines, and lack of surveillance by a medical professional,” said World Health Organization spokesperson Daniela Bagozzi.

She added, “It’s part of an overall problem of the supply of quality medicines in the developing world.”

Risks

Cote d’Ivoire, like other countries across the continent, is battling a flood of counterfeit drugs – products that range from mixtures of toxic substances to inactive, ineffective concoctions. But piled next to these on market tables are also medicines that belong in the pharmacies but make their way into street vendors’ hands.

Often through a lack of controls, prescription drugs end up in the market, where they are not stored properly and might be sold after their expiration date, health officials say. In Cote d’Ivoire, medicines are also making it to the black market through theft either by bandits or by workers who make off with drug stocks and sell them.

“The risks are many,” said Parfait Kouassi, president of the national council of pharmacists (CNOPCI). “Street medicines have caused a dangerous increase in kidney dysfunction, cardiovascular problems, perforated intestines, hepatitis and resistance to antibiotics.”

Health authorities last month struck off a pharmacist found to be a major provider to street vendors. “But, alas, nothing has been done concretely to stop this,” the CNOPCI’s Kouassi said.

CNOPCI recently announced that the street sale of prescription drugs is worth nearly 3 billion CFA francs (US$6.2 million), or about 30 percent of the national pharmaceutical market.

The pharmacists’ group is asking the government to improve controls, to tackle both the trafficking of counterfeit drugs and the uncontrolled sale of prescription drugs. “We have asked for reinforced regulation… a commitment from the government against all illegal dispensation of medicines, which represents an unacceptable threat to patients,” Kouassi said.

WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients take them incorrectly. “Irrational use of medicines is a major problem worldwide,” WHO says. “The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards.”

One pharmacist told IRIN the improper sales of prescription medicines must be stopped. "We know that some higher-ups are implicated in this medicine trade," said Anges Tape. "It is time to think about putting an end to this for the sake of people's lives."

Amateur pharmacists

Fanta Kone, a vendor in the Roxy market, says the little she knows about medicine she learned from the young men who come and sell cartons of medicines from area pharmacies. “Sellers from the pharmacies deliver medicines in bulk and we resell them at a profit of 10 to 20 percent,” she said. “I didn’t study medicine or even pharmacology. But when our providers come with the medicines, I ask their professional advice.”

The vendors’ lack of medical knowledge does not stop people like Jacques Koffi, who regularly buys his blood pressure medicine on the black market. “I’m sure to find the medicines I need here. I buy in the black market every time I have a prescription… I don’t have the means to buy this kind of prescription [in the pharmacy] every month.”

“All sorts of medicines are available here,” Kone told IRIN. “Whatever the ailment a person has, we offer him the product he needs to get well,” she added with a smile.