Adulterated, Misbranded, and Spurious Drugs: Are We Waiting for a Disaster to Wake Up? — Dr. Fiaz Maqbool Fazili
Dr. Fiaz Maqbool Fazili
If rotten meat on our plates has already shaken public trust in Kashmir, a greater and more silent danger lurks in our medicine cabinets: adulterated, misbranded, and spurious drugs. Unlike food scandals, which are visible and tangible, drug adulteration is invisible, insidious, and far more lethal. One tainted pill can mean the difference between life and death. The scene repeats daily across Kashmir: a diabetic patient takes their usual metformin and even Insulin prescription, yet their blood sugar remains dangerously high. A child’s infection worsens despite antibiotics. Meanwhile, the same medicines work flawlessly for relatives outside the valley. Doctors in Delhi warn patients about the quality of medicines available in the valley. This medical paradox has become an open secret among Kashmiris, fueling a crisis of confidence in the region’s healthcare system. Amid shocking seizures of rotten mutton, artificial eggs, and chemically-laden foods, the public now demands answers to an even more terrifying question—*are our medicines actually medicine
The Hidden Threat;While much of the public discourse has revolved around food safety, the issue of drug safety remains grossly underreported. Across low- and middle-income countries, and increasingly in India, fake or substandard drugs have infiltrated supply chains. For patients, this means a double jeopardy: the illness they suffer continues untreated, while the so-called “medicine” they consume may cause unforeseen harm.
What Are Misbranded and Spurious Drugs? The terms often confuse the public, but their implications are deadly: Adulterated drugs are medicines that are contaminated, substandard, or produced in unsanitary conditions. Misbranded drugs are medicines that carry false or misleading labels, exaggerated claims, or incorrect information about dosage, safety, or efficacy.Spurious drugs are outright fakes—imitations designed to pass off as genuine medicines, often sold under fictitious or incorrect names of manufacturers.
In simple terms, adulterated drugs harm health, misbranded drugs deceive, and spurious drugs kill.
Why Does This Matters Now? -Kashmir, like many other regions, faces a fragile healthcare system already burdened by overcrowded hospitals, shortages of specialists, and inconsistent regulatory oversight. If spurious or adulterated drugs creep unchecked into this system, the consequences could be catastrophic: A hypertensive patient unknowingly consuming fake antihypertensives risks stroke or sudden death. A cancer patient given a misbranded chemotherapy drug may lose months of precious treatment time.A child taking adulterated antibiotics may not just fail to recover but also develop resistant infections.These are not hypothetical fears. Globally, the WHO estimates that 1 in 10 medical products in low- and middle-income countries is substandard or falsified. In South Asia, the situation is far worse due to porous supply chains and weak enforcement.
Regulatory Failure; The Drugs and Cosmetics Act in India lays down strict definitions and penalties for adulterated, misbranded, and spurious drugs. Yet, enforcement remains patchy. Inspections are irregular, testing labs are underfunded, and penalties rarely deter repeat offenders. The result is a market where unscrupulous manufacturers and distributors gamble freely with public health.
The Next Disaster in Waiting; Kashmir cannot afford complacency. Just as the rotten meat scandal has forced society to confront questions of food safety and faith, the issue of unsafe drugs is a ticking time bomb. Unlike food, drugs enter the bloodstream directly—where the margin for error is zero.The question is not if but when a major tragedy will expose the cracks in our system. Are we waiting for hundreds of deaths, as seen in past tragedies in other parts of India and abroad, to finally wake up?
What Must Be Done?Strengthen Regulatory Surveillance-Regular, surprise inspections of pharmacies, wholesalers, and distributors must be conducted. Drug inspectors should be empowered with resources and independence.Upgrade Testing Infrastructure-Regional labs must be equipped with modern technology to detect substandard, misbranded, or spurious drugs swiftly and reliably.Enforce Traceability-Every medicine, from factory to pharmacy, must have a traceable supply chain. QR codes and digital verification systems can empower consumers to verify authenticity.
Public Awareness Campaigns-Patients must be educated to demand bills, check packaging, and be alert to anomalies in drug appearance, labelling, or effects.The sale of spurious and counterfeit medicines is a severe, data-backed public health crisis in Kashmir. While comprehensive Kashmir-specific data is scarce, national figures paint a dire picture. A 2017 study by the National Institute of Biologicals found that approximately 3.16% of drugs in the Indian market were Not of Standard Quality (NSQ), a category that includes substandard and spurious drugs. In certain therapeutic categories, this rate can be significantly higher.Applied to Kashmir’s population of over 12 million, this percentage translates to a massive volume of potentially dangerous medicines circulating annually. The problem is exacerbated by the region’s heavy reliance on pharmaceutical imports from outside the state. A 2014 report by the Drug and Food Control Organization (DFCO) in Jammu and Kashmir itself revealed that nearly 50% of drug failures in their tests were from brands manufactured outside the union territory.
These fake drugs often lack active ingredients, incorrect dosages, or contain harmful contaminants. They are most commonly found in antibiotics, painkillers, and medicines for chronic diseases like diabetes and hypertension. The primary drivers are the lucrative black market, porous borders enabling smuggling, and patients seeking cheaper alternatives. This illicit trade not only fails to treat illnesses but also breeds drug resistance, turning treatable diseases into deadly threats and eroding public trust in the healthcare system.
Unfortunately, many laboratories, especially in low- and middle-income countries (LMICs)/States/or Ut like ours, lack proper quality control systems. Internal quality control (IQC), which requires running control samples alongside patient samples, is often absent. Similarly, external quality assurance (EQA), which benchmarks results against reference laboratories, is rarely practiced. Machines are frequently poorly calibrated, reagents may be procured without standard certifications, and in many cases, inadequately trained technicians operate without supervision from qualified clinical pathologists. The consequences of poor lab quality are grave. Patients may suffer misdiagnosis in the form of false positives or false negatives, which can result in unnecessary treatments or, conversely, missed treatments. This not only erodes public trust in healthcare institutions but also escalates costs due to repeated testing, prolonged illness, and complications that could have been avoided with accurate results. To address this crisis, regular proficiency testing, mandatory participation in EQA programs, for instance, NABL accreditation plays a crucial role in enforcing baseline standards and stringent calibration protocols are essential to ensure accuracy. In short, laboratory tests are only as good as their accuracy and reliability. Without stringent internal and external quality controls, test results can become dangerous rather than helpful—transforming laboratories from places of healing into sources of harm.
Accountability of Manufacturers and Distributors; Heavy penalties, including cancellation of licenses and criminal charges, must be enforced against violators. Public “naming and shaming” of offenders is vital.Role of Civil Society and Media; Civil society organizations, watchdog groups, and responsible media must raise awareness and hold regulators accountable. Silence enables crime; vigilance prevents disaster.
The rotten meat scandal taught us how easily trust can collapse when regulators fail. But rotten food, however dangerous, affects digestion. Rotten drugs end lives.If adulterated, misbranded, and spurious medicines remain unchecked, Kashmir risks a public health disaster of unprecedented scale. The time to act is not after the tragedy—it is now.We must not wait for coffins to pile up before realizing that the drugs meant to heal us may, in fact, be poisoning us. — (to be concluded – the Deadly Trade of Spurious Medicines in Kashmir.
The writer is a Srinagar-based public health researcher and Clinical auditor , Certified professional in healthcare quality and patient safety can be reached at drfiazfazili@ gmail.com
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