Recognition of Substandard and Falsified Medicine Red Flags among Pharmacy Students

Lara Samyan Hayhat

Abstract


Substandard and falsified medicines threaten treatment effectiveness, patient safety, antimicrobial stewardship, and public confidence in health systems. This study compared the recognition of substandard and falsified medicine red flags among pharmacy students with and without prior drug-quality-related exposure. An exploratory single-institution study involved 50 undergraduate pharmacy students, divided into an unexposed group (n = 25) and a prior-exposure group (n = 25). Prior exposure included community pharmacy training, pharmaceutical analysis or drug-quality coursework, or formal teaching on substandard and falsified medicines. A 34-point questionnaire assessed knowledge, scenario recognition, and counseling readiness. Group differences were analyzed using the Mann-Whitney U and Fisher’s exact tests, with rank-biserial effect sizes and odds ratios reported. The groups were similar in age and sex but differed in academic year, with more senior students in the prior-exposure group. Content-validity indices were at least 0.938, and Cronbach’s alpha ranged from 0.721 to 0.907. Median knowledge, scenario-recognition, counseling-readiness, and total scores were 8 versus 5, 11 versus 8, 7 versus 5, and 26 versus 18, respectively (all p < 0.001). Rank-biserial effect sizes ranged from 0.806 to 0.976. Prior exposure was associated with higher recognition and counseling-readiness scores. However, the findings do not establish causality because of the small convenience sample, single-institution design, academic-year imbalance, absence of multivariable adjustment, unavailable item-level data, and lack of external instrument validation. Larger prospective multicenter studies with academic-year matching or adjustment and external validation are needed.

Keywords


Substandard and falsified medicines threaten treatment effectiveness, patient safety, antimicrobial stewardship, and public confidence in health systems. This study compared the recognition of substandard and falsified medicine red flags among pharmacy st

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References


World Health Organization, “Substandard and falsified medical products,” Fact sheet, Dec. 3, 2024. Available: https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products

B. A. Mekonnen, M. G. Yizengaw, and M. C. Worku, “Prevalence of substandard, falsified, unlicensed and unregistered medicine and its associated factors in Africa: a systematic review,” J. Pharm. Policy Pract., vol. 17, art. 2375267, 2024. Available: https://doi.org/10.1080/20523211.2024.2375267

B. Chabalenge, T. Sahota, I. Ermolina, and S. Tanna, “Substandard and falsified medicines in Africa: healthcare systems challenges, supply chain issues, regulatory challenges and strategies to increase access to quality medicines,” Front. Pharmacol., vol. 16, art. 1708784, 2025. Available: https://doi.org/10.3389/fphar.2025.1708784

M. M. Sorato, M. Davari, and A. Kebriaeezadeh, “Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: scoping review,” J. Med. Access, vol. 8, art. 27550834241236598, 2024. Available: https://doi.org/10.1177/27550834241236598

J. Ahmed, L. Modica de Mohac, T. K. Mackey, B. T. Raimi-Abraham, and M. Orlu, “A critical review on the availability of substandard and falsified medicines online: incidence, challenges and perspectives,” J. Med. Access, vol. 6, art. 23992026221074548, 2022. Available: https://doi.org/10.1177/23992026221074548

M. M. Falah, E. Daar, D. Zahra, and M. J. Dillon, “Prevalence, experience and awareness of substandard and falsified medicines among the public and healthcare professionals in Jordan,” BMJ Glob. Health, vol. 10, art. e018189, 2025. Available: https://doi.org/10.1136/bmjgh-2024-018189

A. Persson, M. Troein, S. Lundin, P. Midlov, and C. Lenander, “Exploring pharmacists’ perspectives about substandard and falsified medical products through interviews,” Explor. Res. Clin. Soc. Pharm., vol. 13, art. 100421, 2024. Available: https://doi.org/10.1016/j.rcsop.2024.100421

N. Mourad, C. Haddad, H. Sacre, S. Al Tawil, R. M. Zeenny, S. Younes, et al., “Knowledge, practices, and recognition ability of counterfeit medicines among Lebanese community pharmacists during concurrent national crises,” Sci. Rep., vol. 16, art. 109, 2026. Available: https://doi.org/10.1038/s41598-025-29268-9

Z. Kusynova, Y. Bais, H. A. van den Ham, A. K. Mantel-Teeuwisse, G. Etame-Loe, E. Kaale, et al., “Improved knowledge on substandard and falsified medical products through a dedicated course for pharmacy students at three universities in sub-Saharan Africa,” BMJ Glob. Health, vol. 6, no. Suppl. 3, art. e009367, 2023. Available: https://doi.org/10.1136/bmjgh-2022-009367

A. Selcuk, Z. Kusynova, and J. B. Hertig, “Guide for educators to implement newly developed course on the risk of substandard and falsified medical products sold online,” J. Med. Access, vol. 9, art. 27550834251342900, 2025. Available: https://doi.org/10.1177/27550834251342900

International Pharmaceutical Federation, A Curriculum for Addressing the Risk of Substandard and Falsified Medical Products Sold Online: A Handbook for Educators. The Hague: FIP, 2024. Available: https://www.fip.org/file/6047

I. M. E. Bakker-’t Hart, D. Ohana, and B. J. Venhuis, “Current challenges in the detection and analysis of falsified medicines,” J. Pharm. Biomed. Anal., vol. 197, art. 113948, 2021. Available: https://doi.org/10.1016/j.jpba.2021.113948

E. Melia, A. English, and B. D. Naughton, “The impact of global falsified medicines regulation on healthcare stakeholders in the legitimate pharmaceutical supply chain: a systematic review,” Front. Med., vol. 11, art. 1429872, 2024. Available: https://doi.org/10.3389/fmed.2024.1429872

R. K. Salami, S. V. de Almeida, A. Gheorghe, S. Njenga, W. Silva, and K. Hauck, “Health, economic, and social impacts of substandard and falsified medicines in low- and middle-income countries: a systematic review of methodological approaches,” Am. J. Trop. Med. Hyg., vol. 109, pp. 228–240, 2023. Available: https://doi.org/10.4269/ajtmh.22-0525

A. Sharma, N. T. M. Duc, T. L. T. Thang, N. H. Nam, S. J. Ng, K. S. Abbas, et al., “A Consensus-Based Checklist for Reporting of Survey Studies (CROSS),” J. Gen. Intern. Med., vol. 36, pp. 3179–3187, 2021. Available: https://doi.org/10.1007/s11606-021-06737-1

J. B. Hertig and T. M. Kennedy, “Pharmacy student perceptions and knowledge of online pharmacy use,” Am. J. Pharm. Educ., vol. 87, art. 8933, 2023. Available: https://doi.org/10.5688/ajpe8933

J. B. Hertig, S. M. James, C. J. Hummel, and M. J. Rubin, “Evaluation of pharmacists’ awareness of illegal online pharmacies and perceived impact on safe access to medicines,” Med. Access Point Care, vol. 5, art. 23992026211005642, 2021. Available: https://doi.org/10.1177/23992026211005642

A. Persson, M. Troein, S. Lundin, P. Midlov, and C. Lenander, “Swedish community pharmacy employees’ knowledge and experience of substandard and falsified medical products: a cross-sectional descriptive survey,” Int. J. Pharm. Pract., vol. 30, pp. 414–419, 2022. Available: https://doi.org/10.1093/ijpp/riac059

A. B. Ali and R. Barrett, “Community pharmacists’ knowledge of substandard and falsified medicines in clinical practice: a cross-sectional survey in Saudi Arabia,” Int. J. Pharm. Pract., vol. 31, pp. 176–182, 2023. Available: https://doi.org/10.1093/ijpp/riac107

R. Barrett, “A cross-sectional study on substandard and falsified medicines in UK pharmacies during the COVID-19 pandemic,” Expert Opin. Drug Saf., vol. 22, pp. 1289–1299, 2023. Available: https://doi.org/10.1080/14740338.2023.2147922

E. Pal, L. Merchant, A. K. Koffi, R. Mehta, J. C. Rusatira, L. Kubiak, et al., “Assessing knowledge, attitudes, and practices and demand-side interventions for combating substandard and falsified medicines: a scoping review,” J. Pharm. Policy Pract., vol. 18, art. 2550369, 2025. Available: https://doi.org/10.1080/20523211.2025.2550369

J. Siraj, A. Gebre, M. Shafi, A. Birhan, F. Ejeta, and S. Hambisa, “Health care providers’ knowledge, attitude and practice toward counterfeit medicines in Mizan-Tepi University Teaching Hospital, South West Ethiopia: a cross-sectional study,” Inquiry, vol. 59, art. 469580221108335, 2022. Available: https://doi.org/10.1177/00469580221108335

B. A. Mekonnen, K. Berhanu, N. Solomon, M. C. Worku, and Y. K. Anagaw, “Community pharmacy professionals’ knowledge, attitudes, and practices toward substandard and falsified medicines and associated factors in Bahir Dar City, Northwest Ethiopia,” Front. Pharmacol., vol. 16, art. 1523709, 2025. Available: https://doi.org/10.3389/fphar.2025.1523709

D. Musoke, G. B. Lubega, C. E. Nabbanja, F. Niyongabo, M. O. Brown, et al., “Knowledge, attitudes and practices on substandard and falsified medicines for human and animal use in Wakiso district, Uganda,” J. Pharm. Policy Pract., vol. 18, art. 2564822, 2025. Available: https://doi.org/10.1080/20523211.2025.2564822

M. C. Worku, M. L. Mitku, W. Ayenew, L. W. Limenh, A. E. Ergena, D. T. Geremew, et al., “Assessment of knowledge, attitude, and practice on substandard and counterfeit pharmaceutical products among pharmacy professionals in Gondar City, North-West Ethiopia,” Curr. Pharm. Teach. Learn., vol. 16, art. 102140, 2024. Available: https://doi.org/10.1016/j.cptl.2024.102140

A. A. Al-Jumaili, M. M. Younus, and M. Z. Saleh, “The epidemic of substandard and falsified medications in Iraq: evaluating the effectiveness of national pharmacovigilance alerts to community pharmacies,” Pharm. Med., vol. 35, pp. 169–186, 2021. Available: https://doi.org/10.1007/s40290-021-00386-9

M. Noun, L. Nasr, I. Khan, and S. Assi, “Knowledge and perspectives of the public towards the prevalence and harm associated with counterfeit medicines in Lebanon,” Pharm. Med., vol. 35, pp. 277–289, 2021. Available: https://doi.org/10.1007/s40290-021-00379-8

A. Bashir, S. Galal, A. Ramadan, A. Wahdan, and L. El-Khordagui, “Community pharmacists’ perceptions, awareness and practices regarding counterfeit medicines: a cross-sectional survey in Alexandria, Egypt,” East. Mediterr. Health J., vol. 26, pp. 556–564, 2020. Available: https://doi.org/10.26719/2020.26.5.556

O. P. Adigwe, “The role of pharmacists in eliminating counterfeit medicines in Nigeria,” Front. Public Health, vol. 11, art. 1170929, 2023. Available: https://doi.org/10.3389/fpubh.2023.1170929




DOI: https://doi.org/10.37311/ijpe.v6i3.40437

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