{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T15:47:46Z","timestamp":1775836066540,"version":"3.50.1"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>The issue of quality of medicine is a worldwide phenomenon and counterfeit, substandard, spurious, and adulterated (CSSA) drugs are a substantial threat to public health. This issue is rampant in the context of low-middle-income countries such as Pakistan. The current study involved a phenomenology-based qualitative approach to explore these drugs\u2019 perception, knowledge, practice, and issues in combating this menace.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A semi-structured interview guide was developed. Eleven drug law experts were interviewed through a purposive sampling technique. All interviews were audio recorded, transcribed verbatim, and analysed using a framework analysis approach, yielding seven distinct themes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The results showed that CSSA drugs are a serious public health threat and drug law experts confirmed its prevalence in the market. They indicated shortcomings in legislation up to the extent of undue amendments, failure to interpret and implement the law by regulators, ineffective law enforcement machinery, the sub-optimum performance of quality control boards, drug testing laboratories, and courts, and the dubious role of rogue middlemen and wholesalers in drug supply chain and corruption were salient issues highlighted.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The study revealed that proper drug surveillance, ensuring the presence of a pharmacist, enforcing the law, securing the supply chain, infrastructure for a drug control regime, and training regulators can help tackle this problem.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0322188","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T17:38:37Z","timestamp":1745516317000},"page":"e0322188","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["A qualitative exploration of counterfeit, substandard, spurious, and adulterated drugs in Pakistan: A perspective of drug law experts"],"prefix":"10.1371","volume":"20","author":[{"given":"Farooq Bashir","family":"Butt","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamid","family":"Saeed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7639-1167","authenticated-orcid":true,"given":"Zobia","family":"Mubarak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed Atif","family":"Raza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usman Rashid","family":"Malik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4921-3739","authenticated-orcid":true,"given":"Furqan Khurshid","family":"Hashmi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"issue":"8","key":"pone.0322188.ref001","doi-asserted-by":"crossref","first-page":"e002923","DOI":"10.1136\/bmjopen-2013-002923","article-title":"Substandard and counterfeit medicines: a systematic review of the literature","volume":"3","author":"T Almuzaini","year":"2013","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0322188.ref002","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.sapharm.2012.05.002","article-title":"Counterfeit drug demand: perceptions of policy makers and community pharmacists in Sudan","volume":"9","author":"AA Alfadl","year":"2013","journal-title":"Res Social Adm Pharm"},{"issue":"8","key":"pone.0322188.ref003","first-page":"9","article-title":"Improving the drug control regime in public health facilities of the Punjab","volume":"1","author":"A Khan","year":"2020","journal-title":"Pakistan Journal of Urban Affairs"},{"key":"pone.0322188.ref004","article-title":"446 medicines found spurious in five years","author":"I Junaidi","year":"2020","journal-title":"Daily Dawn"},{"issue":"1","key":"pone.0322188.ref005","first-page":"91","article-title":"Pharmacovigilance in low and middle-income countries: the case of Pakistan","volume":"13","author":"R Hussain","year":"2005","journal-title":"Int J Pharm Pract"},{"key":"pone.0322188.ref006","unstructured":"Tribunal JIJL, Pakistan. Batch J093, the Pathology of Negligence. 2012."},{"key":"pone.0322188.ref007","author":"Dawn","year":"2008"},{"key":"pone.0322188.ref008","unstructured":"Malik R. There has to be a campaign against spurious drugs in a big way in the country. Pakistan is suffering from 45% of fake medicines in the market. 2015."},{"issue":"7","key":"pone.0322188.ref009","first-page":"1904","article-title":"The problem of spurious drugs in Pakistan: Need of government intervention and protection of consumer rights","volume":"18","author":"M Salim","year":"2021","journal-title":"J Appl Emerg Sci"},{"issue":"2","key":"pone.0322188.ref010","first-page":"220","article-title":"Quality of ceftriaxone in Pakistan: reality and resonance","volume":"22","author":"A Obaid","year":"2009","journal-title":"Pak J Pharm Sci"},{"issue":"11","key":"pone.0322188.ref011","doi-asserted-by":"crossref","first-page":"4571","DOI":"10.1002\/jps.22679","article-title":"The global counterfeit drug trade: patient safety and public health risks","volume":"100","author":"TK Mackey","year":"2011","journal-title":"J Pharm Sci"},{"issue":"3","key":"pone.0322188.ref012","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1021\/ie0703787","article-title":"Prevalence and detection of counterfeit pharmaceuticals: a mini-review","volume":"47","author":"F Fernandez","year":"2008","journal-title":"Ind Eng Chem Res"},{"issue":"2\u20133","key":"pone.0322188.ref013","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/009885880603200208","article-title":"Trojan drugs: counterfeit and mislabeled pharmaceuticals in the legitimate market","volume":"32","author":"D DeKieffer","year":"2006","journal-title":"Am J Law Med"},{"key":"pone.0322188.ref014","unstructured":"WHO. Counterfeit Medical Products. 2008. Available from: apps.who.int\/gb\/ebwha\/pdf_files\/EB124\/B124_14-en.pdf"},{"key":"pone.0322188.ref015","article-title":".","author":"The Drug Act"},{"key":"pone.0322188.ref016","author":"Organization WH.","year":"2017"},{"issue":"23","key":"pone.0322188.ref017","doi-asserted-by":"crossref","first-page":"2482","DOI":"10.1056\/NEJMc096117","article-title":"An unusual outbreak of hypoglycemia\u2014a correction","volume":"360","author":"S Kao","year":"2009","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0322188.ref018","doi-asserted-by":"crossref","first-page":"63","DOI":"10.7861\/clinmedicine.9-1-63","article-title":"Public health issues with counterfeit medicines","volume":"9","author":"P Feldschreiber","year":"2009","journal-title":"Clin Med (Lond)"},{"issue":"6","key":"pone.0322188.ref019","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/j.1542-2011.2011.00108.x","article-title":"Counterfeit medications: impurities in the american drug supply","volume":"56","author":"A Stoneman","year":"2011","journal-title":"J Midwifery Womens Health"},{"issue":"1","key":"pone.0322188.ref020","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.sapharm.2008.05.002","article-title":"Safeguarding against substandard\/counterfeit drugs: mitigating a macroeconomic pandemic","volume":"5","author":"AI Wertheimer","year":"2009","journal-title":"Res Social Adm Pharm"},{"issue":"4","key":"pone.0322188.ref021","doi-asserted-by":"crossref","first-page":"e100","DOI":"10.1371\/journal.pmed.0020100","article-title":"The global threat of counterfeit drugs: why industry and governments must communicate the dangers","volume":"2","author":"R Cockburn","year":"2005","journal-title":"PLoS Med"},{"issue":"2","key":"pone.0322188.ref022","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1080\/15228910903187957","article-title":"Taking counterfeits out of the pharmaceutical supply chain in Nigeria: leveraging multilayer mitigation approach","volume":"10","author":"CI Enyinda","year":"2009","journal-title":"J Afr Bus"},{"issue":"2","key":"pone.0322188.ref023","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/jicj\/mqr005","article-title":"Why and how to make an international crime of medicine counterfeiting","volume":"9","author":"A Attaran","year":"2011","journal-title":"J Int Crim Justice"},{"issue":"1","key":"pone.0322188.ref024","doi-asserted-by":"crossref","first-page":"2332872","DOI":"10.1080\/20523211.2024.2332872","article-title":"Academia-pharmaceutical industry linkage: an academic perspective","volume":"17","author":"Z Mubarak","year":"2024","journal-title":"J Pharm Policy Pract"},{"issue":"7","key":"pone.0322188.ref025","doi-asserted-by":"crossref","first-page":"e0305989","DOI":"10.1371\/journal.pone.0305989","article-title":"Industrial prospects on regulatory gaps and barriers in pharmaceutical exports and their counteraction: local experiential with global implication","volume":"19","author":"Z Mubarak","year":"2024","journal-title":"PLoS One"},{"issue":"2","key":"pone.0322188.ref026","first-page":"299","article-title":"Perceptions of stakeholders on the causes and rectification of export barriers for the domestic pharmaceutical industry: a basis of a proposed export startup program","volume":"43","author":"Z Mubarak","year":"2024","journal-title":"Lat Am J Pharm"},{"issue":"1","key":"pone.0322188.ref027","first-page":"1","article-title":"Using framework-based synthesis for conducting reviews of qualitative studies","volume":"9","author":"M Dixon-Woods","year":"2011","journal-title":"Br Med J"},{"key":"pone.0322188.ref028","unstructured":"Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. 2009."},{"key":"pone.0322188.ref029","unstructured":"Shukla N, Sangal T. Generic drug industry in India: the counterfeit spin. 2009."},{"issue":"2","key":"pone.0322188.ref030","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1331\/JAPhA.2012.11085","article-title":"Role of the pharmacist in preventing distribution of counterfeit medications","volume":"52","author":"WG Chambliss","year":"2012","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"5","key":"pone.0322188.ref031","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3923\/rjmsci.2011.257.261","article-title":"The menace of fake drugs: consequences, causes and possible solutions","volume":"5","author":"A Chika","year":"2011","journal-title":"Res J Med Sci"},{"issue":"1","key":"pone.0322188.ref032","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1186\/s12913-021-06897-0","article-title":"The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review","volume":"21","author":"A Ahmed","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0322188.ref033","first-page":"65","article-title":"The role of hospital pharmacists in counterfeit medicines","volume":"14","author":"L Besan\u00e7on","year":"2008","journal-title":"J Hosp Pharm Pract"},{"key":"pone.0322188.ref034","doi-asserted-by":"crossref","unstructured":"Glass BDJR, Medicine RiT. Counterfeit drugs and medical devices in developing countries. 2014;5:11.","DOI":"10.2147\/RRTM.S39354"},{"issue":"1","key":"pone.0322188.ref035","first-page":"1","article-title":"A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan","volume":"17","author":"F Hashmi","year":"2017","journal-title":"J Pharm Pract"},{"issue":"7","key":"pone.0322188.ref036","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.3390\/ijerph17072379","article-title":"Pharmacy services beyond the basics: a qualitative study to explore perspectives of pharmacists towards basic and enhanced pharmacy services in Pakistan","volume":"17","author":"M Atif","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0322188.ref037","first-page":"307","article-title":"Quality of pharmacies in Pakistan: a cross-sectional survey","volume":"17","author":"Z Butt","year":"2005","journal-title":"J Fam Community Health"},{"issue":"9821","key":"pone.0322188.ref038","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/S0140-6736(12)60277-3","article-title":"Pakistan\u2019s deadly cocktail of substandard drugs","volume":"379","author":"S Nishtar","year":"2012","journal-title":"Lancet"},{"issue":"7","key":"pone.0322188.ref039","first-page":"1904","article-title":"The problem of spurious drugs in Pakistan: need of government intervention and protection of consumer rights","volume":"18","author":"M Salim","year":"2021","journal-title":"PalArch\u2019s J Archaeol Egypt\/Egyptol"},{"issue":"1","key":"pone.0322188.ref040","first-page":"1","article-title":"Regulatory framework in Pakistan: situation analysis of medicine quality and future recommendations","volume":"12","author":"H Rasheed","year":"2019","journal-title":"J Pharm Pract"},{"key":"pone.0322188.ref041","unstructured":"Iwokwagh NS. Assessment of new media use in the fight against counterfeit medicine in Nigeria. CCMTD-. 2013:18."},{"issue":"1","key":"pone.0322188.ref042","doi-asserted-by":"crossref","first-page":"24","DOI":"10.5530\/ijper.50.1.4","article-title":"Review of pharmacy professionals and drug jurisprudence to achieve the millennium development goals in Punjab Province of Pakistan","volume":"50","author":"T Nazir","year":"2016","journal-title":"IJPER"},{"key":"pone.0322188.ref043","doi-asserted-by":"crossref","DOI":"10.4135\/9781529734669","volume-title":"Medicine supply chain of the public healthcare system in the Punjab.","author":"MN Jalil","year":"2018"},{"key":"pone.0322188.ref044","unstructured":"Harris J, Stevens P, Morris JJIPN. Keeping it real: Combating the spread of fake drugs in poor countries. 2009."},{"issue":"3","key":"pone.0322188.ref045","doi-asserted-by":"crossref","first-page":"20","DOI":"10.5912\/jcb940","article-title":"The spreading cancer of counterfeit drugs","volume":"25","author":"P Pitts","year":"2020","journal-title":"JCB"},{"key":"pone.0322188.ref046","unstructured":"Warranty by distributor\/Wholesaler. Drug Court Lahore 2017."},{"issue":"5","key":"pone.0322188.ref047","doi-asserted-by":"crossref","first-page":"e07031","DOI":"10.1016\/j.heliyon.2021.e07031","article-title":"Illicit sale of controlled drugs at community pharmacy\/medical stores of Punjab, Pakistan: a road to demolition of public health","volume":"7","author":"I Bashir","year":"2021","journal-title":"Heliyon"},{"issue":"14","key":"pone.0322188.ref048","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1056\/NEJMp038231","article-title":"Counterfeit drugs","volume":"350","author":"P Rudolf","year":"2004","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0322188.ref049","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1310\/hpj5106-493","article-title":"Review of the 2015 drug supply chain security act","volume":"51","author":"ED Brechtelsbauer","year":"2016","journal-title":"Hosp Pharm"},{"issue":"2","key":"pone.0322188.ref050","first-page":"407","article-title":"Addressing the North-South divide in pharmaceutical counterfeiting","volume":"8","author":"D Cahoy","year":"2007","journal-title":"Pharm Policy Law"},{"issue":"4","key":"pone.0322188.ref051","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.1331\/JAPhA.2008.07069","article-title":"Roles for pharmacy in combatting counterfeit drugs","volume":"48","author":"RJ Ziance","year":"2008","journal-title":"J Am Pharm Assoc"},{"key":"pone.0322188.ref052","unstructured":"Yakubu OP. An analysis of loopholes in the Pharmaceutical supply chain, and methods for improving control of counterfeit drugs in Nigeria 2020."},{"key":"pone.0322188.ref053","unstructured":"Cohen JC, Hawkins L. Corruption and pharmaceuticals: Strengthening good governance to improve access."},{"issue":"9","key":"pone.0322188.ref054","first-page":"689","article-title":"WHO launches taskforce to fight counterfeit drugs","volume":"84","author":"W Burns","year":"2006","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pone.0322188.ref055","first-page":"46","article-title":"Counterfeit drugs: problem of developing and developed countries","volume":"2","author":"S Yadav","year":"2015","journal-title":"Int J Pharmceut Chem Anal"},{"key":"pone.0322188.ref056","volume-title":"Combatting Falsification and Counterfeiting Of Medicinal Products in the European Union: A Legal Analysis","author":"VP Kohli","year":"2018"},{"key":"pone.0322188.ref057","unstructured":"Jehangir C. 2016."},{"key":"pone.0322188.ref058","article-title":"Spurious medicines cases SHC questions minor penalties by the Drugs Court","author":"T Siddiqui","year":"2010","journal-title":"Daily Dawn"},{"issue":"1","key":"pone.0322188.ref059","first-page":"47","article-title":"Enforcement of the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954, in the State of Andhra Pradesh: situational analysis and lessons learned","volume":"9","author":"R Ayyanar","year":"2018","journal-title":"J Public Health Saf Res"},{"issue":"1","key":"pone.0322188.ref060","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2017-000007","article-title":"Substandard medicines: a greater problem than counterfeit medicines","volume":"1","author":"HM Sammons","year":"2017","journal-title":"BMJ pediatrics open"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0322188","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T17:38:54Z","timestamp":1745516334000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0322188"}},"subtitle":[],"editor":[{"given":"Charles Odilichukwu R.","family":"Okpala","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":60,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0322188","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,24]]}}}