[aurizon]

Africa and China are awash with fake meds - perhaps even in India. Large amounts of fake drugs are common in Africa/China = deaths are common. Pharmacies are very aware of this and watch their sources. The big problem is very good copies of the container, box and printed insert that mimic exactly the true drugs are everywhere. A copied box/insert/vial/tablet that costs $1 can hold drugs worth $200 or more. There are gangs that buy them from China and try to insert them in the supply chain. I was with Sanofi-Pasteur(before I retired) and we had strict QC controls on every batch(every single ingredient). Every ingredient was sampled and tested locally and a sample sent to various head offices in USA/Canada/UK/etc. Batch ingredients were kept in locked areas and only allowed out in a weighed batch amount. The whole area was a clean and watched area with limited access badges on each person working there. You could only enter your zone and use your lunch/toilet area. Some ingredients are active and can have high values. Some are inert fillers. 1 milligram of fentanyl is minuscule = it ends up in a 25 or 50 milligram pressed tablet for ease of patient/pharmacy handling. Even adding the inert is complex as the active and the inert must mix with no settling or gravity segregation. Often the active is mixed with an intermediate diluent and a fluid that will not dissolve either and mixed in wiped surface mixer to make a very uniform paste which was then dried and granulated and this was added to the final diluent and a 'binder'. The binder is a material that will glue the tablet together in a high speed press. Some tablets get an enteric coating that resists acid but dissolves in the lower gut alkaline state = breaks and dissolves. Fentanyl and other strong opioids are killers in small amounts, so extreme precautions are taken to ensure correct doses.