This $1 paper test could tackle counterfeit meds in the developing world

Fake pharmaceuticals are a real problem in the developing world, and by it’s nature, the problem is a difficult one to solve. A fake little white pill looks exactly like a real little white pill, and most people who need the medication neither have the expensive equipment to test the drugs, nor the medical expertise to interpret the results.

A team from the University of Notre Dame has come up with an innovative answer that neatly sidesteps both of these issues: a $1 test that comes in the form of a strip of paper, and gives a near-instant snapshot of whether the drug is what it says on the box, a worthless placebo or worse.

“People who don’t have access to the best-quality medicines also don’t have as many resources to buy the analytical instrumentation to detect the quality problems,” explains Marya Lieberman, Ph.D. “Instead of a $30,000 instrument, we’ve developed a $1 paper card.”

This isn’t a simple litmus test: in fact, the numerous ways in which medicines could be fake (they could be heavily diluted versions of the genuine products or could contain any cocktail of chemical adulterants) means that the test stick contains 12 separate tests, split across lanes. Each lane contains a different set of reagents, kept apart from its neighbouring test by a wax strip.

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Simply crush a pill, rub the dust across all 12 lanes and then dip it in water, and the results appear on the paper before your eyes. As the water dampens each lane, it mixes the reagents with the powder. The colours appear when each reagent reacts – or doesn’t react – with the medication. You then compare the results with what the actual product should look like – something that can be done by the eye, or via a smartphone app.

It doesn’t just work for fake pills either: medication that has been poorly stored or deteriorated over time also brings up results that are visibly different from the reference drug. To test this, Lieberman and Hamline University undergraduate Sara Bliese heated Ceftriaxone and found that the resultant deterioration was matched by the results on the card. Ceftriaxone is a particularly important drug, rated by the World Health Organisation as “essential”, and on recent visits to Kenya and Uganda, Lieberman and Bliese found their test effective on a number of real-world samples collected throughout the countries.

Elsewhere Bliese is tackling another problem of counterfeit medications: colourants added to some counterfeit pills in order to make them look closer to the real deal sometimes contain toxic heavy metals. At Hamline University, Bliese and Deanna O’Donnell, Ph.D. are trying to establish if a portable X-ray fluorescence spectroscopy device could screen pills for these harmful substances.

Of course, counterfeit drugs aren’t just a problem for the developing world, with the rise of underground online pharmaceuticals. Another area Liberman is keen to explore is herbal medicines and nutritional supplements. “Sometimes those ‘herbal products’ are actually spiked with pharmaceuticals. The paper test cards could be a defense against this.” Her next project, however, is to develop a similar paper test that would help emergency workers quickly assess whether a given pill is an illicit drug or a legitimate medication.

Image: Lierberman AND Bliese