The illegal prescription business is flourishing in South Africa, posing increasing public health and economic risks, warn experts, who urge greater effort to combat the expanding market for counterfeit, smuggled, and unregulated drugs.
According to the TRACIT 2025 Strategic Review, South Africa ranks 60th globally out of 158 countries and fourth in Africa on measures of resilience to illegal markets, with a score of 52.4 out of 100, reports IOL.
The report notes that the illicit economy includes pharmaceuticals alongside alcohol, tobacco, foodstuffs, and other sectors, with unregulated spaza shops and informal markets serving as common distribution points.
Street markets, cross-border smuggling
The South African Health Products Regulatory Authority (SAHPRA) says 507 suspected cases of counterfeit or illicit medicines were reported in 2024/25, with 110 confirmed. Around R3m was spent on destroying the fake products.
In Johannesburg, investigators have documented a thriving informal market for prescription-grade medicines, particularly antibiotics, sold on the streets without valid prescriptions, SAHPRA spokesperson Lindiwe Motsoaledi has said.
Many of these products are reportedly smuggled from Malawi and Zimbabwe.
The digital dimension
While street sales remain prevalent, the illegal trade has increasingly moved online. Research from the University of KwaZulu-Natal highlights the risks in digital spaces.
A study reviewing 25 South African online pharmacy websites found that three operated without links to physical pharmacies and supplied prescription medicines without requiring valid prescriptions, exposing consumers to the risk of receiving substandard or harmful products.
The SAPS and regulators recently bust an online syndicate selling steroids, stimulants, and other scheduled medicines without proper authorisation.
The illegal trade also extends to scheduled medicines being sold in unlicensed shops. Health authorities in Gauteng have repeatedly found pharmacies and retail outlets selling drugs that are meant to be controlled, in direct contravention of South African law.
Regulatory response intensifies
SAHPRA, in collaboration with the WHO, last year developed Africa’s first National Action Plan to combat falsified medicines, which aims to improve surveillance, inspections, and enforcement against illegal medical products.
The growth of the illegal prescription industry is not just an enforcement issue, but also a public health crisis, according to SAHPRA spokesperson Lindiwe Motsoaledi.
Experts caution that the problem is likely to worsen if regulatory gaps are not closed. Online pharmacies remain difficult to monitor, cross-border smuggling continues, and informal street markets persist in major urban centres.
Co-ordinated action by law enforcement, regulators, and healthcare providers is essential to reduce the scale of the illegal trade, they said.
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