A review of 10 news sites, official news agencies, and related newspapers revealed 139 reports of drug trafficking. The frequency of news in relevant databases is presented in Table 1 (Table 1, Fig. 1). After coding the news inductively, the news was categorized into four themes and ten sub-themes for challenges (Table 2) and four themes and nine sub-themes for strategies (Table 3). This classification was based on news content and included economic, legal, regulatory and structural, infrastructure, cultural, social, and informational themes.
Table 1
Number of news headlines published concerning drug trafficking in news agencies and sites
Type of news media | Name of news agency/news site | Description | Number of headlines about drug trafficking | Website addresses of news agencies and sites under review |
General | Mehr news agency | Mehr News Agency is an Iranian news agency belonging to the Islamic Development Organization. Mehr News Agency currently publishes news in six languages: Persian, English, Kurdish, Arabic, Urdu, and Istanbul Turkish, and has four general offices, including domestic news, foreign news, provincial news, and new media. | 17 | https://www.mehrnews.com/ |
Khabaronline agency | Khabar Online is part of the Khabar Media Group, including sections of Khabar-e-Junub, Khabar-e-Varzeshi, the weekly Siyahat & Tejarat, and the weekly literary Negah-e-Panjshanbeh. Other publications of this group are also considered prominent and sometimes experienced publications in their field. | 18 | https://www.khabaronline.ir |
ISNA | ISNA is the first unofficial news agency in Iran, and the first news agency in Iran, established on the Internet for free in 2000, and access to its news is open to all audiences. | 18 | https://www.isna.ir/ |
Khane Mellat News Agency | Khane Mellat News Agency is a government news agency in Iran, established in 1998. Its purpose is to cover various political, social, economic, and international issues in society. | 9 | https://www.icana.ir/Fa |
IRNA News Agency | The IRNA is the official news agency of the Islamic Republic of Iran. IRNA currently has 60 representative offices in provincial and city centers and more than 30 offices worldwide and publishes news about the university, social, economic, political, international, and sports issues. | 7 | https://plus.irna.ir |
Donyaye Eghtesad Newspaper | Donya-e-Eqtesad is an Iranian economic newspaper launched in 2002 and is currently the third most popular print newspaper in Iran, focusing on economic and social news. | 13 | https://donya-e-eqtesad.com |
Hamshahri Newspaper | Hamshahri is a morning newspaper published in Iran. It has several active sections and covers the selected news from other online, visual, audio, and written media. | 9 | https://www.hamshahrionline.ir/ |
Specialized | Sepid newspaper | Sepid is the first medical newspaper published weekly and posted the latest medical news. | 26 | http://sepidonline.ir/ |
News and information site of the Ministry of Health and Medical Education (Webda) | The news and information base of the Ministry of Health, Treatment, and Medical Education, called Webda, was inaugurated at the same time as Journalist's Day in August 2010. Webda publishes information in the field of health, treatment, and medical education. In this database, while posting the latest news about the health system, promoting health culture is also very important. | 7 | https://behdasht.gov.ir/ |
Food and Drug Administration news site (IFDANA) | This news site provides information about food and medicine, beverages, cosmetics, biology, supplements, and products. | 15 | https://ifdana.fda.gov.ir/fa/ |
Total | | | 139 | |
Table 2
Coding of drug trafficking challenges in Iran resulting from the study of media news with an inductive approach
Themes | Sub-themes | codes |
Economic issues | - Trade deficits and economic sanctions -Exchange rate problems -Price and demand issues | - Unrealistic prices of the domestically produced drugs - Defects in drug pricing system in Iran - Multiple currency rates - Extensive financial exchanges in the drug market - Difference in price and demand - Liquidity problem - Economic sanctions |
Legal, regulatory, and structural issues | -Obsolescence of anti-trafficking law -Regulatory problems -Stewardship defects | - Bugs in the system of distribution and supply of health-oriented products - Imperfection in intersectoral cooperation -outdated law - Poor supervision of the government on the sale of government currency and performance of pharmaceutical industry owners - Weakness of the anti-trafficking law - Low authority of the Ministry of Health - Inefficient pharmaceutical subsidy policy - Conflict of interest (Some create artificial shortages of medicine in the country for their benefit. The food and drug industry is constantly moving between the private and public sectors, which take the interests of the private sector into account in their decisions when conflicts of interest arise). -Insufficient intersectoral and intra-sectoral cooperation of all regulatory agencies - Lack of will to prevent drug smuggling - Brokerage in pharmacy - Prescribing foreign drugs by doctors despite having a similar internal version - Ignoring clinical guidelines - Induced demand -Weakness of strict control of the country's borders regarding drug smuggling -Collusion and receiving money from smuggling by customs |
Infrastructure issues | -Defects in the infrastructure of electronic systems -Defects in infrastructure for the development of countermeasures and preventive measures | - Lack of electronic prescriptions - Defect in TTAC* system - Lack of identification of health products and focus on domestic production - Shortage of workforce in this area - The possibility of hacking the TTAC system |
Cultural, social, and informational issues | -Defective culture concerning drug trafficking -Defects in information and awareness | - Failure to justify people and doctors culturally - shortage of accurate and clear information for people - Absence of correct consumption pattern - Lack of awareness -Deficiency of culturalization about not taking contraband drugs |
*The Tracing, Tracking, and Authentication Control system, also called "TTAC" for short, is a central database for tracking and tracing health-oriented goods and the currency allocated to them in the supply chain.
Findings obtained from analysis of online news media showed that in drug trafficking, the challenges could be categorized into four themes, which were reviewed separately.
Economic Issues
Economic issues include any issue related to the price and demand of medicine. Accordingly, this theme consists of three sub-themes.
Several news sources emphasized economic sanctions and consequent non-return of money from drug sales to the country. In this regard, it was stated that:
“Sanctions have prevented returning the money from selling drugs to the country easily, which has become a problem for domestic companies. This situation has led to an increase in the illegal export of the domestically produced drugs, meaning that the rate of smuggling of Iranian drugs abroad is increasing”. (Mehr news agency)
In many news, defect in the drug pricing system in Iran, and the multi-exchange rate were raised among the major challenges in drug trafficking. The government uses NIMA currency (NIMA currency is a currency that is traded in a system called NIMA. In the NIMA system, exporters and importers buy and sell currency online. The required currency for some imported goods is provided in this way) to import medicine, so the drug's price is low in the country. This issue leads to drug smuggling inside the country. For example, the news showed that:
“Pharmaceutical companies dependent on selling products domestically have faced a liquidity crisis in financing production costs because of unrealistic prices of the domestically produced drugs. That is, the domestically produced drugs are so cheap that they are smuggled abroad. The government pays 42,000 Iranian Rials (NIMA currency) for the imported medicine. However, the domestic industry receives government currency only for raw materials, and the rest of drug production needs are met through free currency, which has caused costs of producing medicine domestically to be more than the price”. (Mehr News Agency)
Also, according to most of the news, price and demand issues, and consequently large financial exchanges in the drug market, were mentioned as challenges in the field of drug trafficking:
“Traffickers have extensive financial exchanges with drug trafficking from inside to outside and from outside to inside. This issue has caused the Naser Khosrow Bazaar's black market to continue its activities for several years. Wherever the patient is disappointed with the supply of the medicine that he needs, he can easily go to Naser Khosrow Bazaar to get the medicine. Differences in price and demand are two important factors motivating drug trafficking from inside to outside and from outside to inside. ”. (Mehr News Agency)
Legal, Regulatory, And Structural Issues
Legal, regulatory, and structural problems refer to issues related to enacting laws in this regard and monitoring performance in the field of medicine. This theme contains three sub-themes.
Many news sources emphasized the lack of up-to-date and codified laws. In this regard, it was stated that:
“Enactment of the law against drug trafficking dates back to 50 years ago, and given that this law has more than 150 articles, the government must try to review it and submit a bill to the parliament. The existing anti-trafficking law is not a deterrent, and this factor has led to the abuse of many traffickers”. (Khane Mellat News Agency)
A vast majority of news showed that the government does not monitor the sale of governmental currency; the government must adequately monitor the performance of pharmaceutical industry owners. Also, the government should seek help from strong regulatory agencies in this area, although the food and drug administration (FDA) should now be strengthened for further oversight.
“We expect all regulatory bodies, such as the FDA and the Pharmacists' Association, to monitor the supply of medicine in the country. The people are also expected to pay special attention to this sector as the third dimension of monitoring. There is no will to stop drug trafficking; although many warnings are given to the authorities in this regard, there is no will to control it”. (Donya-e-Eqtesad)
There were several reports on the lack of broad authority of the Ministry of Health, inefficient pharmaceutical subsidy policy, and conflict of interest:
“The Ministry of Health has no authority outside the" pharmacy "to monitor and deal with drug violations, and the law does not allow the Ministry of Health to intervene. The black market of medicine is outside the scope of authority of the health system and FDA”. (ISNA)
Infrastructure Issues
Infrastructure issues are also among the issues that need to be addressed regarding the problems of drug trafficking. Therefore, this theme contains two sub-themes.
Fewer news items were also about electronic infrastructure. The lack of proper infrastructure in medicine makes it possible to print counterfeit prescriptions, and it is possible to manipulate drug systems and enter the desired information. In this regard, it was stated that:
“The reason for corruption of the TTAC system is the possibility of manipulating it and entering the desired information. So, even those who do not receive foreign exchange have succeeded in receiving foreign exchange by importing the banned drugs”. (Khabar Online news)
“If prescriptions become electronic, no one can tamper with them, and it is impossible to print counterfeit prescriptions. Pharmacies will also be held accountable for the delivered drug. This action will block the reverse drug trafficking route”. (Mehr News Agency)
Few news sources emphasized that the Ministry of Health personnel is not commensurate with drug smuggling attacks, requiring a well-developed infrastructure to address workforce shortages. In this regard, it was stated that:
“The Ministry of Health is facing a shortage of manpower in this area”. (Khabar Online news)
Cultural, Social, And Informational Issues
Cultural, social, and informational issues refer to problems emphasizing a lack of awareness, culture, and transparent information. This theme contains two sub-themes.
In a small number of news items, it was stated that cultural defects and a lack of clear justification for drug users and physicians are the basis for the spread of drug trafficking in Iran:
“The most important reason for people's tendency to smuggle drugs is their lack of cultural justification. In addition to the people, doctors must also be justified in this regard”. (Mehr News Agency)
In a few news items, cultural issues, such as lack of proper consumption patterns and lack of awareness and information to consumers, were mentioned as the cause of drug trafficking. In this regard, it was stated that:
“Regarding prevention of smuggling and fraud, cultural issues, such as the absence of correct consumption pattern and lack of awareness, and about the geographical area, the extent of borders, conditions of neighbors, especially unstable economic and security conditions are involved in drug trafficking”. (Khabar Online news)
As shown in Fig. 2, the theme of legal, regulatory, and structural issues had the most news headlines, while the theme of cultural, social, and informational issues had the lowest frequency.
Table 3
Coding of suggested strategies to combat drug trafficking and its reduction, resulting from the review of media news with an inductive approach
Themes | Sub-themes | codes |
Economic issues | -Creating economic inefficiency of smuggling - Realize medicine prices - Capacity building and support of the country's pharmaceutical factories | - Production of medicine with NIMA currency - Adapting conditions for better operation of pharmaceutical factories with domestic needs - Realizing drug prices - Using insurance capacity - Drug pricing is based on the cost price of the drug - Supporting drug manufacturers |
Legal, regulatory and structural issues | - A multifaceted view in the fight against trafficking - Capacity building for using and strengthening drugs’ information system - Setting tariffs for the subsidized goods and banning the prescription of foreign drugs | - There should be a multifaceted view in the fight against smuggled and counterfeit goods in the health market. - Inquiring about the authenticity of pharmaceutical products through the pharmaceutical information system - Identifying bottlenecks in corruption - Designing an administrative health assessment model - Imposition of duties or tariffs for the subsidized goods by the Trade Development Organization together with other responsible agencies - Prohibition of prescribing drugs out of the permitted list of drugs - Full control of borders and strengthening governance in the country - Outsourcing of pharmacy supervision |
Infrastructure issues | -Electronic infrastructure | - Electronic prescriptions - Using the capacity of electronic health records, insisting on the development of electronic infrastructure and elimination of paper booklets - Identifying the route of drugs distributed - Identifying health-oriented goods and designing labels of the authenticity of pharmaceutical goods - Creating a comprehensive software to show all drug distribution processes clearly - smartening drug registration, prescribing, and drug delivery processes |
Cultural, social, and informational issues | -Community awareness - Culturalization | - Informing people about the effects of drug trafficking - Culturalization for not using contraband drugs - Proportionate, intelligent, and comprehensive propaganda in service of this struggle - Informing people about how to inquire about the TTAC system |
Findings obtained from analysis of online news media showed that in drug trafficking, the suggested strategies could be classified into four themes, which were reviewed separately (Table 3).
Economic Strategy
Economic solution means ways to get out and solve the problems existing in the country in the economic field of drug trafficking. Accordingly, this theme consists of three sub-themes.
Many news sources stated that there are ways to reduce the economic benefits of drug trafficking, such as producing drugs in NIMA currency and subsidizing insurance companies. In this regard, it was stated that:
“Other mechanisms, such as the NIMA currency, can be used to produce drugs and pay subsidies to insurance companies or directly to drug users themselves”. (ISNA)
“The Ministry of Health agrees with eliminating the governmental currency of medicine if there will be a difference in insurance support of patients' medicine”. (Hamshahri newspaper)
Sometimes, the best way to control smuggling is by increasing drug prices and using insurance capacity. Because people in the country can use cheap medicine and thus, cheap drugs cannot be smuggled abroad. It can be in line with the interest of the manufacturer, consumer, and insurers, as mentioned in the news:
“When the final product price does not match the costs paid for it, quality will be reduced, and smuggling will increase. The price should be commensurate with production costs, legal profit, and marketing of the final product. Increasing the price and using the capacity of insurance companies to cover medicine can benefit producers, consumers, and insurers”. (Khane Mellat News Agency)
“The medicine is supplied with the currency of 42,000 Rials in the country, which has many consequences. It imposes a heavy financial burden on the government and often leads to reverse drug trafficking abroad. However, medicine is cheap in Iran, so it is smuggled abroad, and then medicine is out of reach of real consumers”. (Sepid newspaper)
Also, most of the news mentioned reduction of domestic production costs and support for drug manufacturers as ways to prevent drug trafficking:
“For preventing entry of the smuggled drugs into the country, efforts should be made to provide conditions for better operation of active pharmaceutical factories by domestic needs, so in line with the resistive economy, the least imports should be made, especially in the field of drugs. Reducing domestic production costs and supporting producers, increasing public awareness of their cultural, national, and religious identity, are executive strategies to prevent drug trafficking”. (Webda)
Legal, Regulatory, And Structural Strategy
Legal, regulatory, and structural measures address the issues not covered by the law and monitor the distribution performance of the drugs. This theme contains three sub-themes.
According to a few news sources, one solution has a comprehensive and multifaceted view to combat drug trafficking. In this regard, it was stated that:
“Health-oriented goods are of special importance from economic and public health aspects, so there should be a multifaceted view in the fight against the smuggled and counterfeit goods in the health market.” (Khabar Online news)
“In the field of supervision, it should be noted that as far as possible, the supervisory system of a field in the country should be a specific body itself. If various bodies are responsible for this, various regulations and directives provide space for smuggling and fraud, but if the supervisory body is identified, it allows the regulatory body to carry out its programs properly; therefore, from the experts’ point of view, they must be responsible for supervision together”. (Sepid newspaper)
In a few news items, inquiries about the authenticity of pharmaceutical goods through the TTAC system were mentioned as a solution to combat drug trafficking.
“The TTAC system is obliged to track drugs from production or import to supply so that, by doing so, the smuggled drug imported into the country is deprived of services, such as transportation and insurance, and thus drug smuggling is not profitable.” (Sepid newspaper)
Several news sources also considered imposing duties or tariffs on subsidized goods, effectively reducing smuggling. Smuggling can be reduced by imposing tariffs on subsidized goods, such as medicine:
“The Trade Development Organization (TDO), along with other responsible agencies, should impose duties or tariffs on the subsidized goods so that we will no longer see some profits”. (Khabar Online news)
Infrastructure Strategy
Infrastructure solutions should be used to solve some problems of drug trafficking. Therefore, this theme contains a sub-theme.
A large number of news items focused on the solution of electronic infrastructure. One of the most important ways to combat drug trafficking is insisting on smartening the health system, eliminating paper booklets, and clarifying the distributed drugs' route by solving drug system problems. In this regard, it was stated that:
“Smart drug registration, prescription, and drug supply processes are considered factors that can reduce or eradicate trafficking in the country's drug market and cut the hands of traders from this market”. (IRNA)
“We will identify the route of distribution drugs of companies by designing the TTAC”. (ISNA)
Cultural, Social, And Informational Strategy
Cultural, social, and informational solutions mean influencing the level of awareness and culturalization and transparent information. This theme contains two sub-themes.
In some news, it was stated that innovative and comprehensive advertisements could increase people's awareness about drugs and the effects of drug trafficking:
“Advertising must be proportionate, intelligent, and comprehensive, and it must be done to combat drug trafficking. The FDA and manufacturers must simultaneously inform the public about the authenticity of the goods so that people know that label of authenticity alone does not indicate the authenticity of the goods and that a product’s authenticity is confirmed through inquiry on the TTAC”. (Webda)
A few news items emphasized that in combating drug trafficking and informing consumers, a culture must be created to fight against this phenomenon. In this regard, it was stated that:
“Creating a culture against drug trafficking is one of the ways to fight against drug trafficking”. (Khabar Online news)
“Many examples of trafficking can be radically confronted including drugs and supplements used for weight loss, weight gain, beauty, sexual activity, and so on by correcting people's beliefs and thoughts and changing ideas and tendencies.” (IFDANA)