HSA Seized Over 737,000 Units of Illegal Health Products Worth $640,000 in 2022 Through Concerted Enforcement Efforts

In 2022, the Health Sciences Authority (HSA) continued to heighten surveillance of the sale and supply of illegal health products in targeted locations such as Geylang areas and on local e-commerce and social media platforms. Illegal health products include unregistered or counterfeit health products, and those with potent medicinal ingredients and/or banned substances illegally added to them.

2        Last year, HSA seized over 737,000 units of illegal health products worth $640,000 in street value through enforcement raids and covert purchases. This is about $200,000 higher compared to the seizure amount in 2021, due to the stepping up of enforcement operations against illegal suppliers at hotspot areas. The most common products seized in 2022 were codeine cough syrups (46%), sexual enhancement or male vitality products (39%) and sedatives (9%) [Figure 2.1]. The seized codeine cough syrups and sedatives had been intended for sale to recreational abusers.

Figure 2.1: Types of products seized during enforcement operations in 2022

3        On local e-commerce and social media platforms, the most common product listings detected and removed were those for lifestyle products such as sexual enhancement or male vitality products (55%), topical products marketed for allergies or eczema (43%), pain relief products (1%) and weight loss products (1%) [Figure 3.1]. HSA has removed 477 illegal online listings of these lifestyle products and issued 192 warnings to sellers in 2022. The numbers of these removed listings and issued warnings were about half of those in 2021, as HSA had been working closely with local platform administrators to promptly remove product listings and educate sellers on the regulations for sale.

Figure 3.1: Types of products detected and removed from local e-commerce platforms in 2022

Illegal health products found to contain potent medicinal ingredients and/or banned substances

4        During the past year, HSA issued public alerts on 12 products that were adulterated with potent medicinal ingredients and banned substances:

• Potent steroids were commonly found, particularly in pain relief products and topical products for skin conditions such as eczema and psoriasis.

• Ten persons, including three young children, had reported serious adverse effects or unusually quick effects, through their doctors or directly to HSA, after consuming or using adulterated products.

• These products were either purchased online, locally from a makeshift stall, or from overseas through friends or relatives, and were marketed to meet various health and/or lifestyle needs. Please refer to Table 4.1 for more information.

Table 4.1 List of illegal health products found to contain potent medicinal ingredients and/or banned substances

Please refer to Annex A for photos of the products and Annex B for more information on the adulterants.

Serious steroid-induced adverse effects caused by illegal health products

5        Dexamethasone, a potent steroid, was found to be illegally added into seven products detected by HSA. One of these products, ‘AlphaMiracHERBS’, which was obtained overseas, caused a man in his 60s to develop Cushing’s syndrome[1]. He shared with HSA the lesson he learnt, which was that consumers should buy only products that are reputable with a known source. “Otherwise, be prepared for long-term side effects like what I am suffering now. After five months, I still have a very weak immune system, with tiredness, running nose and aching bones.”

6        In another case, a woman in her 60s had taken ‘Shu Jin’ capsules regularly over 10 years for joint pain¹. When she stopped taking it, she had to be hospitalised and was diagnosed with adrenal insufficiency[2] and osteoporosis.

Topical creams marketed for infant use falsely claimed to be “natural”, “herbal”

7        HSA detected another potent steroid, clobetasol propionate, in five topical creams that were marketed for wound care and skin conditions such as eczema and psoriasis. Three of these products, ‘Star Cream’, ‘Tao Ju Hui Yi Mei Li Shang Kou Hu Li Ruan Gao’, and ‘Jolicare™ Baby Cream’ were promoted for use in infants. They had falsely claimed that they contained natural herbal ingredients or had no medicinal effects. There were three cases detected with these products:

·       A four-month-old infant was hospitalised due to steroid toxicity[3] after ‘Star Cream’ was used for his diaper rash. He had experienced serious adverse effects such as persistent vomiting, abnormal eye alignment, and a bulging fontanelle[4], and took a long time to recover from them. He also developed Cushing’s syndrome, which required long-term monitoring.

• A four-year-old developed symptoms of Cushing’s syndrome after ‘Tao Ju Hui Yi Mei Li Shang Kou Hu Li Ruan Gao’ was used on him regularly for rash over a period of four months[5]. He developed a “moon” face, excessive hair growth on the body and thinning of skin.

• A three-year-old child experienced unexpected improvement from chronic eczema after using ‘Jolicare™ Baby Cream’ for only three days[6]. This effect was due to a potent steroid that was illegally added into the product and could have led to serious consequences had the case not been detected early.

8        The parents of the four-month-old infant, who had bought ‘Star Cream’ online, shared, “It was a nightmare that no parent would want their child to go through. It was only a very short period of four months of use, but to recover from its consequence requires a much longer time. Even after close to one year, our son has yet to be discharged from his condition. We hope all parents refrain from using unknown nappy creams on their child. Please use nappy creams from reputable brands.”

9        Dr Lim Woan Huah, a paediatrician who handled the case involving ‘Tao Ju Hui Yi Mei Li Shang Kou Hu Li Ruan Gao’, commented, “We would like to advise parents to be extremely careful when purchasing medicines from unregulated sources and online platforms. Please consult your doctor and pharmacist for advice.”

Consumer advisory

10       Illegal health products are a threat to public health and safety. As long as there is demand, they will continue to be sold and may resurface under different names or packaging to evade detection by the authorities. The dangers of adulterated products include:

• False claims and harmful ingredients – They are often falsely promoted to be “natural” or “herbal” when in fact, they contain undeclared medicinal ingredients which can cause serious adverse effects when used in the absence of medical supervision.

• Lack of quality controls, manufacturing and product information – There is no knowing how these products were made, what ingredients they contain and under what conditions they were manufactured and stored.

• No recourse for consumers – It can be difficult to determine the source of products purchased from unknown or unfamiliar sellers such as from overseas, online or street peddlers. Consumers may therefore not be able to claim for any damages or get any refund should anything go wrong.

11  It is not possible to know for sure whether a health product is illegal or harmful just by looking at a product or its packaging. Hence, consumers are advised to always be wary and follow the A-B-C-D steps before buying or taking a health product:

• Avoid making purchases from suspicious or unfamiliar sources. Find out who you are buying from and what you are buying, even when the product is recommended by someone you trust. As a general guideline, buy from reputable sources such as pharmacies or established retail stores. When purchasing from e-commerce platforms or over the internet, consumers are strongly encouraged to purchase from businesses with established retail presence.

• Beware of deals that sound too attractive. If the price is much lower than expected, or product information sounds too good to be true, it probably is.

• Check the claims and products. Not all advertised claims are true and they can be exaggerated or over-promise. Do not be misled by positive product testimonies or reviews online as they cannot be verified. Consumers may also refer to HSA’s database of notified health supplements and traditional medicines (https://www.hsa.gov.sg/vns-list) before making their purchases.[7]

• Discuss with your doctor or pharmacist on the suitability of a product if you are unsure.

Advisory to sellers and suppliers

12       HSA will take stern enforcement actions against anyone who sells and/or supplies illegal health products. Sellers and suppliers who are selling such health products are liable to be prosecuted and if convicted, may be imprisoned for up to 3 years and/or fined up to $100,000. In 2022, HSA prosecuted 15 persons for the sale and supply of illegal health products, including a 59-year-old male who was sentenced to an imprisonment term of 6 months and 2 weeks for the sale of illegal codeine cough syrup and nitrazepam tablets (sedatives). In the past three years, HSA has prosecuted 44 persons for the sale and supply of illegal health products.

13       Members of the public who have any information on the sale and supply of these illegal products may contact HSA's Enforcement Branch at Tel: 6866-3485 during office hours (Monday to Friday) or email: hsa_is@hsa.gov.sg.

HEALTH SCIENCES AUTHORITY
SINGAPORE
20 FEBRUARY 2023

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[1] https://www.hsa.gov.sg/announcements/press-release/hsa-alert-five-products-detected-to-contain-potent-medicinal-ingredients

[2] Adrenal insufficiency is a serious steroid withdrawal condition, where the body does not produce adequate amounts of steroid hormones after stopping long-term steroid use.

[3] https://www.hsa.gov.sg/announcements/press-release/StarCream-infant-hospitalised-for-serious-adverse-reaction

[4] A fontanelle is a soft spot on top of a baby’s skull.

[5] https://www.hsa.gov.sg/announcements/press-release/hsa-alert-child-rashcream-makeshift-stall

[6] https://www.hsa.gov.sg/announcements/press-release/hsa-alert-five-products-detected-to-contain-potent-medicinal-ingredients

[7] https://www.hsa.gov.sg/announcements/press-release/hsa-voluntary-notification