Drug shortages drive a black market in Iran and cost lives

A surge in counterfeit drugs has worsened Iran’s strained medicine market, forcing many with serious conditions to rely on the black market for scarce medication.

The shortage has deepened in recent months, driving prices ever higher. More than 100 essential medications, including treatments for cancer and rare diseases, are either scarce or entirely unavailable.

While Iran has long had an underground market for imported medicine, prices have soared since late summer, and reports of counterfeit drugs are rising.

Investigations by Iran International reveal that counterfeit medications are being sold at exorbitant prices—often reaching hundreds of dollars—right in the heart of Tehran. Cancer patients, in particular, face an increasingly dire situation.

“Not only have cancer and rare disease medications become shockingly expensive, but some have completely disappeared from pharmacies and even the underground market,” a pharmacist in Tehran said on condition of anonymity. “As original medicines grow scarce, counterfeit sales have increased.”

He noted that cancer drug prices range from 150 million rials ($180) to as much as four billion ($4800).

“A breast cancer patient had to pay 900 million rials ($1,100) for just 56 pills,” the pharmacist added. “She could have had a lower-quality Indian version a bit cheaper, but she was desperate to get the best on offer. We’ve had patients selling their property to get cancer treatment for themselves or loved ones.”

Buying drugs on the black market isn’t just costly—it’s dangerous. The pharmacist recalled a case where a patient needed Zavicefta, an antibiotic unavailable in pharmacies. Desperate, they turned to the underground market, paying 3 billion rials ($3600).

“The patient brought the drug to me and I could tell immediately it was fake. The real version comes in sealed packaging but theirs had been tampered with,” he said. “Imagine paying that much money and getting a counterfeit.”

A lawmaker on Iran’s parliamentary health committee had warned of the crisis a month earlier, reporting 116 scarce medications and predicting the number could increase tenfold within months without government intervention.

Iran International contacted several pharmacies in Tehran to inquire about various medications, and all confirmed the scarcity of imported drugs. Even major state-run pharmacies, such as 13-Aban and the Red Crescent, had limited or no stock.

Some Iran-made drugs are also becoming scarce due to shortages of raw materials and hoarding by suppliers who benefit from rising prices.

A young art student who lost her sister to leukemia shared her experience.

“My sister’s doctor prescribed German-made drugs, saying local alternatives wouldn’t be as effective and would make chemotherapy even harder. My father, two brothers, and I spent everything we had on her medication, but in the end, we lost her.”

She described the excruciating process of hunting for medication.

“For months, we visited 13 Aban and Red Crescent pharmacies every other day, only to be told they didn’t have it. We often had to buy from the black market. Some drugs, like Endoxan, we never found.”

For patients with rare conditions like hemophilia, MPS, and SMA, the situation is even worse. Patients and their families have staged several protests outside the Health Ministry and Iran’s Food and Drug Organization.

Such medication is not produced in Iran because it is not economically viable, Hamidreza Edraki, head of Iran’s Rare Diseases Foundation, told ILNA last month. Imports are stuck in customs for so long that they often expire before reaching patients, he added.

Those in charge are yet to address the situation despite warnings from all stakeholders.

On January 28, Iran’s Health Minister Mohammad Reza Zafarghandi announced that the price cap on several drugs would have to be raised because pharmaceutical companies could no longer afford production costs.

This policy may help increase supply gradually. The impact it had on prices, however, was immediate. For those Iranians in urgent need of treatment, things are looking to get a lot worse before getting any better.