Abstract
Substandard and falsified (SF) medicines pose a significant global health threat, particularly in regions experiencing socioeconomic instability. Lebanon’s multiple crises have increased vulnerability to counterfeit medications, positioning community pharmacists as crucial gatekeepers for medication safety. This study aimed to assess Lebanese community pharmacists’ knowledge, practices, and ability to detect counterfeit medications during the country’s ongoing, multifaceted crises and identify factors influencing their capacity to recognize SF medicines. A cross-sectional study was conducted between April and July 2024 using an anonymous, self-administered questionnaire among community pharmacists across Lebanon. Most pharmacists (84.2%) reported prior knowledge of counterfeit medicines and 54% had encountered such products. Despite relatively high knowledge scores (mean 7.69 ± 2.74), a critical gap was identified between theoretical knowledge and the practical ability to recognize counterfeit products assessed through picture-based identification of four commonly counterfeited medications, as indicated by the non-significant Pearson correlation between knowledge and recognition ability (r = 0.006, p = 0.864). Higher knowledge scores were significantly associated with non-smoking status (Standardized Beta (β)=-0.090, p = 0.010), verification of supplier credibility (β = 0.103, p = 0.004), belief in pharmacists’ role in combating counterfeits (β = 0.106, p = 0.003), and having previous knowledge on counterfeit medicines (β = 0.123, p < 0.001). However, these factors did not translate into enhanced recognition ability. This study reveals an alarming gap between Lebanese community pharmacists’ theoretical knowledge and practical recognition skills regarding counterfeit medicines. These findings highlight the urgent need for hands-on training programs and technological authentication tools to bridge the knowledge–recognition gap and strengthen pharmacists’ role as medication safety gatekeepers. A comprehensive national strategy should integrate practical counterfeit detection training into continuing education requirements, deploy digital authentication systems at points of dispensing, and establish real-time reporting platforms for suspected counterfeit incidents.