By Dr. Hossain Jahansouz, Ph.D., Biochemist and a Leading Scientist and Industry Executive in the United States for Over Three Decades
1.Introduction: A System in Collapse
Iran was once recognized for its strong pharmaceutical industry and highly trained medical professionals. Today, it is facing a health crisis of massive proportions. From insulin and chemotherapy drugs to basic antibiotics, life-saving medicines are disappearing from pharmacy shelves.
This is not just a crisis of supply. It is a crisis of corruption. Behind the shortages is a powerful network of profiteers. These actors—commonly referred to as the “drug mafia”—operate with impunity. Many are closely linked to regime elites and the Islamic Revolutionary Guard Corps (IRGC) [1][2].
Officials frequently point to U.S. sanctions as the root cause. But this narrative does not hold up. Humanitarian trade exemptions for medicine exist and are still active. The real problem is what happens after the drugs enter the country. Supplies often vanish from the public distribution chain. They reappear in black markets, sold at inflated prices. The issue is not foreign pressure. It is domestic looting [3][4].
2. A Manufactured Crisis: From Scarcity to Speculation
Iran produces over 95 percent of its basic medicines domestically. More than 140 licensed companies manufacture or assemble drugs for the domestic market [5]. The infrastructure for supply exists. Yet, essential drugs are missing from pharmacies across the country.
This is not due to a lack of production or imports. It is the result of deliberate mismanagement. Shipments of medicine often bypass pharmacies. Instead, they are diverted to private warehouses or online sales platforms. Prices are marked up. Desperate patients pay five to ten times the regulated rate [6][7].
Pharmacists and health experts call this practice “artificial scarcity.” It is no longer an occasional glitch. It is a business model. A 2024 report from DW Persian warned that Iran’s strategic drug reserves have dropped to critical levels [8]. Black-market dealers, many of them linked to regime insiders, continue to sell critical medications at outrageous prices.
The crisis is also impacting production. According to a Shargh Daily article, seven major pharmaceutical companies reported financial losses in the first half of 2024. Some have reduced output or halted specific production lines. The cause is not sanctions. It is the broken pricing and payment system [9].
Pharmaceutical firms are caught between fixed government pricing and runaway inflation. At the same time, the national health insurance system owes billions of tomans to hospitals and pharmacies [10]. These debts block financial flows and disrupt supply chains. Even manufacturers with inventory on hand are unable to distribute their products efficiently.
3. Black Market in White Coats: The Rise of Rogue Pharmacies
A second health system now exists in Iran. It operates outside the law. It exists online, in private Telegram channels, unlicensed websites, and underground courier networks. Here, patients can buy drugs that are unavailable in pharmacies. But they pay much more. And they take a serious risk.
Many of these platforms are run by regime-connected actors. Some are tied to companies that hold official import licenses. Others operate through shell firms or online pharmacies with no oversight [11]. The drugs sold may be genuine. But there is no guarantee. Reports of expired, counterfeit, or contaminated medications are increasing. So are hospitalizations linked to black-market drugs [12].
Patients often have no choice. Long lines, empty shelves, and rationed prescriptions push them toward illegal channels. In some cases, cancer patients or families of children with rare diseases are forced to rely on these sources. They pay five, sometimes ten times the normal price. They risk their lives with each purchase [13].
The Iranian Pharmacists Association has warned about this new black market. In a public letter in 2024, they described a “virtual drug bazaar” that undermines both public health and professional ethics [14]. Yet little has been done.
Licensed pharmacists are also under pressure. Many cannot compete with unregulated sellers. Some are shutting down. Others face punishment for speaking out. A Tehran pharmacist said anonymously: “We are no longer health professionals. We are witnesses to a public health crime that no one is willing to stop.” [15]
Those who try to report abuse face threats or retaliation. Regulators often turn a blind eye—especially when powerful interests are involved.
4. The IRGC’s Shadow in the Drug Supply Chain
The Islamic Revolutionary Guard Corps (IRGC) is best known for its role in military and security affairs. But it is also one of Iran’s most powerful economic forces. Over the past two decades, the IRGC has extended its reach into key industries. These include construction, energy, telecommunications—and pharmaceuticals.
Through a network of affiliated companies, the IRGC has taken control of much of Iran’s drug import and distribution system. These firms operate under the guise of “resistance economy” policies. They claim to support national self-sufficiency. In practice, they exploit loopholes, bypass regulations, and dominate key markets [16][17].
Companies linked to the IRGC receive exclusive import licenses. They face little or no scrutiny from customs officials. Some re-export medicine to neighboring countries for profit. Others delay distribution to inflate prices. This leaves hospitals and pharmacies empty, while black markets thrive [18].
The financial networks that support these operations are opaque. Many of the firms are technically private. But they receive favorable contracts, government backing, and immunity from investigation. Whistleblowers say that even basic audits are avoided. The Ministry of Health is often powerless—or complicit [19].
IRGC-linked holding companies have also invested in online platforms. These sell medication outside the official network. They promote themselves as fast and convenient. In reality, they are a key part of the drug mafia’s infrastructure. They move high-demand medicines into private channels. They profit while patients suffer.
This is not just corruption. It is a militarized monopoly. And it is growing.
5. Patients Pay the Price
The cost of Iran’s drug crisis is not abstract. It is personal, painful, and deadly. Millions of Iranians—especially the poor and the sick—are now unable to access the medications they need.
Essential drugs like insulin, blood thinners, and cancer treatments are either unavailable or unaffordable. A full course of chemotherapy, once covered by subsidies, now costs millions of tomans. Many families fall into debt. Some abandon treatment altogether [20].
Patients with chronic conditions suffer the most. Delays in access mean real harm. A missed dose of epilepsy medication can cause seizures. Interruptions in cardiovascular treatment can lead to strokes or death. Even basic antibiotics are now scarce in some regions [21].
Desperate patients turn to underground markets. But there they face another danger—fake or expired drugs. There are growing reports of adverse reactions, poisoning, and hospitalization. In some cases, patients have died after taking black-market medicine [22].
The system favors the rich. Well-connected elites and government officials receive treatment at military or VIP hospitals. These facilities have reliable access to imported drugs. But ordinary citizens must search pharmacy after pharmacy. Or they must buy from smugglers at black-market prices [23].
The result is a widening gap. Not just in health outcomes—but in dignity, safety, and hope.
Iran’s constitution promises healthcare as a right. Today, it is a luxury.
6. Patients Pay the Price
The cost of Iran’s drug crisis is not abstract. It is personal, painful, and deadly. Millions of Iranians—especially the poor and the sick—are now unable to access the medications they need.
Essential drugs like insulin, blood thinners, and cancer treatments are either unavailable or unaffordable. A full course of chemotherapy, once covered by subsidies, now costs millions of tomans. Many families fall into debt. Some abandon treatment altogether [20].
Patients with chronic conditions suffer the most. Delays in access mean real harm. A missed dose of epilepsy medication can cause seizures. Interruptions in cardiovascular treatment can lead to strokes or death. Even basic antibiotics are now scarce in some regions [21].
Desperate patients turn to underground markets. But there they face another danger—fake or expired drugs. There are growing reports of adverse reactions, poisoning, and hospitalization. In some cases, patients have died after taking black-market medicine [22].
The system favors the rich. Well-connected elites and government officials receive treatment at military or VIP hospitals. These facilities have reliable access to imported drugs. But ordinary citizens must search pharmacy after pharmacy. Or they must buy from smugglers at black-market prices [23].
The result is a widening gap. Not just in health outcomes—but in dignity, safety, and hope.
Iran’s constitution promises healthcare as a right. Today, it is a luxury.
7. A Policy Blueprint for Reclaiming Public Health
Solving Iran’s drug crisis will take more than importing more medicine. The country needs structural reform. The health system must be freed from corruption, monopoly, and political interference. While I firmly believe that meaningful reform in Iran is nearly impossible without full regime change, here are – at least in theory – five urgent steps that must be taken:
i. Independent Oversight
Create civilian-led agencies to oversee drug imports, pricing, and distribution. These agencies must be independent. They must have full investigative powers. They must report to the public, not to the regime [28].
ii. Regulate Online Sales
All platforms selling medicine online must be licensed. They must track where the medicine comes from, how it is stored, and to whom it is sold. Platforms that do not meet standards should be shut down [29].
iii. Enforce Anti-Corruption Measures
Companies and officials who profit from medicine shortages must be investigated and prosecuted. This includes those linked to the IRGC or operating under state protection. International pressure may help, but domestic action is essential [30].
iv. Protect Whistleblowers and Professionals
Pharmacists and doctors must have a voice in drug policy. They must be allowed to report abuse without fear. Legal protections for whistleblowers are essential. So is ending retaliation against critics [31].
v. Reinvest in Public Health
Budgets must be redirected. Funds now flowing to military-affiliated firms should go to hospitals, pharmacies, and domestic drug producers. Health policy must serve the public—not the elite [32].
Without these steps, the crisis will deepen. The drug mafia will grow stronger. And more patients will suffer.
8. Conclusion: A System Designed to Fail
Iran’s medicine crisis is not a natural disaster. It is a political and moral failure. A system built to enrich a few has abandoned the many. Patients are suffering. Some are dying. And those in power are doing nothing to stop it.
This crisis was not caused by sanctions alone. It was created by corruption. By the drug mafia. By the militarization of the health economy. It thrives on opacity, fear, and silence.
Iran has the knowledge to produce medicine. It has the factories, the pharmacists, and the trade channels. But it lacks honesty. It lacks accountability. And it lacks the political will to dismantle the networks that profit from human suffering.
Every delay in reform means more lives lost. More families broken. More trust destroyed.
Change must begin from within. It must begin with truth. And it must begin with justice—for the pharmacists, for the doctors, and above all, for the patients.
9. References
1. Human Rights Watch. *“Iran: Corruption in Health Sector Harms Patients.”* April 2023.
2. Radio Farda. *“Drug Mafia and IRGC Ties in Iran’s Pharmaceutical Sector.”* March 2023.
3. U.S. Department of the Treasury. *“Sanctions Programs and Exemptions for Humanitarian Trade.”* Updated 2023.
4. BBC Persian. *“Medicine Crisis in Iran and the Role of Sanctions vs Corruption.”* January 2024.
5. Donya-e-Eqtesad. *“وضعیت تولید دارو و تجهیزات پزشکی در کشور.”* July 2025. [https://donya-e-eqtesad.com](https://donya-e-eqtesad.com)
6. Al-Monitor. *“Patients Forced to Buy Medicine on Black Market.”* November 2023.
7. Shargh Daily. *“صنعت داروی ایران در آستانه بحران.”* July 2025. [https://sharghdaily.com](https://sharghdaily.com)
8. DW Persian. *“وضعیت ذخایر استراتژیک دارویی وخیم است.”* July 2025. [https://dw.com/fa-ir](https://dw.com/fa-ir)
9. Iranian Pharmacists Association. *Open Letter on Black Market Drug Sales.* June 2024.
10. Financial Tribune. *“Shortages and Smuggling in Iran’s Pharmaceutical Market.”* December 2023.
11. Middle East Institute. *“Iran’s Health System and the IRGC’s Economic Role.”* July 2022.
12. Melliun.org. *“بحران دارو در ایران؛ وضعیت ذخایر استراتژیک وخیم است.”* July 2025.
13. Transparency International. *Middle East and North Africa Corruption Report.* 2022.
14. World Health Organization. *“Access to Medicines in Sanctioned Countries: The Case of Iran.”* 2021.
15. Econegar. *“پیشبینی هولناک توقف تولید دارو در ایران.”* April 2024. [https://econegar.com](https://econegar.com)
16. ISNA. *“سهم قرارگاه خاتم در پروژههای سلامت و دارو.”* 2023.
17. Khabar Online. *“سودآوری واردات دارو توسط شرکتهای خاص.”* 2023.
18. Tasnim News. *“قاچاق معکوس دارو از ایران به کشورهای همسایه.”* March 2024.
19. Transparency Center Iran. *“دادههای پنهان سازمان غذا و دارو.”* 2024.
20. Iran International. *“افزایش هزینههای درمان بیماران سرطانی در ایران.”* 2023.
21. Etelaat Newspaper. *“نایابی داروهای خاص در شهرستانها.”* January 2024.
22. Mehr News Agency. *“داروهای تقلبی در بازار سیاه.”* 2023.
23. BBC Persian. *“داروهای خاص چگونه به بیمارستانهای خاص میرسند؟”* 2024.
24. OFAC. *“Guidelines for Humanitarian Trade with Iran.”* 2022–2023.
25. WHO. *“Iran: Country Cooperation Strategy.”* 2021–2025.
26. Radio Zamaneh. *“فساد ساختاری در زنجیره دارویی ایران.”* 2023.
27. IranWire. *“آیا تحریمها باعث بحران دارو در ایران هستند؟”* 2024.
28. Iran Medical Council. *“پیشنهاد نظارت مستقل بر دارو.”* 2023.
29. Etemad Daily. *“فروش اینترنتی دارو؛ قانونمند یا خطرناک؟”* 2023.
30. IRNA. *“لزوم مقابله با رانت در واردات دارو.”* 2024.
31. Human Rights Activists in Iran (HRAI). *“سرکوب افشاگران دارویی.”* 2022.
32. Free Iran Scholars Network (FISN). *Internal Memo on Healthcare Corruption and IRGC Involvement.* 2024.