The States of the world, whether in the “North” or the “South,” use a variety of mechanisms to regulate pharmaceutical distribution. These mechanisms are built around the issue of the pharmacist's monopoly, granted by the State, and the scope of this monopoly, which varies by country. Through this chapter, we examine this monopoly and the consequences of the different ways it is applied to retail and wholesale distribution in Benin and Ghana as a result of the institutional and legal legacies of their former colonial powers: existence of a large informal market in Benin, sale of therapeutic classes exceeding those authorized in drugstores in Ghana, wide distribution by wholesalers in Ghana including to unauthorized buyers. The need to dissect the different applications (professional, dispensing, ownership) of this monopoly will appear, as will the need to consider the tensions between profession and capital, between public health and trade. These reflections will finally be discussed in relation to the changes currently underway in terms of pharmaceutical policies in West Africa.