Sub-standard drugs: A serious case of overdose

Corruption, ignorance and indifference the chief causes of a high wastage of essential medicines
By Nadia Fazlulhaq

Large quantities of sub-standard drugs are flowing into the country unchecked, say medical sources. As long as there is no monitoring and no proper controls in place in the import of drugs, patients will continue to suffer and the country will lose money, these sources say.

In 2008, more than 35 drugs were found to be sub-standard. These included anti-epilepsy drugs and a number of antibiotics, as well as drugs used to treat brain tumours and rheumatoid arthritis; support labour contraction during childbirth, and stabilise blood glucose levels. Various types of surgical equipment were also on the list of substandard medical products.

In 2009, a massive stock of the painkiller pethidine – 360,000 vials – had to be thrown away because it was past the expiry date. Pethidine is favoured by doctors because it is a less addictive drug than other painkillers. As a result of the pethidine shortage, hospitals were compelled to use morphine, which is highly addictive, in surgery on injured soldiers and civilians.

The Government Medical Officers Association (GMOA) has meanwhile warned that the public is at serious risk if hospitals across the country continued to face drug shortages or were forced to use inferior quality drugs on their patients.

The GMOA says prompt action by the government is vital. GMOA spokesman Dr. Upul Gunasekare told The Sunday Times that “corruption, ignorance and indifference” were the chief causes for the high level of wastage of essential drugs seen at hospitals.

“We have a vital question: Why are drugs that are already close to their expiry date being brought into the country? The Ministry of Health had to throw away 360,000 vials of pethidine. One vial of pethidine costs about Rs. 30. The country has wasted more than Rs. 10 million on expired pethidine. Airlifting this painkiller from India only adds to costs.”

Dr. Gunasekare said a recent shortage of thyroxin, a drug used to treat thyroid conditions, forced the government to purchase a supply of the drug, which has since been found to be of inferior quality.
A National Drugs Policy that was drafted by a select group of medical professionals was handed over to the Health Minister. However, according to medical sources, no apparent action has been taken to implement the policy’s recommendations. In the absence of a national drugs policy, a huge quantity of brand-name drugs is being used across the country with no proper monitoring, sources say.

“Although the Health Ministry has directed doctors to prescribe generic drugs, rather than brand-name drugs, Sri Lanka has registered a surprisingly large number of brand-name drugs, compared with other countries,” Dr. Gunasekare said.

Taking the antibiotic Amoxicillin as an example, Dr. Gunasekare said most developing countries sold only a handful of Amoxicillin brands, while Sri Lanka had hundreds. When local doctors use generic names in their prescriptions, they give unethical pharmacists a chance to recommend expensive brands for their own profit, he said.

‘Why are drugs that are already close to their expiry date being brought into the country?’ – GMOA spokesman Dr. Upul Gunasekar

According to Dr. Gunasekare, the State Pharmaceutical Manufacturing Corporation (SPMC), the manufacturing wing of the State Pharmaceuticals Corporation (SPC), produces quality Amoxicillin, but the government chose to buy the drug at a lower cost from India. However, the India-manufactured Amoxicillin was later found to be of inferior quality and was subsequently withdrawn.

The Sunday Times learns that more than 75 brands of the analgesic Tramadol are available in Sri Lanka, while only five to six brands of the drug are used in Britain.

Dr. Gunasekare said certain doctors and pharmacists were taking advantage of the fact that Sri Lanka had no national drug information centre, and that the general public was generally ignorant about drugs and their proper usage.

“Most countries have drug information centres. These are important for both patients and doctors. Unfortunately, the average Sri Lankan patient knows little or nothing about the drugs he or she is being prescribed. With a drug information centre, patients, doctors and the general public can learn about drugs, online or on the phone, on drugs prescribed, drugs available in the country, and how to use those drugs,” he said.

Meanwhile, a leading medical consultant told The Sunday Times that the last Sri Lanka Hospital Formulary, a publication that provides comprehensive information on drugs and their usage, came out in 1993.

“In Britain, a British National Formulary comes out every six months,” the consultant said. “We have no up-to-date Sri Lanka Hospital Formulary to turn to for reference. Doctors who go overseas for training have to bring back used copies of the British National Formulary for reference.”

The drugs index, which covers all available drugs, registered drugs and new drugs, was last published in 2004.

Meanwhile, Dr. Ajith Mendis, the Director General of Health, has given an assurance that all steps will be taken to track and eliminate sub-standard drugs from hospital stocks and pharmacy shelves, and that a revised index on drugs will be made available as early as possible.

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