KATHMANDU, DEC 20 - The emergency unit at the Tribhuwan University Teaching Hospital (TUTH) records 15 to 20 cases of drug overdose every month, according to Dr Hari Poudel, Medical Officer at the TUTH emergency. That is, however, only a small portion of complications related to drug misuse in the capital.
Misuse, abuse and overuse are the stories dominating the allopathic drug market in the kingdom, as sales of classified drugs without prescription go unabated in the pharmacies. Drugs Act specifically prohibits such sales.
The Drugs Administration Act has classified drugs into three categories: A) narcotics B) antibiotics and hormones; and C) basic drugs. The Act prohibits the sales of category A and B drugs without prescription from a medical practitioner, while category C drugs—also termed ‘over the counter’ drugs— do not require medical prescription.
However, a survey conducted by The Kathmandu Post revealed that one can easily buy category A and B drugs without a prescription. Among the five pharmacies in front of the Bir Hospital sampled for the survey, only one denied giving out Alprazolam, an anti-depressant belonging to narcotic group. The rest willingly sold the drug without asking for a prescription. Other retail drug outlets in the Valley are even less sensitive about prescription. Despite such rampant sales of sensitive drugs without prescription, monitoring of the pharmaceutical market and law enforcement has remained lackadaisical.
“Lack of evidence with regard to sales of medicines without doctor’s recommendation leaves the culprits unpunished,” said Bimal Man Shrestha, senior pharmacist at the Department of Drug Administration (DDA). However, if a journalist can go and buy a drug without prescription from major drug stores in the capital, the argument of “lack of evidence” holds little ground.
Shrestha further argued that lack of manpower in the DDA and the increasing tendency of self-medication among the populace have further complicated monitoring and law enforcement.
In Kathmandu Valley alone, according to Shrestha, there are 3178 registered allopathic drug traders inclusive of both retailers and wholesalers. Interestingly, the number of drug inspectors assigned to operate in the area is just four!
Amidst this weak monitoring, the demand for some sensitive drugs is on the rise. “There has been an increase in demand of ‘ultimate’ antibiotics like carbapenams,” said Shrestha. He ascribed this surge in demand to immunity that patients have developed towards lighter drugs.
Part of this rise in use of narcotic drugs could also be attributed to rising self-diagnosis and self-medication practice, which doctors say is a very serious thing and could have long-term health ramifications.
“Self- medication can complicate further treatments as it can result in multi-drug resistance,” said Dr Dhurba
Bahadur Singh, in-charge of Bir Hospital emergency section.
If pharmacists that sell drugs without prescription can be called culprits, so are the people buying it without prescription, Shrestha added. However, he also admitted shortcomings in the monitoring of drugs circulation.
“The act itself lacks clarity on certain vital issues,” said Shrestha. “It says prescription can be made by ‘medical practitioner’, but it is not explicit about who medical practitioners are.”Posted on: 2003-12-21 01:41

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