MEDICATION PRACTICES IN BANGLADESH ----- ROLES OF PHARMACISTS AT CURRENT CIRCUMSTANCES Review Article MANIK CHANDRA SHILL 1 , ASISH KUMAR DAS 2* 1. Coordinator – IPD Pharmacy, Square Hospitals Ltd. Dhaka, Bangladesh, 2. Received: 12 April 2011, Revised and Accepted: 6 May 2011 Associate Professor, Pharmacy Discipline, Khulna University, Khulna-9208, Bangladesh. Email: dasasish03@yahoo.com ABSTRACT Principal objectives of the National Drug Policy, 1982 were to make available essential drugs, ensure good quality drugs, control drug prices, ensure rational use of drugs, develop an effective drug monitoring system, improve the standard of hospital and retail pharmacies and ensure good manufacturing practices. Though we have earned lots of things but still we are far from achieving these entire goals. Unsafe and irrational use of drugs not only increasing financial burden but also causing death and engender our quality of lives. Studies have shown that pharmacists can reduce medication errors and also play vital role in rational use of medication thus reducing financial load as well as can cut down national budget on drugs procurement. Pharmacists are also a good source of drug informations for healthcare professionals and counseling patients regarding medication and other social issues. To achieve the goals of National Health policy 2010, more involvement of pharmacists in the healthcare system especially in the hospital and community pharmacies is inevitable. Keywords: Irrational drug use, Medication error, Pharmacist, Healthcare system, Hospital and Community pharmacy. BACKGROUND The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer”. 1 Medication errors result from faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent mistakes. Problems can result from illegible handwriting, use of dangerous abbreviations, overlooked interactions with other medicines, oral miscommunications, and sound-alike or look-alike products. Poor product quality, adverse drug reactions (ADRs), and medication errors have huge impact on healthcare system which is almost impossible to estimate. 2 3 Authors of a meta-analysis estimated that ADRs alone—excluding medication errors—killed over 100,000 people in 1994 and were the fourth to six leading causes of death in the United States. 4 A similar study estimated that over 70 percent of ADRs that resulted in hospitalization in the United Kingdom could have been avoided. Bates et al., reported that 56% of adverse drug events occurred during the prescribing stage and 34% during the administration stage; only 4% occurred at the dispensing stage. 5 6 The common medication errors includes wrong dose, overdose, under-dose, inadequate follow up, inappropriate drug or wrong choice, decline in renal/hepatic function requiring alteration, avoidable delay in treatment, known allergy, wrong drug name, wrong frequency, drug-drug interaction, physician practicing outside area of expertise, wrong route etc. The most common causes of medication error are lack of knowledge about the drug (dose, form, frequency, route of administration, error in the choice) and lack of informations about the patient (results of lab test, current drugs and recent doses). The quality of health care, particularly the rational use of drugs, depends on a wide range of activities, such as making the correct diagnosis, prescribing the appropriate drug(s), and dispensing them properly. When used rationally, drugs cure ailments; on the other hand, it could be dangerous and life threatening when used irrationally. 7 8 Bangladesh Perspective Thus medication errors should be prevented through proper education and effective healthcare system comprising of prescribers, pharmacists, nurses, administrators and patients. Bangladesh Government spent Tk. 5,500 crores in health only in the year 1996-1997, out of which total spending on drugs was Tk. 2,700 crores (49%). 9 Due to exploitative market, almost 50% of our population has no reliable access to modern medicines and the rest 50% have access but are trapped into using non-essential, irrational and even dangerous drugs. This widespread irrationality prevails both in the private and public sectors, leading towards serious health problems and wastage of scarce resources. Pharmaceutical industries of Bangladesh have flourished tremendously after the implementation of National Drug Policy and Drug Control Ordinance 1982. Availability of essential drugs also increased remarkably with the increase in the volume of local production of all types of recognized drugs and the monetary value of which grew from Taka 1730 million in 1981 to about Taka 41000 million in 2002. Quality of products has improved and substandard drugs fell from 36% in 1970 to only 2% in 2002 and becoming a drug exporting country. 10 11 But a survey conducted in 1988 – 91 has showed that numerous small companies still market substandard drugs in the country. 12 Fake or substandard medicines, including lifesaving ones, with an estimated worth of US$ 150 million per year, are flooding the domestic market. National Drug Policy (NDP) 2005 states that only registered drugs should be allowed to distributed and sold throughout the country under person having professional qualification or holding valid professional license. NDP 2005 again indicates that no drugs other than OTC should be sold or dispensed without prescriptions. Rational use of drugs (RUD) should be ensured by conducting survey on the system of prescribing, dispensing and patient compliance. Monitoring and reporting adverse drug reactions (ADR) should be done seriously to ensure safe and rational use of drugs in the country. 13 11 But according to the Bangladesh Chemist and Druggist Association, there are about 70,000 illegal drugstores. Most of them are selling substandard or fake, poor quality, smuggled and adulterated medicines and a significant proportions of these medicines are selling without registered doctors’ prescription indicating violation of NDP. 14 Drugs Testing Laboratory in its annual testing of 5,000 local samples found 300 either counterfeits or of very low quality. 15 Weak enforcement of the provision of laws of National Drug Policy and Drug Control Ordinance 1982 like punishment by imprisonment or fine for those who manufacture or sell substandard drugs might endanger the situation. F. Ahmed et al. in their study showed that 13.33% of Metronidazole tablet and 20% suspensions of the same under investigation were less potent. 12 16 Again, a study involving a sample of 15 brands of ciprofloxacin collected for chemical and bioassay revealed seven brands contained active ingredient less than the USP specification. 17 Another report noted that 69% of Paracetamol tablets and 80 per International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 3, Suppl 4, 2011 A A c c a a d d e e m mi i c c S S c c i i e e n n c c e e s s