Friday, September 22, 2023

Bitter pills

The issue of sale of spurious and substandard drugs in Nagaland is nothing new as we have been witnessing this for decades now. It can be said that neither all the medicines available in our markets can be labeled to be altogether spurious or substandard nor all of them be declared to be of paramount standard quality. We cannot also rubbish public perception about quality of drugs since common masses consume these medicines themselves and they have got a first-hand experience about their quality and effectiveness. So if they are not satisfied with the quality of drugs, something is wrong somewhere that needs to be addressed rather than adopting an ostrich approach and burying our head in the sand saying that nothing is wrong at all. If drug regulatory authorities have not been able to detect any spurious drugs in our markets they need to rethink about their drug sampling and drug testing procedure, strategy, designs, quantities and schedules and accordingly devise innovative modalities to track down these sourly bitter pills. Have our drug inspectorate been equipped enough to bust spurious drug rackets through intelligence networking cells that provide lucrative incentives to the informers? Are they sufficiently trained in such skills? Do they have the requisite technological and logistic support in terms of mobile drug testing vans laced with sophisticated equipments that could enable them to test the quality of drugs on spot instantly? Here a major reason for plummeting quality standards of medicines in our markets is the mushrooming of drug retailers and wholesalers in every nook and corner of the state. Thousands of pharmacy registration certificates have been issued to every Tom, Dick and Harry irrespective of their educational qualifications. Persons without diploma and degree in pharmacy have been registered as pharmacists without any basic know-how of pharmacy and subsequently they were provided drug sale licenses as a result of which today we can see beelines of drug stores not only outside hospitals but along the length and breadth of the state, which sometimes gives a notion that people living in Nagaland probably eat medicines in place of food. This in turn has led to the deterioration of pharmacy services with drugs manufactured by third rate companies being sold for higher profits and that too in absence of any prescriptions, which in turn promotes abuse of prescription drugs and psychotropic substances. There is also the case of most of the spurious drugs by virtue of ‘weak’ policy finding their way legally into government institutions like hospitals and dispensaries. The government makes bulk purchases of drugs and surgical items through the tender system and settles for the lowest bids instead of focusing on qualitative standards. The rates quoted by the pharma companies manufacturing fake and sub standard drugs are most of the times much lower than even the basic costs of raw materials. This allegedly has forced many established pharmaceutical companies to stop bidding for government procurement orders, which allows a free hand to manufacturers of spurious drugs to pump large volumes of such drugs into the market, with tragic consequences for the general public. The policy loopholes have encouraged a class of non-state subject medical entrepreneurs into the state to capitalize on the business opportunity. The question, therefore is, can we get rid of spurious and substandard drugs or not? Of course we can provided we have the will, wherewithal and the resolve to change the existing scenario rather than continue to live in a complete mode of denial. Way forward is to revise the state drug policy, implement it in letter and spirit, stop issuing drug licenses to non-pharmacy professionals, augment the staff strength and infrastructure of drug control department, upgrade drug testing laboratories and open new ones and ensure availability of standard quality generic drugs in government hospitals throughout the year without any stock-outs, incorporate the professional pharmaceutical care services in all hospitals through qualified pharmacy graduates and post-graduates, mandate prescribing of drugs on their generic names only, appoint pharmacy inspectors specifically for inspecting pharmacy stores for ensuring drug dispensing in accordance with established guidelines, pressing mobile drug testing vans into service for instant testing of drugs in far flung areas of the state, etc. This alone can bring some semblance of order in the chaotic state of affairs existing presently.