Thursday, March 06, 2014

Georgia: Georgia Tightens Up on Pharmacy Sales

This article originally appeared in the Institute for War and Peace Reporting,
Georgia Tightens Up on Pharmacy Sales

The health ministry in Georgia is tightening up on sales of pharmaceuticals to stop some people self-medicating and to prevent others from manufacturing illicit drugs.

Some experts say Georgia’s health service is not geared up to cope with the mass of prescription requests that are likely to result from the new rules.

David Macharashvili, the head of the health ministry department that supervises pharmaceuticals use, told IWPR that one reason for having tougher rules was to stop criminals buying legal drugs and turning them into illegal substances.

“Home-made narcotics remain a most acute issue. They include amphetamines and desomorphine, also known as ‘crocodile’,” he explained. At the moment, he said, “The substances needed to make them are very easy to buy at pharmacies, even for minors, although it’s against the rules.”

To underline the point, Macharashvili described checks that the health ministry ran together with the Georgian police between October and December last year, which revealed that 27 registered pharmacies had sold 3.5 million pills containing codeine. Illegally-made desomorphine, known as “crocodile” in Georgia and its neighbours, can be derived from over-the-counter codeine.

Dr Gela Lejava, a specialist in dealing with illegal drug use, says that with around 45,000 “problem addicts” in Georgia, most of them using needles, imposing a requirement for prescriptions was a much-needed step.

At the same time, another reason for restricting access to certain drugs is to improve healthcare.

“People in Georgia often resort to self-medication. This makes no sense from the perspective of rational pharmacology practice. It fixes problems for a time, but they will then reappear, only now in aggressive form,” Macharishvili said. “Buying medicines without a prescription increases rather than reduces one’s outgoings. The problem doesn’t go away and you’ll still have to see a doctor…. Treatment works out dearer in the end.”

The mandatory prescription requirement applies to the middle of three groups in which pharmaceuticals are categorised. This group includes antibiotics, cancer and cardiovascular medication and the like. In theory, these are already supposed to be sold on prescription, but a health ministry instruction from 2009 created a loophole by forbidding chemists to refuse to sell them even when the customer had no prescription.

The most tightly restricted class of drugs such as those containing narcotic and psychotropic substances is already strictly prescription-only, and that will remain the case, with somewhat tighter regulation.

The third class consists of general over-the-counter medicines, which will continue to be freely on sale. However, both they and the two classes of prescription-only drugs can no longer be sold to minors.

The new rules are being introduced in phases from February to the end of September.

While some pharmacists fear that sales will plummet, the head of Georgia’s Pharmaceutical Association, Bidzina Chumburidze, welcomes the reform as a way of bringing the country into line with international best practice.

“Human health is the main thing for the medical and pharmaceutical sectors – only after that does profit come in,” he told IWPR.

Although few would dispute the principles behind the new rules, some experts fear that in practice, a deluge of prescription requests for “class two” pharmaceuticals could lead to drug shortages and provide scope for corruption.

According to Tina Turdzeladze, who heads the board of the Healthcare Experts’ Club, the system the health ministry has come up could undermine the very aims it seeks to achieve.

“The healthcare system won’t be able to cope with the numbers of patients who will have to request prescriptions,” she said. “Prescriptions will be written out for acquaintances or as ‘a mark of respect’ [ie. in exchange for a bribe]. A visit to the doctor will become more expensive.”

Some patients might resort to buying over-the counter products instead of going to the trouble of getting a prescription for the drugs they actually need, despite the serious health risks of doing so.

“It’s a certainty that sales of medications will fall, most likely by up to 80 per cent,” Kakha Panchuladze, director of the PSP Pharmacy, said. “They [customers] will go over to other substances like herbal treatments.”

Medical care in Georgia now operates on a system of health insurance, either paid by the individual or by the state, depending on income level. Health ministry officials insist that the more rigorous prescription rules should not really affect this.

Macharashvili says that since people are already covered by health insurance, prescription drugs are not going to cost them any more.

However, Health Minister David Sergeenko has acknowledged that patients could face delays in waiting to see a doctor for a prescription, in the minority of cases where they are not free to choose between different health service providers.

“This mainly applies to children and the elderly, and it will create a degree of discomfort,” Sergeenko told reporters. “We have done our best to ensure that they don’t have to wait in a long queue as a result of these new rules.” 

Sopho Bukia is an IWPR trained journalist and works for the Rustavi-2 broadcasting company in Georgia.