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Pharmacist Nalini Dial is calling on Health Minister Terrence Deyalsingh to immediately release the names of fake drugs that are ending up on pharmacy and store shelves across the country.
She also wants Deyalsingh to address a list of issues involving pharmacies.
Her call follows Deyalsingh’s comments in a Sunday Guardian article titled “Trinis play Russian roulette with their health” on April 22. The minister noted in the article that after five pharmacies had been investigated for the sale of unregistered drugs, there will be more checks and it was an ongoing process since May 2015. He also said the ministry had also written to the Pharmacy Board reporting certain pharmacies for their actions.
Speaking to the Sunday Guardian, however, Dial said “The minister cannot have the public and also the pharmacists in a state of confusion and worry.
“He is making claims that the drugs are counterfeit. Therefore, does this mean that they have been tested by Food and Drug for potency and quality?
“Are these drugs still being sold at other pharmacies and what are the dangers to one’s health? He should immediately issue a release of the drug names.”
She also gave a list of discrepancies taking place at pharmacies that she wanted Deyalsingh to look into. Dial said they were the main problems she had witnessed in her 34 years as a pharmacist. She said the issues had been ongoing for many years but the Pharmacy Board and the ministry did not have the manpower to investigate all pharmacies. Dial claimed that for many years there had also been no inspection of premises or record books.
Her complaints are:
1. Pharmacies operating without a licensed pharmacist on the premises
2. Pharmacy technicians and ordinary clerks posing as pharmacists, recommending dispensary drugs, giving counselling and advice
3. Pharmacies buying drugs from suitcase drugs that had not been registered and tested for potency
4. Pharmacies selling expired drugs, removing the expiry date and selling the drugs knowing them to be expired
5. Unethical practices; pharmacies selling high-priced drugs instead of lower priced drugs that could work just as well
6. Selling of controlled, antibiotic and narcotic drugs without a prescription
7. Selling of the drug Cytotec to induce abortion without a prescription
8. Overpricing of drugs and no pricing control enforced
9. Selling CDAP stock if their own stock runs out
10. Substituting prescribed drugs without a doctor’s permission
11. Lack of drug inspectors to inspect records of antibiotics and control stock.
Dial also claimed since Deyalsingh’s appointment he has not appointed any representative to sit on the Pharmacy Board. She said he was allowed to select two people but because of this, the board has not been able to have any meetings.
Commenting on Dial’s claims and the state of the pharmaceutical environment locally, Pharmacy Board of T&T president Andrew Rahaman said while the Health Ministry uses the Caribbean Industrial Research Institute (Cariri) labs in Jamaica and Miami for testing of drugs, pharmacists were not getting the results and therefore could not determine which pharmaceuticals are counterfeit. He said he had called on Cariri and Deyalsingh to produce the results of the institute’s tests to prove the claims, because pharmacists need to know this so they could take the necessary actions.
Regarding pharmacies operating without a licensed pharmacist on the premises, he said the board was aware of a few instances, in which case they were not granted their annual pharmacy licenses by the board’s council until they satisfied the council that pharmacists were working during opening hours. As to pharmacy technicians and ordinary clerks posing as pharmacists, recommending dispensary drugs and giving counselling and advice, he said they usually assisted pharmacists with dispensing.
But Rahaman admitted the council cannot monitor every pharmacy in T&T, adding that CDAP, the Drug Inspectorate and Chemistry, Food and Drugs Division and Ministry of Health assisted the council in this regard. He said the public can also assist by reporting such instances to the council.
On pharmacies buying drugs from suitcase traders, he said there was a humongous problem with registration and re-registration of drugs by the Ministry of Health.
He said the potency of such drugs was in question and checks were critical, since doctors continued to prescribe these medications.
Rahaman said over a three to five-year period, costs of most of these medications from the wholesalers of the registered medications had almost doubled and continue to rise.
He said some pharmacists, after examination of the package and medications, attempt to assist to keep patients’ medication costs affordable. But he said even registered medications were not tested during their registration process for potency.
He said he could not confirm whether pharmacies were selling expired drugs, but noted pharmacies actually get back their full purchase price from wholesalers for full boxes/bottles returned by the stipulated time and so don’t lose money from expired medication for the most part. The expired drugs are also usually destroyed, he said.
But he said customers could assist by asking pharmacists to see the packaging to check for expiry dates on medication and report it to the council.
He admitted that pharmacies were either not getting sufficient stock or any CDAP stock at all to sell. Rahaman said in any event, most CDAP drugs were so low priced that there was no profit in doing so and CDAP monitors stock sent to pharmacies.
Adding to the overall problem, Rahaman said, was the fact that there were insufficient drug inspectorate officers and to a lesser extent Chemistry, Food and Drugs inspectors to conduct inspections of pharmacies more often.
Rahaman also denied Dial’s claim that Deyalsingh did make his appointees to the Pharmacy Board. He said this was done in October 2017, but the council remained not fully constituted because the Medical Council had not informed the Pharmacy Council of their appointees.
Contacted for comment on some of the issues raised, Deyalsingh said the questions were better posed to Rahaman.
Deyalsingh did, however, confirm that he had appointed two people to the board last year.