The consequences of nonprescription medication sales in Saudi Arabia's community pharmacies: regulations without implementation.

Abstract

To the Editor, The sale of nonprescription medications is a major challenge faced by developing countries. High treatment costs, limited access to advanced care, patients’ personal experiences and easy access are some of the main factors responsible for self-medication. In developed countries like the United States, approximately 80 products are sold over-the-counter (OTC), which means that patients may purchase them without first consulting a healthcare provider. These OTC medications mainly include analgesics, acne treatments, sunscreen lotions and weight loss pills. The decision to make a drug available OTC is based on the drug’s safety profile and low abuse potential [US FDA, 2012]. Medications with low safety profiles and high abuse potential may not be sold without a prescription. However, in Saudi community pharmacies, every drug is treated as an OTC drug and may be purchased without a prescription [Bin Abdulhak et al. 2011; Emeka and Khan, 2012; Khan and Ibrahim, 2013]. The recent death of an expatriate is a painful reminder of the consequences. The event happened when an Egyptian community pharmacist advised the patient to take an intravenous medication (the media reported it as a ‘flu shot’), which was administered by a ‘pharmacy worker’ [Irfan, 2014]. According to the 1978 law regulating Saudi pharmacy practice, all operations in a pharmacy must be performed by a licensed pharmacist, not by a pharmacy worker, and no medicines other than those designated as OTC should be dispensed without a prescription [Bawazir, 1992]. For three decades, this law has awaited implementation. This malpractice may have resulted in many adverse events, which may not have been reported due to a lack of knowledge among community pharmacists about the adverse event reporting system [Khan, 2013; Mahmoud et al. 2013]. Some patients may have died and relatives simply considered it ‘the will of God’. But the practices in Saudi community pharmacies remain the same. One possible reason for such practices is the lack of Saudi pharmacists in community pharmacies – most of the pharmacists working in Saudi community pharmacies are expatriates from other Gulf countries, mainly Egypt, Jordan and Syria. Practices in their home countries and deficient training may be the main factors affecting their levels of professionalism and responsibility while practicing in Saudi Arabia. Thus, they may concern themselves more with profits, markup percentages and revenue generation (for their companies and themselves) than with patient and community safety [Bawazir, 2004]. Considering patient safety and the severity of current malpractice, it is time for regulatory authorities to take solid measures to implement the drug sale regulations outlined in the 1978 Saudi drug law. All pharmacists working in Saudi community pharmacies should be trained and certified, with up-to-date knowledge about medication safety. Passing the Saudi drug law exam and recertification should be made compulsory for all community pharmacists. The penalties for violation should be explained in their employment contracts, and pharmacy chains should introduce consumer databases to reduce the chances of disease–drug and drug–drug interactions. Last, but not least, an electronic prescription system should be introduced in all polyclinics and community pharmacists should be provided with the tools to countercheck for any potential errors or ambiguities before dispensing a prescription medication. These timely initiatives will not only ensure high levels of professionalism and responsibility among community pharmacists, but will also assist in improving patient safety in Saudi community pharmacies [Haseeb and Elrggal, 2013]. To date, in Saudi Arabia, pharmacy has been considered a respected and lifesaving profession. If this trust is lost, it may take years to regain consumer confidence in the pharmacy profession.