National Drug Policy Research Articles

Inconsistencies between national drug policy and professional beliefs about psychoactive drugs among psychiatrists in the United States.

Evidence points to an incongruence between international drug policy and expert opinion about safety, abuse potential, and therapeutic potential of specific drugs. However, no prior studies have directly explored psychiatrists' attitudes about the current drug schedule. Therefore, we examined whether American psychiatrists' perceptions of four psychoactive drugs differed from those indicated by their schedules. A quasi-experimental online survey of a convenience sample of psychiatrists in the United States (N=181; Mean age=48.7; Female=35%). Participants were randomized to receive 1-of-4 vignettes, each depicting a depressed patient reporting relief from symptoms after non-prescribed psychoactive drug use (i.e., psilocybin [Schedule I], methamphetamine [SchedII], ketamine [SchedIII], or alprazolam [SchedIV]). Participants responded to questions related to this clinical scenario and then rated the safety, therapeutic, and abuse potentials of these four drugs and alcohol. There were significant differences by vignette condition in mean likelihood ratings of: warning against engaging in drug use again (p<.01), being concerned about developing a new psychiatric problem (p<.001), being concerned about increased suicide risk (p<.01) and being supportive of further use of this drug as part of the treatment plan (p<.001). Overall, non-prescribed use of methamphetamine and alprazolam was rated more concerning and less acceptable than non-prescribed use of psilocybin and ketamine. Compared to psilocybin and ketamine, participants rated methamphetamine and alprazolam as less safe (p<.001), having less therapeutic potential (p<.001), and having more abuse potential (p<.001). Mean ratings of safety and abuse/therapeutic potential of alprazolam and methamphetamine were equivalent to that of alcohol, and all three were rated more harmful than psilocybin and ketamine. American psychiatrists' perceptions about safety and abuse/therapeutic potentials associated with certain psychoactive drugs were inconsistent with those indicated by their placement in drug schedules. These findings add to a growing consensus amongst experts that the current drug policy is not scientifically coherent.

New indicators of health among adolescent drug users and evaluation of drug policies comparing countries

&#x0D; By correlating essential features of the national drug legislations and policies of some European countries and various indicators of consumption and health of consumers, interesting patterns emerge.&#x0D; We conclude that it is the correct balance between a drug policy aimed at prevention, rehabilitation, and a less restrictive legislation, that, on the basis of what we have analyzed and measured, has a positive effect on drug consumption and that indicators are efficient and should be applied regularly to compare quantitatively country policies to identify best practices.&#x0D;

THE PATTERN OF DRUG USES IN PREGNANT WOMEN ATTENDING THE ANTENATAL CLINIC OF THE OBSTETRICS AND GYNAECOLOGY DEPARTMENT AT A TERTIARY CARE HOSPITAL

Objective: The aim of the study was to study and evaluate the pattern of drug use in pregnant women attending the antenatal clinic of obstetrics and gynaecology department at a tertiary care hospital. Methods: A prospective observational study was conducted at the Department of Gynecology and Obstetrics in M.G.M. Medical College and Hospital, Kishanganj, Bihar. The study included 368 pregnant women who consented and provided written informed consent for participation in this study during the study period from January 2020 to November 2021. Results: Time for seeking the first antenatal check-up was majorly in 1st trimester (48.10%), followed by 35.60% in the 2nd and 16.30% in the 3rd trimester. A total of 3054 drugs were prescribed in all three trimesters from all organ systems. The majority belonged to blood and bone-forming agents, followed by antimicrobials and gastrointestinal drugs. Analyzing the prescribing trend grossly depicts that the drug prescribing showed a gradual increase from 18 to 2nd trimester, followed by a slow drop in 3rd trimester. During the entire study period, there were 177 prescriptions for 1st trimester, 306 prescriptions for 2nd trimester, and 366 prescriptions for 3rd trimester. Conclusion: Our study site revealed a greater tendency to prescribe by generic name rather than by brand name in our hospital, which is a good sign as it reduces the economic burden on the patients. In other previous studies, it was less. Prescribing percentage of antibiotics in all trimesters was on the high rise, while the percentage of encounters with injection was within acceptable ranges. The majority of prescribing corroborated with national drug policy and was in concurrence with the national drug formulary and NLEM 2015, which reflects the essence of rational prescribing of pregnancy drugs in our set-up.

Normalizing not using substances: DFC grants

Most young people don't use drugs, and the federal Drug‐Free Communities (DFC) program helps support those people. On July 8, the House Office of National Drug Policy (ONDCP) announced about $81 million for 645 local coalitions across the country as part of the DFC Support Program Continuation Grant Awards.

ONDCP announces $81 million for 645 youth coalitions

On July 8, the House Office of National Drug Policy (ONDCP) announced about $81 million for 645 local coalitions across the country as part of the Drug‐Free Communities (DFC) Support Program Continuation Grant Awards.

Police officers' attitudes and practices toward harm reduction services in Sweden - a qualitative study.

Since the 1980s, Swedish drug policy has combined a restrictive zero tolerance approach with the vision of a "drug-free society". However, in recent years, access to harm reduction services has increased through local initiatives and new national guidelines. The possible success of these services may be affected in part by police drug law enforcement. The aim of this study was to explore how Swedish police officers act toward and view harm reduction services in a national drug policy setting of zero tolerance toward drug use. Applying a qualitative research design, we conducted 19 in-depth interviews with police officers who worked with drug law enforcement in Malmö. We conducted a qualitative textual analysis of the data. Officers largely supported harm reduction services and refrained from overtly enforcing drug laws in their vicinity. Officers engaged in boundary work that assigned the responsibility of care of marginalized people who use drugs (PWUD) to the health care system, while including policing of drug market problems, young PWUD and dealers in their own jurisdiction. Opioid substitution treatment was seen as positive, although diversion of medicines was pointed out as a problem. Needle exchange programs were seen as offering important public health services and a no-go zone for the police. Several officers wanted to carry naloxone on duty but requested more information about its use. The general support among police officers for harm reduction services is an indication of a changing drug policy landscape in Sweden. Drug policy should take police officers' views into consideration and there is a need for collaboration between police and harm reduction services. Further research should focus on how the police conduct boundary work since police actions may impact on the success of harm reduction services.

IDF21-0168 Pathway to Clinical Diabetes Services in COVID-19 Era: What Has Changed and What Are the Implications?

Background: The known barriers to delivering clinical NCD services in lower-middle-income countries (LMICs) have been exacerbated with the onset of COVID-19. Health facility-instituted COVID-19 control measures could compromise the pathway for seeking care and impact chronic disease care that needs to be examined for future policy direction. Aim: This paper examines the changes COVID-19 has brought to diabetes service delivery in LMICs, using Ghana as a case study, and raises questions on the implication of such changes on the individual- and population-level diabetes treatment outcomes by exploring service provider perspectives. Ghana first recorded COVID-19 cases in March 2020, and from April, the government started implementing lockdown measures as well as closing hospitals' outpatient services, including diabetes clinics and other NCDs services. Method: We conducted eighteen semi-structured personal interviews with healthcare providers in primary, secondary and tertiary facilities within the Ghana Health Service. The topic guide was developed from a literature review conducted for this study and addressed issues such as COVID-19 and service organisation, staffing, referrals, patient concerns, data management and insurance. The interviews were conducted between November 2020 and February 2021, when outpatient services, including diabetes clinics, resumed operations. The analysis was performed using inductive and deductive methods in NVivo 1.4.1. Results and Discussion: The study found that suboptimal patient appointments and reminder systems result in overcrowded diabetes clinics, further increasing the risk of COVID-19 epidemic in hospitals. Tackling overcrowded diabetes clinics is urgently needed with the potential for patients and providers becoming infected with COVID-19. Engineering controls, e.g. fans instead of air conditioners to improve air circulation and ventilation, can help minimize transmission in hospital buildings. COVID-19 controls, e.g., extended time intervals between reviews, fewer appointments per clinic day, and shorter consultation durations, limit opportunities for clinicians to intervene in patients' conditions and consequently lead to poor treatment outcomes. Health systems need to investigate the cost-effectiveness of such controls to support policy decisions. National health insurance and drug policies limit health facilities and diabetes patients access to medicines in the COVID-19 era. Restrictions on the procurement and sales of insured medicines to patients contributed to the shortage of diabetes medication. Granted permission to procure medicines on the open market, a limit on the profit margin to put on medicine cost can result in a loss for health facilities. Known diabetes service delivery challenges, e.g. few trained providers, high treatment cost, and drug shortage, were aggravated, particularly in ambulatory care, during the pandemic. The UK and Italy adapted Facebook chatting, video tele-consultation and government websites for delivering diabetes care during the COVID-19 pandemic. However, we are aware that resource constraints may limit the implementation of similar strategies in LMICs. Our study suggests that COVID-19 presents additional challenges and worsens existing barriers to diabetes service delivery for clinicians and people living with diabetes. These challenges could have negative implications for population-level diabetes treatment outcome, interfering with the sustainable development goals. Further research remains to assess the effect of COVID-19-related structural changes on treatment adherence and outcomes in practice.

Analysis of Registration Situations of Drugs from Medicinal Materials and Traditional Medicines in Vietnam Period 2009-2020

Vietnam not only has a long history in traditional medicines but also has a diversity of medicinal plants to this day. Therefore, since 2016, the Government has introduced that the production of available medicinal materials was prioritized field in the development of pharmaceutical industry. However, until now, there is still little research related to drugs from medicinal materials and traditional medicines in our country, so we conducted this research to provide an overview of the registration situation of this drug group in Vietnam throughout the period 2009-2020. The results showed that in 12 years, drugs from medicinal materials and traditional medicines had had 2985 registration numbers, accounting for 6.9% of all registered drugs. Among 11 effect groups based on traditional medicines, the group of heat-clearing, detoxifying, dispelling rashes, and diuresis ranked first with 21.0%. Domestic drugs accounted for a large amount, with 2814 numbers (94.3%). Capsules and tablets were the two dosage forms with the highest number, holding 54.6%. In terms of drug components of registered traditional medicines, there were 87 products in single-component form and more than 1200 products in combination form. Our country had 224 manufacturers of this drug group, and 81 of them achieved GMP. In general, the registration of drugs from medicinal materials and traditional medicines met the guidelines set out by the Government, and manufactured drugs were qualified to serve the needs of people. However, in order to develop the field of drugs from medicinal materials and traditional medicines like other countries in Southeast Asia, in the coming years, Vietnam needs more support from the state management agencies and research efforts from pharmaceutical companies.&#x0D; Keywords: Registration number, Drugs from medicinal materials, Traditional medicines, Vietnam.&#x0D; References&#x0D; [1] The Government, Resolution No. 226-CP Regarding the Development of Traditional Ethnic Medicine in Close Combination with Modern Medicine, in Order to Build Vietnamese Medicine, Hanoi, 1978 (in Vietnamese).[2] The Government, Resolution No. 37-CP Strategic Orientation of People's Health Care and Protection in the Period 1996-2000 and Vietnam's National Drug Policy, Hanoi, 1996 (in Vietnamese).[3] The National Asembly, Law of Pharmacy, No. 105/2016/QH13, Hanoi, 2016 (in Vietnamese).[4] N. H. Trang, Analyzing and Evaluating the Group of Registered Traditional Medicines for Circulation in Vietnam Until 2006, Department of Pharmacoeconomics and Management, Hanoi University of Pharmacy, 2006 (in Vietnamese).[5] N. T. H. Yen, T. H. Ngan, VNU Journal of Science: Situation Analysis of the Drug Registration in Vietnam from 2009 to 2019, Vol. 37, No. 2, 2021, pp. 2, https://doi.org/10.25073/2588-1132/vnumps 4297 (in Vietnamese).[6] World Health Organization, Regional Office for South-East Asia, Access to Medical Products in the South-East Asia Region 2019: Review of Progress, https://apps.who.int/iris/handle/10665/32682, 2019 (accessed on: March 27th, 2021).[7] Ministry of Health, Health Statistics Yearbook 2018, Medical Publshing House, Hanoi, 2018 (in Vietnamese).[8] The Prime Minister, Decision No. 1893/QD-Ttg Issuing the Program of Developing Traditional Medicine, Combining Traditional Medicine with Modern Medicine by 2030, Hanoi, 2019 (in Vietnamese).[9] The Prime Minister, Decision No. 68/QD-Ttg Approving the National Strategy on Development of the Vietnam Pharmaceutical Industry up to 2020, with A Vision Toward 2030, Hanoi, 2014 (in Vietnamese).[10] Drug Administration of Vietnam, List of Manufacturers of Drugs and Drug Materials in Vietnam that Satisfy the GMP Standards, https://dav.gov.vn/danh-sach-cssx-thuoc-nguyen-lieu-lam-thuoc-tai-vn-dap-ung-tieu-chuan-gmp-cap-nhat-den-ngay-0892020-n2930.html/, 2020 (accessed on: September 25th, 2020) (in Vietnamese).[11] Ministry of Health, Decision No. 3657/QD-BYT Issuing the List of 100 Medicinal Materials with High Medical and Economic Values to Focus on Development in 2020-2030, Hanoi, 2019 (in Vietnamese).[12] Ministry of Health, Circular No.19/2018/TT-BYT Introducing List of Essential Medicines, Hanoi, 2018 (in Vietnamese).[13] Ministry of Health, Circular No.05/2015/TT-BYT Promulgation of List of Oriental Medicines, Herbal Medicines and Traditional Ingredients Covered by Health Insurance, Hanoi, 2015 (in Vietnamese).[14] N. V. Cuong, Pharmaceutical Industry Update Report April 2020, http://www.fpts.com.vn/FileStore2/File/2020/04/10/Pharmaceutical_Update_Report_Apr2020_108753a8.pdf/, 2020 (accessed on: March 20th, 2021) (in Vietnamese).[15] Traphaco Joint Stock Company, Annual Report 2020, http://traphaco.com.vn/upload/files/20210322_TRA_AR2020%20-%20kyduyet%20(1).pdf/, 2020 (accessed on March 20th, 2021) (in Vietnamese).[16] The Prime Minister, Decision No. 1976/QD-Ttg Approving the Master Plan on Medicinal Plant Development Through 2020, with Orientations Toward 2030, Hanoi, 2013 (in Vietnamese).

Generic Medicine and Generic Prescribing in Nepal: An Implication for Policymakers.

Generic medicines are being promoted in many countries for their added benefits over branded drugs, such as reduced price, therapeutic equivalence, and convenience to the patients. However, generic prescribing is still not up to the optimum level in Nepal to assure access to cost-effective, quality medicines to the public and to reduce the overall economic burden and practice-related errors of medications. This review aimed to discuss the current scenario of generic medicine, generic prescribing, hurdles on the one hand, and potentials ways in promoting generic medicine usage and generic prescribing in Nepal on the other. Extensive literature on generic medicine usage and generic prescribing practice in Nepal was reviewed. This review found some of the major challenges to be addressed for the proper implementation of generic medicine prescribing, and utilization. These challenges include lack of facilities and competency to assure therapeutic equivalence of different brand-name medicines, lack of understanding about generic medicines among health care providers (HCPs) and the public, and lack of stringent regulation towards promoting generic medicines. Rational pharmaceutical promotion and awareness about generic medication to the medical students are also inevitable towards promoting the practice of generic medicines. The practice of generic medicine and generic prescribing is not possible without the assurance of therapeutically equivalent generic alternatives. The study recommended the prompt effort of the regulatory authority to enforce the generic prescribing and generic substitution policy through strengthening policies, procedures and laboratory testing to assure citizens’ right to access to cost-effective, and affordable quality medicine, as the Nepal’s National Health and Drug Policy mandated.

Prevalence of antifolate drug resistance markers in Plasmodium vivax in China.

The dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes of Plasmodium vivax, as antifolate resistance-associated genes were used for drug resistance surveillance. A total of 375 P. vivax isolates collected from different geographical locations in China in 2009-2019 were used to sequence Pvdhfr and Pvdhps. The majority of the isolates harbored a mutant type allele for Pvdhfr (94.5%) and Pvdhps (68.2%). The most predominant point mutations were S117T/N (77.7%) in Pvdhfr and A383G (66.8%) in Pvdhps. Amino acid changes were identified at nine residues in Pvdhfr. A quadruple-mutant haplotype at 57, 58, 61, and 117 was the most frequent (57.4%) among 16 distinct Pvdhfr haplotypes. Mutations in Pvdhps were detected at six codons, and the double-mutant A383G/A553G was the most prevalent (39.3%). Pvdhfr exhibited a higher mutation prevalence and greater diversity than Pvdhps in China. Most isolates from Yunnan carried multiple mutant haplotypes, while the majority of samples from temperate regions and Hainan Island harbored the wild type or single mutant type. This study indicated that the antifolate resistance levels of P. vivax parasites were different across China and molecular markers could be used to rapidly monitor drug resistance. Results provided evidence for updating national drug policy and treatment guidelines.

An exploratory assessment of the legislative framework for combating counterfeit medicines in South Africa

BackgroundSubstandard and Falsified (SF) medical products are a growing global concern. They harm the individual patient, the healthcare system and the economy. The World Health Organisation (WHO) has highlighted contributing factors globally: insufficient national medicine regulation, poor enforcement of existing legislation, weak stakeholder collaboration and the rise of novel viruses, such as the COVID-19. The study aimed to assess the legislative and policy framework and institutional relationships governing pharmaceuticals and anti-counterfeiting strategies.MethodsThe study was explorative and consisted of two phases. The first phase was between 2016 and 2017. It looked at document analysis (annual reports and press releases from 2011 to 2016) from government institutions involved in medicines regulation and law enforcement for SF seizure reports between 2004 and 2017. The second phase was between 2016 and 2018 through in-depth semi-structured interviews (seven in total) with selected stakeholders.ResultsFirst Phase—the data collected and reported by various departments was sporadic and did not always correlate for the same periods indicating, a lack of a central reporting system and stakeholder collaboration. In South Africa, counterfeiting of medicines mainly involves the smuggling of non-registered goods. The most common counterfeit items were painkillers, herbal teas, herbal ointments, while some were medical devices. Furthermore, Customs identified South Africa as a transhipment point for SF infiltration to neighbouring countries with less robust regulatory systems. Second phase—interview transcripts were analysed by thematic coding. These were identified as the adequacy of legislation, institutional capacity, enforcement and post-market surveillance, stakeholder collaboration and information sharing, and public education and awareness.ConclusionDocument analysis and interviews indicate that South Africa already has a national drug policy and legislative framework consistent with international law. However, there is no specific pharmaceutical legislation addressing the counterfeiting of medicines. Law enforcement has also been complicated by poor stakeholder engagement and information sharing.

Drug utilization pattern at the cardiac surgical outpatient clinic in a tertiary care hospital at Goa

Background: Drug utilization research encourages rational drug prescribing practices and thus contributes to the contemporary use of drugs in the society. This study assesses the drug utilization pattern (DUP) at the cardiac surgical outpatient department of Goa Medical College hospital. We used the World Health Organization (WHO)-prescribing indicators to analyze the National List of Essential Medicines (NLEM) implementation as recommended in the National Drug Policy. Methods: We used a cross-sectional study design to analyze the DUP. We randomly selected 103 prescriptions dispensed to patients at the cardiac surgical outpatient during the study period. We critically examined these prescriptions for their consistency with WHO core drug use indicators. Results: The average number of drugs prescribed per person was 4.95. The most commonly prescribed top three drugs were antiplatelets (21.46%), beta-blockers (14.76%), and statins (13.78%). Most drugs were prescribed as single drugs (90.98%), whereas 9.02% were fixed-dose drug combinations (FDC). The combination of aspirin and clopidogrel was the most common prescribed FDC. The majority (72.44%) of the drugs prescribed were as per the NLEM 2015 list, whereas the generic name was low (2.8%). We measured Patient-Care Indicators and Facility-Specific Indicators also. The average consultation time and dispensing time were 7.76 and 3.23 min, respectively. The in-house pharmacy dispensed 82% of drugs. 93.75% of the key drugs were available in the facility. A copy of the essential drugs list was readily available in the facility. 96.67% of the patients knew the correct dosage of drugs. Conclusions: Anti-platelets and statins were the most commonly prescribed drugs. There was a high prescribing trend from the NLEM; however, the inclination to prescribe generic names was less. Patient-care and facility-specific indicators were also far from the optimal values except that of the average dispensing time.

Actual directions of work of representatives of military health care in forming a national drug policy

Actual directions of work of representatives of military health care in forming a national drug policy

Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities

BackgroundThe standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development.MethodAn observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher’s exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software.Results107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use.ConclusionThis study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.

Pharmacovigilance in Pakistan: A Peek into the Future Prospects

Pharmacovigilance in Pakistan: A Peek into the Future Prospects

Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh

BackgroundThe National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence.MethodsWe conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations.ResultsBarriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers.ConclusionAwareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.

An assessment of nursing mothers\u2019 and young people\u2019s access to proprietary and patent medicine vendors\u2019 services in rural communities of south-eastern Nigeria: implication for review of national drug policy

BackgroundPatent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage.MethodsA cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18–20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine.ResultsA total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children’s cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8.ConclusionPPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.

Accessing Affordable Medicines in a Post-TRIPS Environment: The Case of Bangladesh

The cost of medicines in Bangladesh is among the lowest in the world. Over the last forty years, Bangladesh, a Least Developed Country (LDC), has nurtured a local industry based on strong industrial policy and a pharmaceutical patent-free system. Of the 46 LDCs in the world, it is the only one to have a thriving industry of this kind. In this paper, we explore how a relatively poor LDC managed to take on the dominance of MNCs in the global production of pharmaceuticals. We focus on the 1982 National Drug Policy (NDP) which transformed the pharmaceutical sector in Bangladesh from one in which three-quarters of drugs were supplied by just eight MNCs to one where almost all domestic demand is met by local industry. The thriving local pharmaceutical industry also exports generic medicines to 147 different countries. In 2026, Bangladesh is due to graduate to ‘Developing Country’ status, at which time, as a member of the WTO, Bangladesh will have to abide by the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Under TRIPS it will have to change its patent regime to allow for the registration of pharmaceutical patents by 2029. Using interview data with key Bangladeshi experts, we argue that TRIPS compliance could potentially wipe out this flourishing local pharmaceutical industry, leading to steep increases in the cost of essential medicines, with dire implications for the right to health. We explore policy options open to the Bangladesh government to protect affordable drugs in the country, in particular protection for the production of domestic generics in a post-TRIPS environment. We also argue that there are ways in which Bangladesh and India could co-operate to protect the affordability of high-quality medicines for domestic and international markets.

Psychiatric and Medical Co-morbidities among the substance abusers presenting at Patna Medical college- A clinical study

Background: The link between hazardous types of illegal drug use and significant public health issues is a critical issue for national and international drug policy. There are several negative health effects connected with drug use, with the avoidance of both overdosefatalities and drug-related blood-borne diseases being of special importance. However, there has been an increasing understanding in recent decades that the existence of mental illnesses connected with drug use poses a significant barrier for public health interventions. Aims and Objectives: • To investigate the trend of drug misuse in North Bihar Patients. • To determine the co-morbid &amp; psychiatric medical illnesses. Materials and Methods: It was a cross-sectional research conducted over a one-year period on 200 drug abusers from North Bihar and presenting at Patna Medical College in the Indian state of Bihar. Individuals from the sample were separated into two groups based on their age (&lt;25 Years &amp; &gt;25 years) and gender. The pattern of drug abuse, as well as the mental and medical co-morbidities that were linked with it, were investigated in relation to age and gender. Results: The sample size of the present study was 200 consisting of 183 males and 17 females. The total sample was analyzed separately with respect to age and sex. There were 55 patients below 25 years and 128 patients’ ≥ 25 years. The study found that 91.5% of substance abusers were males. Among the males, 48.6% were abusing alcohol and 19.1% were abusing polysubstance. 18.6% were intravenous drug abusers and 8.2% showed high risk behavior. Among the females, 29.4% of the female patients were abusing alcohol. The percentage of women abusing poly-substance was 35.3% and poly-substance and alcohol was 17.6%. The number of female patients involved in high-risk behavior was only 11.8%. Intravenous drug abuse and high-risk behavior was commoner in age group &lt; 25 years than in the age group of &gt;25 years. 17.5% received a psychiatric co-morbid diagnosis and 38.5% received a medical co-morbid diagnosis. The prevalence of schizophrenia and depression among male patients with mental co-morbidity was 63.3 % (n=19), with depression accounting for 6.7 % (n=2). On the other hand, only five female patients, were found to have mental co-morbidity. Conclusion: The large number of young individuals taking intravenous drugs in north Bihar reflects the high level of human-to-human contact with bordering North-Eastern states and Nepal. The situation is critical, and immediate action is required.

A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons.

Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM). The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically. The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources. The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant. Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners' families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons. The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons. This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.