Use of unauthorized medicine can have permanent adverse health effects, while selling drugs without prescriptions is punishable by law
Sabrina Nasim, an assistant teacher at a private school in the capital, bought some hydroxychloroquine tablets and stored them for emergency use during the Covid-19 pandemic.
Sabrina, who is a well-educated person, collected the medicine without a prescription, or even a suggestion from any doctor. She claimed she was a conscious citizen but was worried that she would not find the medicine on the market when she would actually need it.
“My mother is suffering from some aging-associated diseases, and there are infants in my family as well,” she said.
“Thinking about their safety, I collected the medicine when I heard somewhere that it was effective in treating Covid-19 patients,” Sabrina added.
In March, people started panic-buying hydroxychloroquine which caused a shortage in supply. This happened after the US President Donald Trump said this antimalarial drug would be used to treat coronavirus infected people.
The US Food and Drug Administration, however, cautioned people against its use for Covid-19 outside of the hospital setting or a clinical trial due to the risk of heart rhythm problems.
On June 16, several international media outlets, including BBC, published a report about the successful use of dexamethasone for treating Covid-19 patients. Those articles claimed this to be effective and the “first life-saving drug”.
Just one day after that, it was reported that people were crowding pharmacies and buying the medicine for storing.
This correspondent visited eight medicine stores in Dhaka’s Dhanmondi area on Wednesday. All of the salespersons said the demand for dexamethasone has suddenly surged.
Neither hydroxychloroquine nor dexamethasone should be taken without a doctor’s prescription, regardless of the disease. Taking these medicines unnecessarily may have severe adverse effects on health.
Dhaka University Pharmacy Faculty Dean Dr SM Abdur Rahman said the long term use of steroid dexamethasone may cause cataracts, bone-thinning, increased appetite, irritability, insomnia, swelling in ankles and feet (fluid retention), heartburn, muscle weakness, impaired wound healing, increased blood sugar levels, etc.
In some cases, this medicine may also cause headaches, dizziness, and mood swings, he added.
On the other hand, antimalarial drug hydroxychloroquine can cause headaches, diarrhoea, stomach cramps, vomiting, and dizziness. These are the mild side effects which may subside in a few days or weeks, according to experts.
But unsupervised use of this drug can cause some serious and permanent damage, too. These include blurred vision, heart failure, and heart rhythm problems.
Other negative effects of hydroxychloroquine include hearing loss, rapid swelling of the skin, sore throat, mild or severe bronchospasm, severe hypoglycaemia, unusual bleeding or bruising, mood swings, and suicidal thoughts.
The scene at the pharmacies
Visiting the pharmacies, this correspondent found that apart from these two aforementioned drugs, people are also trying to buy and store azithromycin, ivermectin, paracetamol, montelukast, doxofylline, salbutamol, fexofenadine, and some vitamin tablets.
Motiur Rahman, the supervisor of Lazz Pharma’s Dhanmondi branch, said he was confused as to why people were suddenly buying dexamethasone, claiming that most of their customers visited them with a prescription.
Unwilling to disclose the name of his pharmacy, shopkeeper Nabiluzzaman said his shop’s average monthly revenue is Tk100,000 and almost half of that comes from selling medicines without prescriptions.
This prescription-less selling is standard practice at most pharmacies of the area.
Nabiluzzaman added that pharmacy salespeople are conscious of not selling sleeping pills without prescriptions, but they are not hesitant about selling antibiotics without one.
Another pharmacy owner of the area claimed he did not sell even antibiotics without a valid prescription. However, this correspondent himself bought Flagyl, an antibiotic, from his shop without a doctor’s note.
Measures against selling medicine without prescriptions
The Directorate General of Drug Administration (DGDA) is also not very strict in these cases.
Nabiluzzaman said in his two years of working at the pharmacy, only once did a DGDA inspector come to inspect the shop.
People are allowed to buy 39 generic medicines as over-the-counter (OTC) drugs for primary treatment.
However, doctors forbid using any drugs for treating Covid-19 patients without a prescription from registered physicians or outside government protocol.
According to the country’s drug law, excluding the OTC drugs, selling medicine without a prescription is a punishable offence.
In April 2019, the High Court directed the DGDA to take necessary steps to put an end to the sales of antibiotics without prescriptions.
Dr Md Ruhul Furkan Siddique, professor at the Department of Public Health and Informatics at Jahangirnagar University, said there is a medicine protocol provided by the government for people who are being treated by doctors, but there is no guideline for those who self-isolating.
Regarding people’s tendency of buying and storing medicine unnecessarily, the professor said people will make up their own mind if the authorities concerned do not show them the way.
Md Ayub Hossain, deputy director and spokesperson for the DGDA, said owing to countless news articles mentioning various drugs being effective against Covid-19, people may try to store those drugs thinking of their health safety.
“To handle the situation, we have published circulars in newspapers to raise awareness among the citizens, so that they do not buy stock drugs or oxygen cylinders unnecessarily,” he added.
Mobile courts are being operated routinely across the country, he mentioned.
The DGDA will take legal action against people selling medicines except for the OTC drugs, Ayub said.
He said: “DGDA members who have been given the authority to inspect are regularly monitoring their assigned areas.”
According to the DGDA, there are only 47 people assigned to inspect the irregularities ongoing in pharmacies across 54 district offices. Of them, 32 are assistant directors, eight superintendents of drugs, and seven drug inspectors.
There are 18,901 retail medicine shops registered with the principal drug regulatory agency in Bangladesh.
However, the World Health Organization data shows that there is also an almost equal number of unregistered drug stores in the country.
Dr SM Abdur Rahman said DGDA should take immediate action to stop the panic-buying.
“People in charge of medicine shops have no expertise or knowledge about medicines. Unauthorized selling could be avoided if there were pharmacists present at the shops,” he added.
Most people working for DGDA are not pharmacists, said the professor.
“There is no discipline in medicine management because, except three private hospitals, there are no pharmacists in hospitals across the country,” he said.
Moreover, relevant establishments such as Essential Drugs Company Ltd and Central Medical Store Depot have no pharmacists either, said Dr Rahman.