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• Pseudoephedrine (5)
• White Paper (3)
Letters to the Editor
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Pseudoephedrine
A New Zealand solution
From Mr M. B. Kerr, MRPharmS
When I was in Auckland in 2003, our suburban pharmacy became aware that
sales of pseudoephedrine products were increasing quickly. These products
were being sold mostly to customers we did not know, many of whom were
of a dubious nature and who often asked to buy more than one pack.
Our sales team was becoming increasingly uncomfortable about this trade,
which we suspected was fuelling local home-based laboratories set up
for turning pseudoephedrine into methamphetamine.
Following discussion with the police we decided to adopt their drug squad’s
policy for community pharmacies. We placed an A4-sized sign with the
New Zealand police letterhead on the doors and the sales counter which
detailed the new requirements for purchase. From that moment we made
it compulsory that every person wanting to purchase any product containing
pseudoephedrine was required to produce photo identification, the details
of which were recorded on a police form which was faxed to the Auckland
Drug Squad every week.
The effect was astounding. Within 24 hours of the signs being displayed,
our sales dropped to the normal levels we would have expected. Most requests
now came from our local people and our sales team were much happier.
Of course this new requirement took a little time to be accepted by our
customers but, as many of the public had read in the press of the rise
of the new cottage industry popularly named “homebake”, it
was not long before they understood and were happy to co-operate. There
were a few who refused to provide their photo ID and, in those cases,
we refused the sale.
We took a firm no-exceptions policy so that staff would not have to make
judgements over who did and who did not have to comply. The usual forms
of identification presented were driving licences or credit cards.
There were some who raised the point of their data privacy and their
civil rights, but fortunately the legal department at the New Zealand
Police had clarified this point and had declared it to be within our
rights to collect the data on their behalf. We had a printed statement
ready to show such inquirers.
It gave us some satisfaction to know that on several occasions the data
we provided contributed to successful prosecutions which resulted in
prison sentences. We learnt that some shoppers were going from pharmacy
to pharmacy, town to town, purchasing where they could and being paid
hundreds of dollars a day to supply a laboratory with the raw ingredient.
The Auckland Drug Squad had also recorded all our employee’s signatures
along with their names, so none of us were ever required to appear in
court to give evidence.
By about 2004 I think about 75 per cent of New Zealand pharmacies had
adopted similar policies. As the retail supply of pseudoephedrine dried
up, it became a common motive for pharmacy and wholesaler break-ins so
stock-holdings were reduced throughout the supply chain and wholesalers
and importers installed secure holding areas.
I do not support the proposal of making pseudoephedrine a prescription-only
product in the UK since that would remove a useful product from pharmacy’s
arsenal. Unfortunately limiting sales to one pack per customer is unlikely
to restrict the purchasing of pseudoephedrine by roving shoppers.
With firm controls, a professional pharmacist approach, along with some
good monitoring of sales from both suppliers and community pharmacies,
the supply to drug pedlars can be contained.
Murray Kerr
Torquay, Devon
Will GPs do better at restricting supply?
From Mr I. D. Kemp, MRPharmS
Bob Dunkley’s letter (PJ, 31 March, p365) gave me the biggest
laugh I have had in years until I realised he was serious in his praise
for the Medicines and Healthcare products Regulatory Agency. The most
amusing part was the concept that criminal gangs would employ shoppers
to buy one pack of Sudafed at a number of pharmacies but would not think
to get these people to go to their GP surgery, from where they could
emerge with a prescription for far more than 12 tablets and, by visiting
often, possibly a repeat prescription.
It does not surprise me that the MHRA thinks that GPs or other prescribers
will do a better job of restricting supply than pharmacists. If the risk
is so high and the benefit of pseudoephedrine so low then the only option
is to remove the product licences altogether. This halfway house is a
typical Government fudge, which is just as likely to have the opposite
effect to that intended, but that could be said about much Government
policy at the moment, especially that which relates to pharmacy.
Ian Kemp
Halifax, West Yorkshire
The MHRA is fit for purpose
From Mr D. P. Sharma, MRPharmS
In response to Steve
Newbury’s question: “Is the Medicines
and Healthcare products Regulatory Agency fit for purpose? (PJ,
24 March, p341)”, the simple answer is “yes”. The move
to reclassify pseudoephedrine is not to “disempower pharmacists”,
nor does it indicate a lack of confidence in pharmacists. Anyone who
rereads the
News feature published
in the PJ on 17 March (p304) objectively, will
understand the difficult position that the MHRA is in.
If the MHRA ignores
the advice of specialist bodies such as the Serious Organised Crime
Agency and it later transpires that over-the-counter ephedrines are
being used
to make Class A drugs, everyone would ask the question: is the MHRA
fit for purpose? Patients will not suffer if this medicine is reclassified;
on the contrary, inhalations as well as other decongestants may be
a
better, safer option. And, at the same time, the potential for Class
A drug production will be reduced.
Incidentally, for all those interested in understanding the role
of the MHRA and its thought processes behind regulatory decisions,
there
is
a consultation
document available on its website Dave Sharma
Cambridge
Write to the MHRA!
From Mr M. Smith, FRPharmS
I read with some incredulity the proposal
to reclassify pseudoephedrine from pharmacy to prescription only medicine (PJ, 10 March, p269) by the
Medicines and Healthcare products Regulatory Agency.
This, frankly, beggars belief at a time when pharmacists are developing
their professional roles to offer more clinical support to patients with
counselling and medicines use reviews.
There may be a small problem with abuse, but pharmacists are ideally
placed to monitor the supply of this valuable, effective and relatively
safe drug. I cannot believe that any pharmacist will consider the supply
of the drug without first checking that any other prescribed medicine
will not cause potentially harmful interactions, for these are well known.
The drug is a safe and effective means of relieving the symptoms of common
self-limiting conditions.
The consequence of reclassification will be to increase the workload
on GPs and defeat the object of the new pharmacy contract, thereby freeing
GP time by dealing with minor ailments, the whole purpose of our enhanced
role.
I encourage all pharmacists to write to the MHRA to oppose this ridiculous
and unjustified proposal.
Mike Smith
Chairman
UniChem Ltd
A large number will be inconvenienced
From Mr L. A. Berg, MRPharmS
I was interested to read the News
feature (PJ, 17 March, p304) concerning
the proposed P to POM switch for pseudoephedrine. I believe that most pharmacists
would be concerned at losing such a useful drug from over-the-counter sales.
There really is nothing else on the market to match the effectiveness and
speed of action of pseudoephedrine and I am sure that the demands on doctors
and practice nurses will increase alarmingly if the switch happened.
Peter Fellows of the British Medical Association thinks that pseudoephedrine
is not widely used in retail practice and that a switch would hardly be
noticed. I think he would be surprised, if he spent a couple of hours in
a busy pharmacy in winter, to see that it is extremely widely used and
that pharmacists are aware and caution customers about its potential to
interact with hypertensive drugs.
It seems to me that a large number of customers and doctors would be inconvenienced
by the switch — all because of a potential risk of abuse in the manufacture
of crystal methylamphetamine. My view is wait and see.
Laurence Berg
Hove,
East Sussex |
The
Pharmaceutical Journal