Syria's Prescription Drug Abuse

13 March 2007

A study carried out by “Stocks and markets”, a Syrian business magazine, has revealed that most pharmacies in Damascus decline to sell medications containing substance dependence ingredients without prescription, even though some violate related Ministry of Health regulations.

The few pharmacies which due to customer persistence sell prescription medications over the counter, enlighten on their use and the unwanted side effects associated with over the counter medications, the magazine noted. Two locally manufactured drugs Simo green and Baltan, which contain substance dependence ingredients and remain popular among Syrians, were chosen as a sample for this survey: Simo green, which contains codeine and is used as a cough treatment, and Baltan, which contains heroine and is often recommended for treating psychosomatic disorders as well as drug addicts suffering from withdrawal symptoms.

Damascus, home to 6 million inhabitants, was divided into four districts, along socio-economic lines, for the purpose of this investigative report. Specific neighborhoods were chosen for the assessment: Al Mazzeh, The Camp (Al Mukhayam), The Dummar Housing Project and Barza Houses. These areas have 32, 34, 21 and 19 pharmacies respectively. However, the number of existing pharmacies may differ from the official figures because the chosen zones are not separated by clear administrative borders – sometimes one pharmacy may belong to two regions.

We visited 44 pharmacies in Al Mazzeh, 46 in The Camp, 17 in the Dummar Housing Project and 20 in Barza Houses. While the majority of these pharmacies strictly observed the relevant regulations and declined to sell prescription drugs without a doctor’s prescription, 30% of pharmacies told their “pushing” customers to return in two days, or a week at the latest, to get their medications. Upon later investigation, we discovered that 12 of them had agreed to sell the medicines even without a medical prescription, while 18 others declined.

During the last round of visits to the pharmacies, this reporter was able to purchase three sachets of Simo, one sachet of Proximol and two sachets of Zanax. Inspection patrols insufficient to cover all pharmacies According to the drug distribution system in effect, pharmacies receive their ration of medications containing substance dependence ingredients directly from the warehouses, which are supplied with the drugs by manufacturers via a network of distributing agents. The pharmacist in charge is asked to write down the medical prescription for each dispensed medication in the inventory of psychosomatic medications.

The Syndicate of Pharmacists monitors the distribution chain in collaboration with the International Inspection Section, run by the Damascus Health Department. Normally, three persons at least do the patrols. But according to a reliable source, the syndicate and the Health Department do not have enough personnel to make the inspection rounds of the capital’s 1,147 pharmacies. Moreover, syndicate sources questioned why they should be the sole party responsible for the inspection if the permits needed by pharmacies are issued by the Health Ministry and the Health Department. In 2005, only six cases involving pharmacies dispensing medications with substance dependence ingredients without medical prescription were formally reported. In three out of the six cases, the pharmacist was given notice, his pharmacy was closed and the pharmacist in charge was referred to the disciplinary board. Usually, a formal notice is sent out three times, followed by a warning. In the case of repeated violation, the syndicate refers the concerned pharmacist to a disciplinary board, to be interrogated from the Health Department.

Pharmacists breaking the rules are also fined Syrian liras 3,000-5,000 (US$60-100). After repeated offences, and as a last resort stipulated by the relevant law in practice, the pharmacy is closed for up to one month at the most, and the licences of the druggist and the pharmacy are withdrawn. The several visits to the drugs warehouses were not enough to obtain exact figures for the sale of the two drugs covered by the survey. A Health Department official, however, revealed that between January and October of 2006, the consumption of Baltan 5mg reached nearly 14,400 sachets in Damascus.

Around 7,000 containers of Simo coughing syrup, was sold during the same period. This amount was delivered directly from the warehouse to the pharmacies in the Syrian capital. The attempts to find out the actual number of sales of the above medications produced no results. Trying to find the names of print houses manufacturing the medication boxes in a bid to arrive at a rough estimate of the boxes remained futile as printers do not publish their names on these boxes. However, a marketing research firm based in Amman, Jordan, gave a gross figure for the sales of the two medicines at stake for benchmarking purposes. The company uses different criteria to reach its estimates.

Under one approach, the firm takes samples from 200 pharmacies in Damascus, then adds up the price of their one-day sales and multiplies it by 1,000 to get to the equivalent of the annual sales of the medications in Syria. According to the firm, from October 2005 through October 2006, a total of 250,000 sachets of Simo Green (with Codeine), 100,000 Simo sachets without Codeine, and 200,000 sachets of Baltan 5mg were sold. The quota was distributed as follows: Damascus: 45%, Aleppo: 35%, the remaining areas: 20%.153 addicts in 17 rooms at the only rehabilitation centre in Damascus At the Abbasiyyin Square in Damascus, a big advertising board welcomes you to a huge building with white walls and a firmly closed iron gate. At the admissions register, you can find the quantities of administered medications and the name of the district.

This shows the most common areas were drugs are used, and one of them is the poor neighborhood and shanty quarters around the Camp and the Barza Houses. The register also indicates the number of admissions during 2004, which reached 744, including 122 for consumption of medication using dependence drugs. In 2005, however, the admission rate dropped to 573, while the number of drug dependence cases mounted to 153. The facility comprises only 17 rooms that are supposed to handle all the admitted patients. Medications for patients… and addicts! Meanwhile, the challenge regarding the abuse of medication that contains substance dependence ingredients continues. Convinced that the drug stimulates her memory, Alia, a college student, took three tablets of Baltan before sitting for the exam. The 23-year-old student remains confident about its positive effect on her memory. She started by taking half a capsule of Baltan a day.

Today, after six months, she consumes three capsules every six hours. Before switching to Baltan, Alia took Simo, which is relatively cheap – only 50 Syrian liras – in varied doses. At a later stage, she started mixing Simo with a Paraximol, a painkiller Alia had her own ways to get these pills, despite instructions by the Health Department not to sell such medical drugs without a prescription. She would play dumb, pretending to have forgotten the physician’s prescription for her sick mother at home, or to have lost it in the taxi on her way to the pharmacy.


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