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Lahore tragedy and healthcare

December 05, 2012

THIS refers to the news item wherein 16 people died after drinking toxic cough syrup (Nov 27). It reminds me of the first horrendous health tragedy in the Punjab Institute of Cardiology that took the lives of almost 147 people.

Yet another tragedy within the same year and city incites us to ponder over something which has been stressed for years, i.e., overhauling existing healthcare structure.

Various analytical laboratory reports failed to find any formulation error or any deviation from the standard pharmaceutical criteria in the cough syrup Tyno. The immediate apparent cause, as also was reported in the same news report, is the abuse of cough syrup by the addicts.

The history of abuse of cough syrups is not new. Cough syrups contain active pharmaceutical ingredients like codeine, dextramathorphan, noscapine, bromhexine and ephedrine. Most of these are extracted or derived from opioids. These active pharmaceutical ingredients are added to cough syrups to suppress the body’s urge to cough. That is why these syrups are called cough suppressants.

The common side-effects of cough suppressants include dizziness, drowsiness, nausea and vomiting. But when taken in higher quantities, as by drug addicts, these side-effects may include impaired physical coordination, disorientation, confusion, slurred speech and even death.

To avoid the misuse or abuse of cough suppressants, the US Food and Drug Regulatory Authority and the World Health Organisation have issued guidelines for the safe therapeutic use of these cough syrups. Under these recommendations, cough suppressants cannot be dispensed or sold without the prescription of a registered practitioner.

But, unfortunately, it is not difficult for anyone in Pakistan to get such medicines prescribed or dispensed. It is because of the inability of the current healthcare system to maintain a close check on the manufacturing, safe transportation, storage under maintable conditions, prescription and subsequent dispensation of such controlled substances. This is also because of limited number of drug inspectors, as well as of hospital pharmacists. In this systemic negligence the ultimate victim is always a patient. The government is expected to take two steps on a war footing. One, it must put an immediate ban on ubiquitous medical stores. Instead, pharmacies should be allowed to replace them. Second, drug experts (pharmacists) should be hired, not only to maintain vigilance on quality manufacturing of medicines, but also to avoid drug-related incidents in hospitals and community settings.