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Published on July 15, 2007

Nearly Bt1 billion worth of drugs are wasted annually due to improper logistics, with medications for coronary and heart ailments among the most vulnerable to being substandard, according to a recent study conducted by the Hospital Association of Thailand.

"Exposure to heat, sunlight and humidity are among the major factors causing the chemical compounds to degrade," said pharmacist Wongwiwat Tassaneeyakul.

It is estimated that about 5 per cent of all drugs prescribed in Thailand are below standard due to improper storage, mishandling and other logistical problems.

According to Wongwiwat, the figures translate into nearly Bt1 billion per year since a total of Bt18.6 billion was spent in 2005 on pharmaceuticals.

Citing a recent sample of drugs dispensed by state members of the hospital association, he said substandard drugs - around seven out of the 137 selected drugs covered in the study - usually had less active chemical substances than the amount stated.

In addition, the life span of the active ingredients in these medicines is not consistent with generally accepted standards.

Wongwiwat of Khonkaen University, who led the research team, said the findings were worrisome since the study covered accredited state hospitals which usually maintain strict medical standards. "We've found substandard drugs in the best category of hospitals in Thailand. so I don't know about the rest of them," he said.

State hospitals account for 40 per cent of drugs dispensed to all patients, followed by private hospitals (20 per cent) and pharmacies (40 per cent).

The Food and Drug Administration (FDA)'s senior official Sukanya Jearapong said the coronary and heart medicines found to be substandard, whose trade names were withheld, had already been removed from hospitals.

the FDA followed up with its own inspection of the quality of the same drugs in other locations and found they met standards fully, so the problem could have been caused by improper storage at certain hospitals, Sukanya said.

"The general public shouldn't panic over the findings since the amount of inferior drugs is still quite acceptable for developing countries like Thailand and the situation is a lot better than in other countries in the region. However, we do need to improve," Sukanya said.

Wongwiwat agreed that the percentage of substandard drugs was acceptable but said the country needed to work hard to reduce the number of inferior drugs.

"If we do nothing, more and more substandard drugs will lead to greater economic loss and other problems," he said.

Pharmacist Samlee Jaidee of the Drug Study Group said substandard drugs should be minimal as there were several built-in measures to address the problem.

"We have the national drug list, the Good Manufacturing Practice standard and related systems. In the past, the main factor in substandard drugs was the manufacturers themselves. The problem has shifted to transport and storage, from factories to hospitals, from hospitals to patients, from factories to pharmacies and from pharmacies to patients and so on," Samlee said.

Pimolphorn, a pharmacist in Chon Buri, said: "We have no specific storage for drugs. We just try to keep them away from sunlight and humidity and always check the expiry date and packaging. That's all we can do."

In hospitals, Samlee said, management should ensure their purchase orders cover the requirements for reliable logistics.

Wongwiwat said transparency and monitoring were key to resolving the issue.

Another project is to use the Internet to publish the necessary information about drug quality and choices for consumers so the public is better educated on the matter.

"We will try to be creative: instead of announcing the substandard drugs we should reveal those with approved quality on a website. The public can then play a role in drug quality control and monitoring," Wongwiwat said.

Kamol Sukin

The Nation