Drugs aren’t candy: we need experts to sell them

opinion September 12, 2018 01:00

By Tulsathit Taptim
The Nation

2,226 Viewed

Imagine you have just finished your workout and you feel a muscle cramp. You assume it’s because of overexertion, so nothing serious. You stroll into a convenience store, ask for an over-the-counter drug and head home.



An everyday occurrence that could happen to anyone, right? But what the store clerk didn’t ask – and you didn’t tell – was that you were also taking statins. The anti-cholesterol medication can be a cause of muscle pain.

Back home, you treat yourself with the store-bought drugs. The pain subsides and you give yourself a pat on the back for not “wasting” time by visiting a doctor. Chances are you will visit the convenience store again if the pain recurs.

Truth is, if it is the statin that is causing your muscle problems, not over-exercise or an awkward sleeping position, you could be in big trouble. You face the scary possibility of kidney 

failure if you continue taking the 

cholesterol-cutting pills.

Who will you blame? Yourself for not going to see a doctor, who would have informed you of the important details? Or the store clerk, who wasn’t thinking about statins when you described your muscle ache?

This story is not aimed at discrediting the current draft law to relax rules on who can sell certain types of drugs. Instead it is meant to underline the importance of expertise when it comes to dispensing – or not dispensing – drugs.

After all, as one senior pharmacist and critic of the draft put it, “Drugs are not candy.” There are reasons why genuine experts are needed to supervise their sale.

Proponents of the draft point out it will not make all drugs easier to sell. 

But they omit one crucial thing: the fact that even simple, “over-the-counter” drugs can do serious harm.

“Drug interaction” is a term well-known among medical professionals. It usually refers to unwanted effects of drugs when used together, even if the individual drugs are simple and seemingly harmless. In an ideal scenario, drugs reduce or cancel out each other’s effects if they are used at the same time. But in a worst-case scenario, “simple” drugs can interact and become toxic .

Take paracetamol, a popular over-the-counter pain and fever reliever. Not many people know that when combined with anti-tuberculosis drugs, it can cause liver toxicity. Blood-thinning medication, when taken with high quantities of paracetamol, can be responsible for unusual bleeding.

Illnesses we might put down to “natural” factors can in fact sometimes be traced back to intake of drugs. 

Frequent fevers or sore throats could be a side-effect of your anti-thyroid medication. Fainting or dizziness can occur after insulin injections that are not followed by proper or timely consumption of food, causing blood-sugar levels to drop. Again, drug sellers without expertise would likely overlook the real causes of these illnesses.

These are reasons to avoid a slippery slope when it comes to drug dispensing. They also help explain why it takes pharmaceutical students a full six years to complete their university degrees, whereas to qualify as a nurse only requires four years.

Expertise comes from study, practice and experience. Student nurses must gain three course credits on the study of drugs’ effects, whereas pharmacy students need at least 40. The time pharmacy students have to spend in university was recently extended from five years to six, to give them on-the-job training.

Make no mistake, there is room for improvement in the current system. Proponents of the new drug bill may argue that the trained pharmacists in drug stores don’t ask you too many questions either. But that is essentially saying that since the situation is already unsatisfactory, let’s make it worse.

Just as pharmacists should not work as nurses, the latter should not have to dispense drugs just because there is a shortage of certified sellers or because poor people’s access to healthcare is limited.

The phrase “Amazing Thailand” is often used by visitors to describe both positives and negatives in our country. One negative is how easy it is to obtain certain drugs here in comparison with other countries. The new drug bill may or may not cement that reputation right away, but it needs careful thinking.

People who walk into convenience stores with muscle pain may not be thinking carefully, but they certainly want policymakers and legislators to be thinking carefully for them.