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

[webfact]

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

By Tulsathit Taptim 
The Nation

 

 

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.   

 

Source: http://www.nationmultimedia.com/detail/opinion/30354254

 

-- © Copyright The Nation 2018-09-12

[Spidey]

The bulk of this article reads like it was originally published in the US. Completely inapplicable for Thailand and contains scaremongering inaccuracies.

 

If you are prescribed a statin and it causes leg cramps, the doctor will change your statin for your comfort, not because it may harm you.

 

Paracetamol is the recommended (by proper doctors) painkiller if you are on blood thinning drugs. Aspirin is to be avoided if you are on blood thinners.

 

I have, on occasion, purchased drugs that would require a doctor's prescription, in the West, and can have interactions with other drugs, in Thai pharmacies. I have never been asked which drugs I normally take. I take 5 prescription drugs every day. Even at Bangkok hospital, I have never been asked what medication I take before having medication prescribed/administered.

 

Two excellent sources of information on drug interactions are readily available, the leaflet that should come with your medication and the internet. I use NHS online, informative, accurate and unbiased.

 

Take the advice of a pharmacist/doctor/nurse in Thailand? At your peril.

[Lunchbob]

The 1 in a million theory. This should be one "positive"...Typo? One negative is how easy it is to obtain certain drugs here in comparison with other countries. 

Edited September 11, 2018 by Lunchbob

[TravelerEastWest]

1 hour ago, Spidey said:

The bulk of this article reads like it was originally published in the US. Completely inapplicable for Thailand and contains scaremongering inaccuracies.

 

If you are prescribed a statin and it causes leg cramps, the doctor will change your statin for your comfort, not because it may harm you.

 

Paracetamol is the recommended (by proper doctors) painkiller if you are on blood thinning drugs. Aspirin is to be avoided if you are on blood thinners.

 

I have, on occasion, purchased drugs that would require a doctor's prescription, in the West, and can have interactions with other drugs, in Thai pharmacies. I have never been asked which drugs I normally take. I take 5 prescription drugs every day. Even at Bangkok hospital, I have never been asked what medication I take before having medication prescribed/administered.

 

Two excellent sources of information on drug interactions are readily available, the leaflet that should come with your medication and the internet. I use NHS online, informative, accurate and unbiased.

 

Take the advice of a pharmacist/doctor/nurse in Thailand? At your peril.

I think Doctors at Bangkok hospital (and all good ones), scan your records before prescribing drugs - my experience - maybe not yours. 

 

Having a qualified person advise on drug use and interactions is always a good idea. Even for a doctor. Current medical ethics policy is for doctors to not even treat their family - way beyond not treating themselves.

 

I read online and sometimes look at the small pieces of paper that come with drugs but I am not a doctor and would not even dream that I am qualified to know in depth what interactions to be concerned about - but I still research and learn and review carefully what my doctor says and sometimes I don't agree...

 

In summary, the article is very good and in theory correct.

[Spidey]

8 minutes ago, TravelerEastWest said:

Having a qualified person advise on drug use and interactions is always a good idea. Even for a doctor. Current medical ethics policy is for doctors to not even treat their family - way beyond not treating themselves.

Finding a qualified person is the problem in Thailand. I and 3 different members of my family have had treatment at Bangkok hospital, none of us were asked what medication we were on. Our treatment was better than anywhere else in Thailand but fell short of UK standards.

 

This article is unhelpful and, in practice, incorrect.

[manarak]

some medicines require counceling, some don't. some are dangerous, some aren't.

 

medicines that present only a low risk should be freely available.

 

paradoxically, paracetamol is a dangerous lethal poison if overdosed, yet it is sold at 7-11.

On the other hand, relatively harmless stuff like acetylcysteine can theoretically only be obtained from pharmacies.

 

policies are made by idiots.

[Spidey]

6 minutes ago, manarak said:

paradoxically, paracetamol is a dangerous lethal poison if overdosed, yet it is sold at 7-11.

In the UK, paracetamol was often used by people attempting suicide. If antidote not given quickly enough, it resulted in a slow and painful death. Paracetamol is still available in supermarkets but in severely restricted quantities. 16 500 mg paracetamol tablets per purchase. I have bought a bottle of 100 in a supermarket pharmacy in Thailand, with no warning given by the pharmacist.

Edited September 12, 2018 by Spidey

[BritManToo]

11 minutes ago, Spidey said:

I have bought a bottle of 100 in a supermarket pharmacy in Thailand, with no warning given by the pharmacist.

I bought 3x 100 in Makro pharmacy a week or two back (28bht/100).

Most people here seem to jump from a balcony.

 

If people want to kill themselves, let them.

Edited September 12, 2018 by BritManToo

[manarak]

3 minutes ago, Spidey said:

In the UK, paracetamol was often used by people attempting suicide. If antidote not given quickly enough, it resulted in a slow and painful death. Paracetamol is still available in supermarkets but in severely restricted quantities. 16 500 mg paracetamol tablets per purchase. I have bought a bottle of 100 in a supermarket pharmacy in Thailand, with no warning given by the pharmacist.

I wouldn't mind the smaller quantities if it didn't also mean a hugely inflated price.

100 para can be had for 25 baht.

 

In Switzerland, 10 para (largest package here) are sold for approx. 140 baht, feels like paying exhorbitant tax because of suicidal people.

 

 

[Spidey]

Just now, BritManToo said:

I bought 3x 100 in Makro pharmacy a week or two back.

Most people here seem to jump from a balcony.

Quicker and less painful. I can see the new walkway over Sukumvit becoming popular. I've already seen a Thai guy jump off a bridge into the path of an oncoming train. The belt and braces method. Well dead!

[Spidey]

Just now, manarak said:

I wouldn't mind the smaller quantities if it didn't also mean a hugely inflated price.

100 para can be had for 25 baht.

 

In Switzerland, 10 para (largest package here) are sold for approx. 140 baht, feels like paying exhorbitant tax because of suicidal people.

 

 

The irony is that there's nothing to stop you going to different shops, or even returning to the same shop and making multiple purchases.

[attrayant]

9 minutes ago, manarak said:

paracetamol is a dangerous lethal poison if overdosed, yet it is sold at 7-11.

 

The dose makes the poison.  Do we need to point out that alcohol is sold at 7-11, despite its being a group 1 carcinogen that many people drink weekly by the liter with utter disregard?  People go to skin clinics for botox injections, despite botulinum toxin being the most acutely lethal toxin known to man.

 

In addition to providing professional dispensing advice, public education also important.  I knew at an early age never to mix ammonia and bleach, and that children should never be given aspirin, although I didn't know exactly why.  Today that kind of knowledge would probably be called a 'life hack' and be passed around on Facebook with 90% of its audience thinking it's fake news.

[Antonymous]

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.

Thank you Tulsathit for pointing out these facts. They are relevant in the context of the Drug Bill and particularly in the recently debated case of Thai nurses claiming defamation here:

https://www.thaivisa.com/forum/topic/1055337-nurses-file-complaint-over-facebook-insults

[Spidey]

1 minute ago, attrayant said:

I knew at an early age never to mix ammonia and bleach, and that children should never be given aspirin,

You should never drink ammonia or bleach, either together or separately! I drank a small amount of bleach from a bottle, at the age of 5, was rushed to hospital and told to only consume raw eggs and milk for 2 weeks. Yuk. That taught me a lesson.

[attrayant]

1 minute ago, Spidey said:

You should never drink ammonia or bleach, either together or separately!

 

Not sure if that was sarcasm, but I meant just MIX them, like in a bucket.  People sometimes mix ammonia with other cleaners to improve grease-cutting ability, which ammonia is very good at.  But mixing ammonia and bleach (or acids) will create chlorine gas that will put you in the hospital, and maybe the morgue.

[Spidey]

6 minutes ago, attrayant said:

 

Not sure if that was sarcasm, but I meant just MIX them, like in a bucket.  People sometimes mix ammonia with other cleaners to improve grease-cutting ability, which ammonia is very good at.  But mixing ammonia and bleach (or acids) will create chlorine gas that will put you in the hospital, and maybe the morgue.

Sarcasm. Couldn't find a sarcasm emoji.

 

This thread is about dispensing medication not mixing chemicals.

[BritManToo]

54 minutes ago, manarak said:

paradoxically, paracetamol is a dangerous lethal poison if overdosed, yet it is sold at 7-11.

I'd worry more about the toilet cleaner and bug killer, if I were to worry about such silliness.

[ReMarKable]

3 hours ago, Spidey said:

The bulk of this article reads like it was originally published in the US. Completely inapplicable for Thailand and contains scaremongering inaccuracies.

 

If you are prescribed a statin and it causes leg cramps, the doctor will change your statin for your comfort, not because it may harm you.

 

Paracetamol is the recommended (by proper doctors) painkiller if you are on blood thinning drugs. Aspirin is to be avoided if you are on blood thinners.

 

I have, on occasion, purchased drugs that would require a doctor's prescription, in the West, and can have interactions with other drugs, in Thai pharmacies. I have never been asked which drugs I normally take. I take 5 prescription drugs every day. Even at Bangkok hospital, I have never been asked what medication I take before having medication prescribed/administered.

 

Two excellent sources of information on drug interactions are readily available, the leaflet that should come with your medication and the internet. I use NHS online, informative, accurate and unbiased.

 

Take the advice of a pharmacist/doctor/nurse in Thailand? At your peril.

Very true.  I have an annual physical at a Thai hospital and have never been asked what drugs I currently take.  I have volunteered the information myself.  Pharmacies never ask either.  I have a MIMS account where I check the drugs I am given.

[TravelerEastWest]

2 hours ago, Spidey said:

Finding a qualified person is the problem in Thailand. I and 3 different members of my family have had treatment at Bangkok hospital, none of us were asked what medication we were on. Our treatment was better than anywhere else in Thailand but fell short of UK standards.

 

This article is unhelpful and, in practice, incorrect.

I respect your opinion but disagree - the article is quite helpful and is correct. But I am not a health professional so my thoughts are not important...

 

I use Bangkok hospital in Chiang Mai and they are usually very good about asking about allergies and they check on the computer what drugs you are taking. Sorry to hear that you are not getting good service. Since this is Thailand and all is not as back home - I make a note to be sure to both mention any other drugs being taken and to question any drugs suggested.

 

In some ways, medical care in Thailand is far better than in the West - example you can quickly see a specialist and spend as much time as you need instead of being rushed out the door. So you have plenty of time to confirm that your doctor knows what you are taking. Even though doctors here at private hospitals tend to speak English sometimes there are communication challenges...

 

 

[Antonymous]

13 minutes ago, ReMarKable said:

Very true.  I have an annual physical at a Thai hospital and have never been asked what drugs I currently take.  I have volunteered the information myself.  Pharmacies never ask either.  I have a MIMS account where I check the drugs I am given.

I don't doubt what you say - and it is shockingly lax.

 

I get an annual check-up too and they always ask what drugs I am taking. I haven't taken any drugs, not even paracetomol, for many years and that seems to shock them!

 

Suggest you go to a  different hospital next year.

[bluebluewater]

Most of the time here in Thailand when I walk into a pharmacy I will find someone's granny behind the counter.  The boss has set up a shop and now he/she is off to the hospital to work their day job.

[Lupatria]

5 hours ago, webfact said:

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

Always consult your local dealer! 

[ignis]

I find many Thai pharmacy's here are run by retired Dr's, and over the years will sometimes question Med's the Hospital have given..  only last year the Pharmacist suggested one of my problem was  one of my Med's, as I was at the Hospital the next week I asked the Dr = had the same Med's again for the next 3 months ! went to my local Pharmacy he changed to a different one, and another one said not needed at all.  Yes took his advise, after only 3 weeks a lot better, and got even better,

with the past 11 months no problem at all, never been back to that department in the Hospital... 

[DrTuner]

Need experts? Let yourself be colonized, otherwise, no hope.

[DrTuner]

2 hours ago, ReMarKable said:

 I have a MIMS account where I check the drugs I am given.

I had one but they closed access to consumers. Haven't checked in a while but the IT "experts" blocked it by doing an overlay which could easily be circumvented by removing the html layer. 

[attrayant]

3 hours ago, Spidey said:

This thread is about dispensing medication not mixing chemicals.

 

The point was not about mixing chemicals.  It was about basic fundamental knowledge that I always expected people to have, even at a young age.  Here, they just don't seem to know these basic things and they rely on poo-yai (who also doesn't know any better, but can't be seen as ignorant so s/he has to say something) to guide them.

[AsiaHand]

There are a lot of drug"experts" out there but the police keeps throwing them in jail.

[AsiaHand]

I can see it now ,either the government will start making money by "licensing" the drug dealers  or let the cops start selling all those drugs that have been intercepting from the importers coming into Thailand

.

[CGW]

5 hours ago, Spidey said:

This thread is about dispensing medication not mixing chemicals.

Same thing! ?

[Spidey]

25 minutes ago, CGW said:

Same thing! ?

Really? Like apples are the same as oranges?