راهکارهای موثر در توزیع داروهای مسکن مخدر به وسیله داروخانه‌ها در ایران
محورهای موضوعی : -اقتصاد بهداشت و درمانساجد نوروزی 1 , سید علی سبحانیان 2
1 - دانشجوی دکتری حرفه ای داروسازی، دانشکده داروسازی، دانشگاه علوم پزشکی، دانشگاه آزاد اسلامی، تهران، ایران
2 - استادیار، گروه مدیریت و اقتصاد دارو، دانشکده داروسازی، دانشگاه علوم پزشکی، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: روش توزیع مناسب, داروخانه, داروهای مسکن مخدر, درد,
چکیده مقاله :
مقدمه: داروهای مسکن مخدر برای تسکین موثر درد در برخی از بیماری‌ها مانند دردهای مزمن سرطانی، دردهای پس از عمل‌های جراحی و نیز دردهای مزمن در هنگام ترک اعتیاد استفاده می‌شوند. کاربرد این داروها با موانعی از قبیل کمبود دسترسی و هم‌چنین ضعف قوانین و مقررات جهت جلوگیری از انحراف در مصرف این دسته از داروها در بازارهای غیر قانونی به شدت سبب ایجاد اختلال در دسترسی پزشکی به این مسکن‌ها در کشورهای مختلف شده است. هدف از این پژوهش، بررسی و پیشنهاد روش توزیع این داروها از طریق داروخانه‌های منتخب در ایران می‌باشد.روش پژوهش: جامعه آماری در این تحقیق را کارشناسان و صاحب نظران نظام توزیع دارو تشکیل دادند که برای انتخاب ایشان از روش نمونه‌برداری غیر احتمالی گلوله برفی استفاده شد. نقاط قوت، ضعف، فرصت‌ها و تهدیدات پیش رو جهت نیل به این هدف، با بهره‌گیری از مصاحبه نیمه ساختار یافته و هم‌چنین توزیع پرسش‌نامه بصورت حضوری با این افراد بدست آمده و توسط مدل برنامه‌ریزی راهبردی (SWOT) تحلیل شد.یافته‌ها: نتایج نشان داد که مواردی مانند بازبینی قوانین نظارتی جهت تولید و توزیع داروهای مسکن مخدر، تغییر سبد فروش این داروها در داروخانه‌ها جهت سودآوری بیشتر، واگذاری توزیع این داروها به شبکه های خصوصی تحت نظارت سازمان غذا و دارو، توزیع مناسب این داروها در کلیه داروخانه‌ها جهت کنترل بهتر بیماران و نیز دسترسی آسانتر آنها به دارو، شبکه‌سازی و ثبت اطلاعات و سوابق بیماران و معتادان در یک سیستم جامع کشوری و نیز استفاده از رسانه‌های گروهی و شبکه‌های اجتماعی جهت فرهنگ‌سازی و افزایش آگاهی مردم، بعنوان راهکارهای لازم جهت نیل به هدف این تحقیق حاصل شد.نتیجه‌گیری: اجرای یافته‌های حاصل از این تحقیق می‌تواند به عنوان راهکارهای موثری در جهت توزیع مناسب داروهای مسکن مخدر از طریق داروخانه‌ها در ایران بکار گرفته شوند.
Introduction: Narcotic analgesics are used to effectively relieve pain in some diseases. The use of these drugs with barriers such as lack of access as well as weak laws and regulations to prevent deviations in the use of these drugs has severely disrupted medical access to these painkillers in various countries. The purpose of this study is to review and propose the method of distribution of these drugs through selected pharmacies.Methods: The statistical population in this study consisted of experts in the drug distribution system, which was selected by non-probable snowball sampling method. Strengths, weaknesses, opportunities and threats to achieve this goal, using semi-structured interviews and distribution of questionnaires in person with these people were obtained and analyzed by the strategic planning model (SWOT).Findings: The results showed that cases such as reviewing regulatory laws for the production and distribution of narcotic drugs, changing the sales portfolio of these drugs in pharmacies for greater profitability, delegating the distribution of these drugs to private networks under the supervision of the Food and Drug Administration, proper distribution of Drugs in all pharmacies for better control of patients and their easier access to drugs, networking and recording information and records of patients and addicts in a comprehensive national system were obtained as a necessary solution to achieve the purpose of this study.Conclusion: The implementation of the findings of this study can be used as effective strategies for the proper distribution of narcotic analgesics through pharmacies in Iran.
1- Hajebi G, Mortazavi AR, Salamzadeh J, Moshiri K. Surveying the pattern of narcotic analgesia usage insurgical wards of Ayatollah Taleghani Hospital.Pejouhesh dar Pezeshki
Research in Medicine, 2006; 30(4): 291-296. [In Persian]
2- Helms RA, Quan DJ, editors. Textbook of therapeutics, drug and disease management. Philadelphia: Lippincott Williams & Wilkins; 2006.
3- Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ. Alleviating the access abyss in palliative care and pain relief an imperative of universal health coverage: the Lancet Commission report. The Lancet, 2018; 391(10128): 1391-1454.
4- Cherny NI, Baselga J, De Conno F, Radbruch L. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe. A report from the ESMO/EAPC Opioid Policy Initiative. Annals of Oncology, 2010; 21(3): 615-626.
5- Bosetti C, Santucci C, Radrezza S, Erthal J, Berterame S, Corli O. Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016. European Journal of Pain, 2019; 23(4): 697-707.
6- Fartookzadeh H, Moazzez H, Rajabi Nohouji M. Strategies and Policies of Drug Abuse Control in Iran. Social Welfare Quarterly, 2013; 13 (48): 171-199. [In Persian]
7- Rahimi AR, Ghaleiha A, Shamsaei F, Zarabian M K. Survey of the Effective Methods of Decreasing Demands of Narcotic Substances from the Viewpoint of Hamadan People. Scientific Journal of Hamadan University of Medical Sciences, 2007; 13(4): 43-47. [In Persian]
8- Bashir I, Ahmad M, Jamshaid M, Zaman M. Illicit sale of controlled drugs at community pharmacy/medical stores of Punjab, Pakistan: A road to demolition of public healthHeliyon, 2021; 7(5): e07031.
9- Xu J, Mukherjee S. State laws that authorize pharmacists to prescribe naloxone are associated with increased naloxone dispensing in retail pharmacies. Drug and Alcohol Dependence, 2021; 227: 109012.
10- Hohmeier KC , Cernasev A, Desselle Sh,Canedo J, Stewart S, Wheeler J. Exploring the frontline experiences of pharmacy technicians during the opioid epidemic in community pharmacies.JAPhA, 2022 (09 March). Available from: https://doi.org/10.1016/j.japh.2022.03.005
11- Pollini RA,S Slocum , Ozga JE, Joyce R, Xuan Z,Green TC, et al.Pharmacy Naloxone Codispensing: A Mixed Methods Study of Practices and Perspectives under a Statewide Standing Order Program. JAPhA, 2022 (19 March). Available from: https://doi.org/10.1016/j.japh.2022.03.015.
12- Modarai F, Mack K, Hicks P, Benoit S, Parkbe S, Jones C, Proescholdbell S,IsingPaulozzi L.Relationship of opioid prescription sales and overdoses, North Carolina.Drug and Alcohol Dependence, 2013; 132(1-2): 81-86.
13- Vayena E, Dzenowagis J, Brownstein JS, Sheikh A. Policy implications of big data in the health sector. Bulletin of the World Health Organization, 2018; 96(1): 66-68.
14- Karimi I, Salarian A, Anbari Z. A comparative study on equity in access to health services in developed countries and designing a model for Iran. Journal of Arak University Medical Sciences, 2010; 12(4): 92-104.
15- Danaeefard H, Alvani M, Azar A, editors. Quantitative research methodology in management: a comprehensive approach.2th edition, Tehran: Saffar Ishraqi Publications; 2009. [In Persian]
16- Elder S, editor. School-to-work transition survey: a methodological guide.Module 3. Sampling methodology.International Labour Office. Employment Sector, Geneva: ILO; 2009.
17- Ranjbar H, Haghdoost AA, Salsali M, Khoshdel A, Soleimani M, Bahrami N. Sampling In Qualitative Research: A Guide for Beginning AnnalsofMilitary andHealthSciencesResearch, 2012; 10(3): 238-250. [In Persian]
18- Sekaran, U, editor. Research Methods for Business: A Skill Business Approach. New York: John Wiley & Sons; 2000.
19- Momeni M, Faal-Qayyumi A, editors. Statistical analysis using SPSS. Tehran: University of Tehran Press; 2010. [In Persian]
20- Aarabi M, editor.Strategic Planning Manual. Tehran: Agah Publications; 2017. [In Persian]
21- Abbasi-Ghahramanloo A, Fotouhi A, Zeraati H, RahimiMovaghar A. Prescription drugs, alcohol, and illicit substance use andtheir correlations among medical Sciences students in Iran. International Journal of High Risk Behaviors and Addiction, 2015; 204(1): e21945.
22- Okie S.A flood of opioids, a rising tide of deaths. The New England Journal of Medicine, 2010; 363(21): 1981–1985.
23- Stopka TJ, Donahue A, Hutcheson M, Green TC. Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts2015. Journal of the American Pharmaceutical Association, 2017; 57(2): S34–S44.
24- Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain, 1995; 64: 357-64.
25- Burns JW, Hodsman NB, McLintock TT, Gillies GW, Kenny GN, McArdle CS. The influence of patient characteristics on the requirements for postoperative analgesia. A reassessment using patient-controlled analgesia. Anaesthesia, 1989; 44(1): 2-6.
26- Parker RK. Demographic factors influencing the PCA morphine requirement. Anesthesiology, 1990; 73: A818.
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1- Hajebi G, Mortazavi AR, Salamzadeh J, Moshiri K. Surveying the pattern of narcotic analgesia usage insurgical wards of Ayatollah Taleghani Hospital.Pejouhesh dar Pezeshki
Research in Medicine, 2006; 30(4): 291-296. [In Persian]
2- Helms RA, Quan DJ, editors. Textbook of therapeutics, drug and disease management. Philadelphia: Lippincott Williams & Wilkins; 2006.
3- Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ. Alleviating the access abyss in palliative care and pain relief an imperative of universal health coverage: the Lancet Commission report. The Lancet, 2018; 391(10128): 1391-1454.
4- Cherny NI, Baselga J, De Conno F, Radbruch L. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe. A report from the ESMO/EAPC Opioid Policy Initiative. Annals of Oncology, 2010; 21(3): 615-626.
5- Bosetti C, Santucci C, Radrezza S, Erthal J, Berterame S, Corli O. Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016. European Journal of Pain, 2019; 23(4): 697-707.
6- Fartookzadeh H, Moazzez H, Rajabi Nohouji M. Strategies and Policies of Drug Abuse Control in Iran. Social Welfare Quarterly, 2013; 13 (48): 171-199. [In Persian]
7- Rahimi AR, Ghaleiha A, Shamsaei F, Zarabian M K. Survey of the Effective Methods of Decreasing Demands of Narcotic Substances from the Viewpoint of Hamadan People. Scientific Journal of Hamadan University of Medical Sciences, 2007; 13(4): 43-47. [In Persian]
8- Bashir I, Ahmad M, Jamshaid M, Zaman M. Illicit sale of controlled drugs at community pharmacy/medical stores of Punjab, Pakistan: A road to demolition of public healthHeliyon, 2021; 7(5): e07031.
9- Xu J, Mukherjee S. State laws that authorize pharmacists to prescribe naloxone are associated with increased naloxone dispensing in retail pharmacies. Drug and Alcohol Dependence, 2021; 227: 109012.
10- Hohmeier KC , Cernasev A, Desselle Sh,Canedo J, Stewart S, Wheeler J. Exploring the frontline experiences of pharmacy technicians during the opioid epidemic in community pharmacies.JAPhA, 2022 (09 March). Available from: https://doi.org/10.1016/j.japh.2022.03.005
11- Pollini RA,S Slocum , Ozga JE, Joyce R, Xuan Z,Green TC, et al.Pharmacy Naloxone Codispensing: A Mixed Methods Study of Practices and Perspectives under a Statewide Standing Order Program. JAPhA, 2022 (19 March). Available from: https://doi.org/10.1016/j.japh.2022.03.015.
12- Modarai F, Mack K, Hicks P, Benoit S, Parkbe S, Jones C, Proescholdbell S,IsingPaulozzi L.Relationship of opioid prescription sales and overdoses, North Carolina.Drug and Alcohol Dependence, 2013; 132(1-2): 81-86.
13- Vayena E, Dzenowagis J, Brownstein JS, Sheikh A. Policy implications of big data in the health sector. Bulletin of the World Health Organization, 2018; 96(1): 66-68.
14- Karimi I, Salarian A, Anbari Z. A comparative study on equity in access to health services in developed countries and designing a model for Iran. Journal of Arak University Medical Sciences, 2010; 12(4): 92-104.
15- Danaeefard H, Alvani M, Azar A, editors. Quantitative research methodology in management: a comprehensive approach.2th edition, Tehran: Saffar Ishraqi Publications; 2009. [In Persian]
16- Elder S, editor. School-to-work transition survey: a methodological guide.Module 3. Sampling methodology.International Labour Office. Employment Sector, Geneva: ILO; 2009.
17- Ranjbar H, Haghdoost AA, Salsali M, Khoshdel A, Soleimani M, Bahrami N. Sampling In Qualitative Research: A Guide for Beginning AnnalsofMilitary andHealthSciencesResearch, 2012; 10(3): 238-250. [In Persian]
18- Sekaran, U, editor. Research Methods for Business: A Skill Business Approach. New York: John Wiley & Sons; 2000.
19- Momeni M, Faal-Qayyumi A, editors. Statistical analysis using SPSS. Tehran: University of Tehran Press; 2010. [In Persian]
20- Aarabi M, editor.Strategic Planning Manual. Tehran: Agah Publications; 2017. [In Persian]
21- Abbasi-Ghahramanloo A, Fotouhi A, Zeraati H, RahimiMovaghar A. Prescription drugs, alcohol, and illicit substance use andtheir correlations among medical Sciences students in Iran. International Journal of High Risk Behaviors and Addiction, 2015; 204(1): e21945.
22- Okie S.A flood of opioids, a rising tide of deaths. The New England Journal of Medicine, 2010; 363(21): 1981–1985.
23- Stopka TJ, Donahue A, Hutcheson M, Green TC. Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts2015. Journal of the American Pharmaceutical Association, 2017; 57(2): S34–S44.
24- Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain, 1995; 64: 357-64.
25- Burns JW, Hodsman NB, McLintock TT, Gillies GW, Kenny GN, McArdle CS. The influence of patient characteristics on the requirements for postoperative analgesia. A reassessment using patient-controlled analgesia. Anaesthesia, 1989; 44(1): 2-6.
26- Parker RK. Demographic factors influencing the PCA morphine requirement. Anesthesiology, 1990; 73: A818.