Made in India: Drug shortage compels doctors to prescribe smuggled cancer medicines
Black market prices of a Rs175 cyclophosphamide injection go as high as Rs1,500.
According to data received from IRNUM, the hospital treats at least 5,000 cancer patients annually. PHOTO: ATHAR KHAN/EXPRESS
PESHAWAR:
In a desperate move to compensate for the shortage of cancer drugs in Khyber-Pakhtunkhwa (K-P), doctors have resorted to prescribing drugs which are made in India and smuggled to Pakistan.
There is only one cancer treatment facility in K-P; it caters to patients from all over, including the tribal belt and at times Afghanistan – the Institute of Radiotherapy and Nuclear Medicine (IRNUM).
Some doctors at IRNUM admitted prescribing illegally-obtained medicines for treatment. On the receiving end, however, patients have been purchasing drugs of murky origins at much higher rates from privately-owned pharmacies.
According to data received from IRNUM, the hospital treats at least 5,000 cancer patients annually.
The number hit 6,000 in 2012, further increased in 2013. Their problems have compounded because of the drug shortage which began in July.
A doctor at IRNUM requesting anonymity told The Express Tribune the government has permitted different pharmaceutical companies to import cyclophosphamide (used to treat types of cancer, including lymphomas and brain cancer) and doxorubicin (also used to treat a wide range including carcinoma and sarcomas). These firms stopped importing these medicines for various reasons, including the appreciation of the dollar, and created an acute shortage in the country.
The doctor blamed hoarders and smugglers for taking advantage of the situation by supplying the market drugs of “questionable quality at unreasonably high rates.” This, he complained, made treatment unaffordable for patients.
He admitted since the shortage, he and other doctors have been compelled to prescribe medicines made in India to patients, who are obviously desperate to continue some form of treatment.
“Since the last three months, Cyclomide (500 mg injection), Zycram, Cytosine and Vinblas have been in short supply and we’re prescribing an alternative drug Endoxan-N (a cyclophosphamide injection), which is an Indian product.”
It is the responsibility of the government to take action against drug manufacturers for not producing basic cancer medicine even though they obtained special licences from the government to do so, added the doctor.
According to the owner of a medical store, Ibrahim Khan, the demand for Endoxan-N has exponentially increased since the shortage of cyclophosphamide and doxorubicin.
“The original price of the Endoxan-N injection is Rs175 but it being purchased for Rs1,000 from the black market and sold for up to Rs1,500,” shared Ibrahim. The injections is brought from Karachi and then purchased from dealers in Namak Mandi, he added.
Madeeha, a pharmacist at IRNUM, said the shortage is not limited to K-P; it is being felt across Pakistan. “However, second-line drugs [second choice drugs for treatment] like Gemzar [chemotherapy drug] and Docetrust are available at the hospital’s pharmacy though.” All medicines available at the IRNUM pharmacy are registered, “We are not allowed to keep unregistered drugs,” claimed Madeeha.
IRNUM Director Dr Muhammad Rauf Khattak, however, rebutted the notion that India medicines are being prescribed at the hospital. “A doctor can suggest medicines to other doctors but cannot prescribe unregistered medicines to patients.”
Khattak admitted the shortage of cancer drugs stretches back at least three months and urged the government to take action against pharmas which have requisite licences and still do not produce or import the drugs.
“We haven’t even received Zakat funds from the government and patients suffer because of this,” he shared. A majority of patients with cancer depend on Zakat funds for subsidised or free treatment.
Published in The Express Tribune, November 29th, 2013.
In a desperate move to compensate for the shortage of cancer drugs in Khyber-Pakhtunkhwa (K-P), doctors have resorted to prescribing drugs which are made in India and smuggled to Pakistan.
There is only one cancer treatment facility in K-P; it caters to patients from all over, including the tribal belt and at times Afghanistan – the Institute of Radiotherapy and Nuclear Medicine (IRNUM).
Some doctors at IRNUM admitted prescribing illegally-obtained medicines for treatment. On the receiving end, however, patients have been purchasing drugs of murky origins at much higher rates from privately-owned pharmacies.
According to data received from IRNUM, the hospital treats at least 5,000 cancer patients annually.
The number hit 6,000 in 2012, further increased in 2013. Their problems have compounded because of the drug shortage which began in July.
A doctor at IRNUM requesting anonymity told The Express Tribune the government has permitted different pharmaceutical companies to import cyclophosphamide (used to treat types of cancer, including lymphomas and brain cancer) and doxorubicin (also used to treat a wide range including carcinoma and sarcomas). These firms stopped importing these medicines for various reasons, including the appreciation of the dollar, and created an acute shortage in the country.
The doctor blamed hoarders and smugglers for taking advantage of the situation by supplying the market drugs of “questionable quality at unreasonably high rates.” This, he complained, made treatment unaffordable for patients.
He admitted since the shortage, he and other doctors have been compelled to prescribe medicines made in India to patients, who are obviously desperate to continue some form of treatment.
“Since the last three months, Cyclomide (500 mg injection), Zycram, Cytosine and Vinblas have been in short supply and we’re prescribing an alternative drug Endoxan-N (a cyclophosphamide injection), which is an Indian product.”
It is the responsibility of the government to take action against drug manufacturers for not producing basic cancer medicine even though they obtained special licences from the government to do so, added the doctor.
According to the owner of a medical store, Ibrahim Khan, the demand for Endoxan-N has exponentially increased since the shortage of cyclophosphamide and doxorubicin.
“The original price of the Endoxan-N injection is Rs175 but it being purchased for Rs1,000 from the black market and sold for up to Rs1,500,” shared Ibrahim. The injections is brought from Karachi and then purchased from dealers in Namak Mandi, he added.
Madeeha, a pharmacist at IRNUM, said the shortage is not limited to K-P; it is being felt across Pakistan. “However, second-line drugs [second choice drugs for treatment] like Gemzar [chemotherapy drug] and Docetrust are available at the hospital’s pharmacy though.” All medicines available at the IRNUM pharmacy are registered, “We are not allowed to keep unregistered drugs,” claimed Madeeha.
IRNUM Director Dr Muhammad Rauf Khattak, however, rebutted the notion that India medicines are being prescribed at the hospital. “A doctor can suggest medicines to other doctors but cannot prescribe unregistered medicines to patients.”
Khattak admitted the shortage of cancer drugs stretches back at least three months and urged the government to take action against pharmas which have requisite licences and still do not produce or import the drugs.
“We haven’t even received Zakat funds from the government and patients suffer because of this,” he shared. A majority of patients with cancer depend on Zakat funds for subsidised or free treatment.
Published in The Express Tribune, November 29th, 2013.