Transcript REDUCING CODEINE COUGH SYRUP MEDICINE CONSUMPTION

REDUCING CODEINE COUGH
SYRUP MEDICINE CONSUMPTION
TO CONTROL CODEINE ABUSE
IN THAILAND
Naiyana Patcharapisarn
Narcotics Control Division
Food and Drug Administration
Abstract
Reducing Codeine Cough Syrup Medicine Consumption to Control Codeine Abuse in Thailand
Naiyana Patcharapisarn
Problem Statement: Increasing codeine cough syrup medicine abuse has been reported for over a decade in Thailand.
Surveillance data showed increasing codeine cough syrup medicine purchasing through drugstores, especially in the
Southern region of Thailand. Accordingly, Notifications and Ministerial Regulation of the Ministry of Public Health
were launched throughout the country to control codeine cough syrup medicine abuse in December 2002 and in June
2003.
Objective: To assess codeine cough syrup medicine consumption reported before and after launching the Notifications
and Ministerial Regulation of the Ministry of Public Health through surveillance data.
Design: Retrospective design.
Intervention: Ministry of Public Health regulations implemented throughout the country.
Setting and Population: Total amounts of codeine cough syrup medicine consumption reported by manufacturers,
importers and distributors in Thailand to the Food and Drug Administration were reviewed and analyzed across time
concerning the types of medical services and regions between July 2000 and November 2003.
Outcome measure: Average volume of codeine cough syrup medicine consumption reported per month, per region
and per type of medical services were measured before and after launching the regulation.
Results: There was an increasing trend in codeine cough syrup medicine consumption before late 2002, especially in
Bangkok and the southern part of Thailand. Then, a sharply decreased consumption from an average of 861ml/month/1,000 population in November 2002 to an average of 90.7 ml/month/1000 population in February 2003 was
noted. Consumption of codeine cough syrup medicine was reduced throughout the country and is clearly seen in the
southern part of Thailand. In 2003, the proportion distributed to drugstores was reduced throughout the country.
Conclusions: Notifications and Ministerial Regulation from the FDA effectively controls codeine cough syrup
medicine abuse. First, there is a reversed trend of codeine cough syrup medicine consumption from an increasing to a
marked decreasing consumption in the entire country, especially in the Southern part of Thailand. Second, reducing the
distribution of the codeine cough syrup medicine consumption to drugstores is effective.
Background
Although Codeine has been used as medicine but it is also one of
narcotics due to the biologic property of drug dependency. In Thailand,
the Codeine cough syrup medicine has been classified as Narcotic in
schedule III, by the Narcotic Act A.D.1979. Extensive abuse of the
Codeine cough syrup medicine by teenagers, especially via drugstores,
has been reported through the media for over a decade in this country.
Thus, the Ministry of Public Health launched the Notifications in
December A.D. 2002 as well as the Ministerial Regulation in June
A.D.2003 in order to reduce the Codeine abuse throughout the country
as follow;
1.The Notification No.179 A.D.2002: To reduce the total usage
of Codeine to be used for medicinal and scientific purposes throughout
the Kingdom to 1,000 Kg within the year A.D.2003
2.The Notification No.180 A.D.2002: To set a strict control over the
manufactured or imported quantity of the Codeine formula
Background (continue)
3.The Notification No.181 A.D.2002: Specify the amount of the
Narcotics in schedule III-codeine formula, which could be suspected
that, possess for dispose
4.The Ministerial Regulation by the Ministry of Public Health: To
regulate the disposal of the Codeine formula only in the private
hospitals and the public healthcare.
The measure to control the Codeine cough syrup medicine in this
country is regulated by the Food and Drug Administration (FDA), the
Ministry of Public Health. Legally, licensed importers, manufacturers
and distributors have to report the Buy-Sell of Narcotics in schedule
III to the FDA monthly and annually. Surveillance on these data may
reflex an effect on reducing Codeine abuse such as decreasing the
Codeine disposal in the market.
Objective
This study aimed to assess codeine cough syrup
medicine disposal reported to the FDA before and after
launching the Notifications and Ministerial Regulation
of the Ministry of Public Health
Methods
We examined the trend of Codeine cough syrup
medicine disposal reported to the FDA from July A.D.2000
to November A.D.2003, the period including pre and post
launching the Notifications and Ministerial Regulation of
the Ministry of Public Health by surveillance data.
Stratification of Codeine cough syrup medicine
distributions by areas in the country and types of healthcare
sectors were also examined.
Results
There was an increasing trend in codeine cough syrup medicine
consumption before launching the Notifications, especially in
Bangkok Metropolis and the southern part of Thailand.
Two turning pointes have been noted according to the overall Codeine
disposal across time. The first turning point was noted with a sharply
decreased consumption after launching the Notifications in December
A.D.2002. The second turning point was also observed with a slightly
further decreased consumption after launching the Ministerial
Regulation in June A.D. 2003.
According to the areas, consumption of codeine cough syrup
medicine was most reduced in the southern part of Thailand. The
Codeine disposal was reduced markly in drugstores compared to the
other sectors of healthcares.
Amount of Codeine Cough Syrup Medicine reported
( per 1000 population per month)
1400.0
ml_1000 population
1200.0
1000.0
800.0
600.0
400.0
200.0
0.0
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov00 00 00 00 00 00 01 01 01 01 01 01 01 01 01 01 01 01 02 02 02 02 02 02 02 02 02 02 02 02 03 03 03 03 03 03 03 03 03 03 03
Stratification by areas
( per 1000 population per month)
ml/month/1000 population
3500
BKK
3000
Central
2500
NE
2000
North
1500
south
1000
500
year
0
2000
2001
2002
2003
Stratification by types of health care services
Litre/month
45000
40000
35000
30000
hospital
25000
drugstore
20000
clinic
15000
10000
5000
0
year
2000
2001
2002
2003
Implication
The impact on Codeine use in medical practice as
potent analgesic and cough management by the
Notifications and the Ministerial Regulation should be
further investigated.