Buying Ecstasy online in Nonthaburi

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Buying Ecstasy online in Nonthaburi

Official websites use. Share sensitive information only on official, secure websites. Correspondence to Angkana Sommanustweechai email: angkana ihpp. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL. We gathered information, on antibiotic distribution in Thailand, in in-depth interviews — with 43 key informants from farms, health facilities, pharmaceutical and animal feed industries, private pharmacies and regulators— and in database and literature searches. In —, licensed antibiotic distribution in Thailand involves over importers and about 24 distributors — e. Thailand imports antibiotics and active pharmaceutical ingredients. There is no system for monitoring the distribution of active ingredients, some of which are used directly on farms, without being processed. Most antibiotics can be bought from pharmacies, for home or farm use, without a prescription. In Thailand, most antibiotics are easily and widely available from retail pharmacies, without a prescription. If the inappropriate use of active pharmaceutical ingredients and antibiotics is to be reduced, we need to reclassify and restrict access to certain antibiotics and to develop systems to audit the dispensing of antibiotics in the retail sector and track the movements of active ingredients. La plupart des antibiotiques sont en vente dans les pharmacies, pour usage domestique ou agricole, sans ordonnance. To address antimicrobial resistance, antibiotics should be used appropriately in human medicine. The inappropriate use of antibiotics may involve the use of antibiotics for a health problem for which antibiotics are not indicated or the rational use of antibiotics either in doses that are inadequate or in the correct doses, but for an inadequate duration. As exposure of susceptible bacteria to low doses of antibiotics can lead to the selection of resistance, 1 there is a strong association between antimicrobial resistance and inappropriate use of antibiotics at both individual and population levels. In most developing countries, many antibiotics can be easily bought without prescription and self-medication with antibiotics, mostly bought from drugstores or pharmacies or left over from previous treatments, is common. A major aim of the pharmaceutical market is to respond to increased demand. As the number of retail pharmacies and other outlets for the distribution of antibiotics increases, antibiotics become more widely and easily available. Health professionals may also be persuaded to over-prescribe antibiotics by financial incentives. In low- and middle-income countries most drug regulation is focussed on the quality of drugs and the process of licensing; relatively little attention is given to distribution, price and other aspects of market control. Furthermore, in such countries, the enforcement of the drug regulations that do exist is often poor and the sale of substandard over-the-counter antibiotics and weak pharmaco-vigilance are often common. One of the main aims of the Global Action Plan on Antimicrobial Resistance, which was adopted by the World Health Assembly in , was to optimize the use of antibiotics in human and veterinary medicine. In interviews with key informants, we investigated the multiple channels for the distribution of antibiotics, from import and manufacture to retail sale, and the various issues that probably contribute to the inappropriate use of antibiotics. We investigated antibiotic distribution and regulation in Thailand using a combination of key-informant interviews, a review of the relevant drug regulations and database searches. Between the July and November of , we conducted in-depth interviews, lasting a mean of 90 minutes, with 43 key informants. Each interviewee had been selected using a purposive sampling technique in which relevant associations, i. Each potential informant identified was asked if they were able and willing to participate in the study and, if so, they were asked to give their written informed consent. Our initial aim was to recruit at least three consenting informants from each of six main stakeholder groups, i. However, using the snowball technique, more key informants were interviewed until our data became saturated and no new information emerged Table 1. To ensure consistency, the same individual AS interviewed each key informant. All of the interviews were conducted face-to-face, in Thai. They were semi-structured, but based on open-ended questions. The informants were asked about the processes of antibiotic import, manufacturing, distribution, dispensing, prescription and use. For example, they were asked about the sources of active pharmaceutical ingredients used in the manufacture of finished products and about their sale patterns. All of the interviewees were asked about the licensing process and requirements for each distributor, the registration of medicines and the factors that might contribute to the excessive and inappropriate use of antibiotics. The informants representing the farming industry or health facilities were asked about their sources of antibiotics and the processes they followed to purchase such drugs or active pharmaceutical ingredients. The data recorded in each interview were kept confidential. We estimated the numbers of licensees involved in antibiotic distribution in the Thai market and in the regulation of such distribution by analysing the relevant databases held by the Thai Food and Drug Administration 32 and the Thai Department of Livestock Development. We reviewed all of the regulations promulgated by both of the Acts that, in , regulated the use of antibiotics and medicated feed through inspection, licensing and marketing: the Drug Act 30 and the Animal Feed Quality Control Act. The data obtained from the key-informant interviews and document reviews were summarized to provide an overview of the distribution of antibiotics and identify weaknesses that could contribute to the inappropriate use of antibiotics. To assess the accuracy of the interview data, we used triangulation across the 43 interviewees. If information from one interviewee differed substantially from, and contradicted, the corresponding information from another interviewee, both pieces of information were ignored. Interviewees gave their written informed consent. Strict confidentiality was observed and interviewees could opt out from the interviews at any time. We created a flowchart, based on data from the key-informant interviews and reviews of the Drug Act and the Animal Feed Quality Control Act, to summarize the antibiotic distribution channels Fig. It illustrates the complexity of the distribution, of active pharmaceutical ingredients, finished products and medicated feed, from the importers and local manufacturers to final consumption by humans, livestock or pets. Note: An integrated farming system covers all aspects of the commercial production of livestock, including breeding, feeding, processing and marketing. Thailand imported active pharmaceutical ingredients, for local manufacturing into finished products. It also imported medicated premix for the manufacture of medicated feed by feed mills. Active pharmaceutical ingredients were imported either by manufacturers or by licensed importers that then sold the ingredients to manufacturers. Most of the manufacturers either purchased active pharmaceutical ingredients from licensed importers or imported such ingredients themselves — rather than buying them, at a greater cost, from drugstores. Our data indicated that the import and manufacture of human medicines were very similar to those of veterinary medicines, because the Thai Food and Drug Administration regulated all of these processes. Several interviewees, representing regulators, retailers and wholesalers, described the illegal distribution of both finished products and certain active pharmaceutical ingredients. The Drug Act stipulates that all active pharmaceutical ingredients must be used by manufacturers to produce finished products. However, a few informants reported how drug inspectors had confiscated active pharmaceutical ingredients that were being used directly on livestock in farms. The interviewees that represented the farming industry reported how the high cost of buying medicated feed had persuaded some farmers to mix active pharmaceutical ingredients into their animal feed. Although the Animal Feed Quality Control Act prohibited such direct use of active pharmaceutical ingredients in animal feed, inadequate inspection allowed farmers to purchase such ingredients from drugstores or wholesalers. Only a few antibiotics, e. Such drugs cannot be obtained, legally, without a prescription and are reserved for hospital use. Although most of these prescriptions were not required by law, the routine issuing of prescriptions, even for drugs that were not, legally, prescription-only, had become the tradition of most health facilities. Antibiotics were also dispensed directly to consumers and pet owners by licensed pharmacists in wholesalers or drugstores. Informants representing animal feed companies reported how feed mills mostly purchased medicated premix, from importers, manufacturers or distributors, to produce medicated feed that was then sold to farms either directly or via feed stores. According to the key informants from the farming industry, most of the antibiotics that farmers used were given to livestock in medicated feed, either for treatment or for prophylaxis during periods of increased vulnerability, e. The large number of licensed individuals involved in the antibiotic supply chains can be categorized according to the type of license granted to them under the Drug Act or Animal Feed Quality Control Act. Our database searches revealed how, in , about 3. The database records did not distinguish between imported antibiotics and those produced in Thailand. The importation of any drugs must be registered and pre-approved by the Thai Food and Drug Administration. By law, active pharmaceutical ingredients must only be sold by licensed importers and manufacturers. At customs, the licensed importers of active pharmaceutical ingredients are required to notify the Thai Food and Drug Administration before gaining approval for imports. The Drug Act regulates pharmacists working in pharmacies, on aspects such as working hours and the dispensing of special-control drugs. However, most of the dispensing of antibiotics classified as dangerous drugs is not legally regulated and the quality of dispensing is largely reliant on the competences of the doctors, pharmacists and veterinarians involved. Historically, there have been no legal requirements for the keeping of records on the types and quantities of antibiotics dispensed within the retail sector. At the time of our study, prescriptions were routinely issued in hospitals, but no prescription audits were required. In this study, we identified a few key challenges, on both the demand and supply sides of the market as well as in health facilities and the regulatory environment, that perhaps made access to antibiotics too easy Fig. Self-medication with antibiotics obtained without a prescription is a common practice in most developing countries. In China and Viet Nam, inadequate knowledge and lack of awareness of antimicrobial resistance, in both patients and providers, were recognized as important factors contributing to the irrational use of antibiotics. In turn, easy access may boost the inappropriate use of drugs by households. Any economic incentives offered by pharmaceutical companies to boost their market share may contribute to the excessive provision of antibiotics. In much of Asia, the quality of the pharmaceutical services provided by retail pharmacies is often poor. The staff in such pharmacies may offer no counselling or history taking and may recommend inappropriate presumptive treatments, e. In Peru and central Thailand, private retail pharmacies, where dispensing could not be guided by the antibiotic-resistance profiles of the causative agents, were found to be the most common source of antibiotics for the treatment of sexually transmitted diseases. At the time of our study, the records of the Thai Food and Drug Administration did not differentiate between such licensed distributors, retailers and wholesalers. In consequence, there was no easy way to monitor or control the sale of large quantities of antibiotics to individual patients or farmers. We found that, if they could afford it, Thai farmers could easily buy very large amounts of finished products and active pharmaceutical ingredients from drug retailers or wholesalers. The focus of drug regulation in low- and middle-income countries, e. Ethiopia, Thailand, the United Republic of Tanzania and Zimbabwe, is on drug quality and licensing rather than availability and distribution channels. Furthermore, the Act made no attempt to regulate the quantity of antibiotics that could be distributed to any individual or to control the excessive use of antibiotics in livestock. Later, the Animal Feed Quality Control Act prohibited direct use of active pharmaceutical ingredient in the animal feeds. However, our interviews indicated that, many Thai farmers were, illegally, adding active pharmaceutical ingredients to animal feeds, probably as a cost-saving measure. Compared with access to antibiotics, access to active pharmaceutical ingredients appears to be less well regulated, leading to inappropriate use by farmers. In Thailand, all drugs have to be registered with the Food and Drug Administration before production or importation. There is, however, no corresponding requirement for the registration of active pharmaceutical ingredients. Drug distributors and retailers can only sell active pharmaceutical ingredients legally to manufacturers. However, a lack of monitoring and tracking of active pharmaceutical ingredients and inadequate inspections at the drug distributors and retailers mean that this legal restriction is generally ignored. One limitation of our study is that the data maintained by the Thai Food and Drug Administration do not allow any estimation of the national consumption of each major class of antibiotics in terms of, for example, the defined daily dose per inhabitants per day. The Thai Working Group on the Surveillance of Antimicrobial Consumption is working on the development of a sustainable system to monitor annual antimicrobial consumption. In conclusion, this study appears to be the first published study in Thailand to investigate antibiotic distribution, for human and animal health. Such wide availability probably leads to frequent inappropriate use. A general lack of enforcement of the legislation covering the distribution of active pharmaceutical ingredients facilitates the direct use of such ingredients on farms. The unnecessary and inappropriate use of antibiotics will probably lead to an increase in the problem posed by antimicrobial resistance in Thailand. A system for recording antibiotic dispensing at retail pharmacies should be established 29 and then carefully audited by pharmacists. The continued professional education of retail pharmacists should be promoted, as a means of reducing the inappropriate use of antibiotics, and other drugs. The sales of large quantities of antibiotics to individuals need to be restricted by differentiating wholesalers from retailers in the licensing system. This includes prohibiting wholesalers from selling large quantities of antibiotics to farmers, or others who are not licensed retail outlets, and carefully restricting the sale by retailers of large quantities of such drugs to individuals. A national system for tracking active pharmaceutical ingredients should be established immediately, to prevent the direct use of such ingredients on farms. The authors thank Nithima Sumpradit, Sasi Jaroenpoj, Porjai Rattanapanadda, Sopon Iamsirithaworn and Richard Brown, for their kind support, Parinda Seneerattanaprayul, Sasirat Laptikultham and Pohnratchda Mattrasongkram, for their assistance with programme management, and the key informants and experts who made time for us in their busy working days. As a library, NLM provides access to scientific literature. Bull World Health Organ. Show available content in en fr es ar zh ru. Find articles by Angkana Sommanustweechai. Find articles by Sunicha Chanvatik. Find articles by Varavoot Sermsinsiri. Find articles by Somsajee Sivilaikul. Find articles by Walaiporn Patcharanarumol. Find articles by Shunmay Yeung. Find articles by Viroj Tangcharoensathien. Type No. Open in a new tab. Type License held No. NA: not available. This research was supported by the World Health Organization, Thailand. None declared. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Representative of pharmaceutical company b. Representative of animal feed company c. Health professional from human or animal health facility. Wholesaler or owner of retail drug store. Licensed providers. Selling only ready-packed medicines. Pharmaceutical sales — ready-packed medicines only. Selling only ready-packed medicines for animals. Pharmaceutical sales — ready-packed medicines for animals only. Unlicensed individuals. Households involved in the rearing of livestock.

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Buying Ecstasy online in Nonthaburi

If the prescription medicine not listed as controlled drugs. The medications are likely be classified as medication preparations according to the Drug Act B. A patient under treatment of medications in that category is allowed to transport for personal use medications in a quantity Not Exceeding 30 Days of prescribed usage. You can consult that office directly by sending an email to the Director of the Bureau of Drug Control: vinit fda.

Buying Ecstasy online in Nonthaburi