Pharmacy law duels culture of self-prescription

BY MARIA GALLUCCI
The News
April 7, 2010

With a prescription sheet in hand, Fernando Rodríguez disappears from behind various shelves stocked with pills, creams, syrups and serums and returns with a box of the customer’s order. Not quite a remarkable task for a pharmacy counter clerk in Mexico City, except for one tiny detail – the penned doctor’s order in his grasp.

As of last Thursday, the age of easy access to prescription drugs in Mexican pharmacies has come to a close, much to the chagrin of many Mexicans and ex-pats living on a budget. No longer can customers stroll into a nearby shop with just the tongue-twisting drug’s name scribbled down, effectively bypassing the expense of a doctor’s consultation. And they certainly can’t ask a counter clerk for the cheapest antibiotic in stock to treat a rash, cough or the inevitable stomach virus.

Partly a reaction to an increase in self-medication during last year’s H1N1 flu virus outbreak, the Health Secretariat last Thursday began enforcing a 25-year-old law that requires a doctor’s prescription for most antibiotics and amphetamines, as well as medications for diabetes, hypertension and depression. The changes carry the threat of closure for pharmacies that violate the rule.

The secretariat’s greatest concern, officials said, is a rising resistance to antibiotics among a population whose national culture reaffirms self-determined diagnoses. According to the Federal Commission for Protection Against Sanitary Risks (Cofepris), around 40 percent of adverse reactions to medications are related to self-treatment.

While countries such as the United States, Spain, Chile and parts of Europe have already put policies in place mandating prescriptions for certain drugs, many customers in Mexico until recently enjoyed the cost-saving benefit of going doctor-less.

Laura Yates, who moved to Mexico from the United States nearly two years ago, said that she now might try photocopying previous doctor prescriptions to use at her neighborhood pharmacy in Colonia Roma. Although her Texcoco-based office does offer on-site medical services in the State of Mexico, the ex-pat said the law gave her fewer alternatives at home in Mexico City.

“If I get sick over the weekend or during the hours (the doctor) isn’t here, I’m out of luck,” she said from her office. “If they are actually strict about enforcing this, it will be a big hassle, especially if I need to renew a prescription for something that I got from a specialist.

“Once I have already seen a doctor for something…there is no need to waste time and money going back to the doctor’s office to get him to write down what will probably be the same prescription.”

Rodríguez said that many of his customers at Farmacia Elite expressed similar sentiments to Yates’ and would often return without a prescription for refills or to find similar medicines. The clerk agreed with the secretariat, however, that too many clueless customers seek out antibiotics based on little more than family advice, online searches or medical guesswork.

He said that many people had been irked or bothered by the health law’s enforcement, although few in his pharmacy’s upscale Lomas de Chapultepec business district had been truly upset.
Residents of small towns and rural communities, on the other hand, would be hardest hit by the regulatory changes, he said.

Local media have also speculated that inaccessibility to antibiotics for some consumers could mean the rise of black market medications or falsified prescription sheets. Fear of higher medical bills even had some residents throughout Mexico in a frenzy, with throngs of people racing to pharmacies stock up on antibiotics and other drugs before April 1, the papers reported.

Rodríguez noted that many Mexicans had limited access to public health systems, such as the Mexican Institute for Social Security (IMSS) or the Seguro Popular health insurance program. (Participation in Seguro Popular actually went down 16 percent from 2008 to 2009 due to dissatisfaction, according to the program).

Consultations at private hospitals can cost anywhere from 300 pesos for a general doctor to more than 600 pesos for a specialist’s opinion – virtually pennies for many middle-class customers, but more than a day’s wage for others.

“In these tiny pueblos, pharmacies are the only access some people have to medications. We’re there only hope for treatment,” he said.

Guadalupe Tinoco, a counter clerk at the Farmacias del. Dr. Descuento (Dr. Discount Pharmacies) branch in the Cuauhtémoc neighborhood, said that most customers at the shop had reacted far more calmly than the frantic shoppers.

The chain, like many other discount franchises in the city, offers 20-peso consultations through resident medical professionals. The National Association of Pharmacies in Mexico (Anafarmex) has said that around 20,000 pharmacies have at least one medical professional on their staff.
The health secretariat is also expected to offer technical training to around 40,000 pharmacists and clerks in the next two years to facilitate consultations and sales control.

“Not only do we give out prescriptions, but also the security that what you’re taking is safe and will work effectively,” Tinoco said.

“Hopefully people will realize that this law is good for their health; it’s for their own good.”