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Abuse of Codeine containing cough mixtures in Hong Kong

Abuse of Codeine containing cough mixtures in Hong Kong. Dr. CHOI Kin President, HKMA 7 September 2006. Size of the problem. Rising trend Underestimating the size of the problem. Size of the problem. Weight of the problem. 1,600 kg codeine imported yearly 22 Manufacturers

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Abuse of Codeine containing cough mixtures in Hong Kong

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  1. Abuse of Codeine containing cough mixtures in Hong Kong Dr. CHOI Kin President, HKMA 7 September 2006

  2. Size of the problem • Rising trend • Underestimating the size of the problem

  3. Size of the problem

  4. Weight of the problem • 1,600 kg codeine imported yearly • 22 Manufacturers • 56% sold to pharmacies • 43% sold to doctors’ clinics

  5. Cost of the Problem • 3.6 litres packing sold to clinics and hospitals at $420/unit • Sold to pharmacies as 120 ml bottles • Retail at $50/ bottle • 3.6 litres = 30 bottles • 30 bottles retail to young addicts yield $1,500 versus $420 sold to clinics and hospitals

  6. Rising cost of cough mixtures

  7. Bundling of sales of cough mixtures (1)

  8. Bundling of sales of cough mixtures (2)

  9. Survey in folate deficiency and its serious consequences in drug abuse, with emphasis on cough mixture abuse • There is a definite association between cough mixture abuse and folate deficiency. Folate deficiency will in turn cause severe damage to one’s brain and nervous system and even lead to severe permanent disabilities. Pregnant mothers who indulge in cough mixture abuse would cause severe brain damage to the fetus (Dr. WY Au from QMH supported by Beat Drugs Fund)

  10. Cough mixture abuse –a unique situation of Hong Kong • Young abusers, starting from age 8 onwards • All walks of life • Financial situation of youngsters • Difficult to quit • Progress to other drug abuse

  11. Is there a lack of supply in private doctors’ clinics? (1) Dr.York Chow’s reply in respond to Dr. KK Kwok’s enquiry in the Legislative Council on 24/5/06: “我們並沒有收到報告指市面上的含可待因的咳嗽藥物供應未能滿足病人的醫藥需要。”

  12. Is there a lack of supply in private doctors’ clinics? (2) As a member of the Pharmacy and Poisons Board for 8 years, I have repeatedly reflected to the Board and the Department of Health that private doctors have repeated complaint that manufacturers repeatedly could not supply enough codeine containing cough mixtures to private doctors.

  13. The role and responsibility of the Department of Health (1) • We find the reply from the SWHF on 24/5 irresponsible “醫生或藥房所選購的包裝類別、定價、銷售對象均屬商業決定。…我們的責任是確保市民有足夠有效的藥物使用。我們無意干預商業運作。”

  14. The role and responsibility of the Department of Health (2) • By allowing the quota of codeine to the 22 manufacturers based on historical reasons, the Department of Health has a responsibility to ensure that supply to doctors and then to patients is secured and bundling should not be allowed • DH should not be seen to be involved with price control by the manufacturers

  15. Discharging the sale of cough mixtures to pharmacies • The comment of the SHWF on 24/5/06 about family doctor sending their patients to community pharmacies with a prescription to buy cough mixtures reveal a total ignorance of the situation in the community “現時除了醫生診所以外，病人亦可經醫生處方在社區購買藥物。如果家庭醫生認為有需要，可考慮發處方給病人到社區藥房購藥。”

  16. Discharging the sale of cough mixtures to pharmacies • It pushes patients to get cough mixtures at a higher fee and force them to waste more time when they are sick to travel to a pharmacy to get medicine

  17. Failure of test purchase (1) • 2006 first quarter : 610 test purchase • No apprehension

  18. Failure of test purchase (2) 一名13歲少女昨凌晨由較年長的女性朋友帶往旺角一的士高消遣，期間初嘗K仔後不適，結果暈倒街頭，送院後不治。(經濟日報)

  19. Failure of test purchase • 2 raids in Wanchai and Mongkok • 3,400 bottles of cough mixtures seized in 4 pharmacies • WHY the DIFFERENCE?

  20. What has been done? • 生署同時增加試買次數，今年首季610次的試買行動並未發現違例情況。 • 採用多元模式，打擊濫用藥物（包括咳藥水）的問題。 • 教育方面，繼續與禁毒常務委員會和非政府機構緊密合作，透過多種途徑，包括學校學科課程、禁毒講座、宣傳小冊子及短片的各種宣傳計劃，向市民灌輸正確的人生觀及對濫用藥物禍害的知識。

  21. What has been done? • 為了更有效教育青少年對毒品有正確的認識及價值觀，當局已加強對家長及教師的禁毒教育，加深他們對濫藥問題的認識，並鼓勵他們向青少年宣揚禁毒訊息。 • 參考學術界及其他機構所進行有關濫用咳藥水的研究報告，將有關的資料納入為宣傳教育的材料，並與前線禁毒工作者、社工及醫護人員分享這些資訊，以加深他們對濫用咳藥水的認識，及裝備他們處理濫用咳藥水的個案。

  22. What can be done? (1) • ALL codeine containing cough mixtures should be prescription items only and closely monitored

  23. What can be done? (2) • DH: All GOPD uses only DM containing cough mixtures

  24. What can be done? (3) • Heavy penalty

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