[Update on the Mali Pharmacy Code: legislative section]. / Essai de mise au point d'un code de la pharmacie au Mali: partie legislative.

Due to colonization (1895-1960) Mali has been submitted, on the legislative and regulation plan to a corpus of numerous and scattered texts relative to pharmacy. It is essentially the Law AN XI of 21 Germinal or the 11 April 1803 Law; the content of Book V of the Public Health Code relative to pharmacy practice, of which some disposals have been extended to Overseas Territories, Togo and Cameroon in 1953; the 1955 Ministerial Order about the dispatching of the Retail Pharmacy in AOF; the 1960 Law creating the Board of Pharmacists in the Federation of Mali etc. After independence, the new Malian State while renewing the pharmacy legislation issued by the old tutor State which was not opposed to the new fundamental Law, has also set up, according to the political orientations of the moment, some new texts. In the framework of this work, we have collected all the legislative and regulation texts that have been allowed in Mali in the pharmacy area and in that of Studies in Pharmacy. We have examined those texts and proceeded to codify the legislative part. The present Code consists of 189 articles divided in 5 titles layed out in chapters and sections.

Boltushka: a homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine.

BACKGROUND: Homemade amphetamine-type stimulants (ATSs) have been reported in Russia and Eastern Europe for decades. Recipes differ geographically and over time producing differing active ingredients. Vint and jeff (active ingredients methamphetamine and methcathinone, respectively) are two such homemade ATSs originally produced from over-the-counter cold medications and household chemicals. METHODS: During a Rapid Policy Assessment and Responses (RPAR) project in Odessa, Ukraine, researchers found use of boltushka, a novel homemade ATS. Fourteen supplemental qualitative interviews were conducted, including ten interviews with boltushka injectors and four interviews with pharmacists. We report patterns of boltushka use among local injection drug users (IDUs) as well as the role of laws, regulations, and current pharmacy practices. RESULTS: Legal restrictions on over-the-counter cold medicines in Ukraine led to products containing phenylpropanolamine (PPA), which oxidised with KMnO(4) (potassium permanganate), produces a weak ATS, cathinone, called boltushka. Boltushka's ingredients are easily available in pharmacies or on the black market. IDUs reported a mean age at first use of 16 years old (range 12-21). While published data are scant, anecdotal evidence reported here include amphetamine-like effects on energy and appetite, binging patterns of use, and some reports of shaking and other neurological damage consistent with earlier reports from exposure to KMnO(4). Users reported sharing syringes and other non-sterile injection practices. No users reported specific treatment or prevention programs for boltushka users. CONCLUSIONS: Although Ukrainian government regulations have limited access to precursor chemicals, IDUs have continued to make and use boltushka. The actual extent and demographics of boltushka use are unknown. Besides risk of bloodborne disease, the health effects of injected homemade ATSs and their constituent chemicals are poorly documented. Interventions beyond available harm reduction efforts may be required. Education/treatment specific to boltushka users and screening for other physical harms are critical interventions.

[Pharmaceutical distribution and retail pharmacy]. / La distribución y dispensación de medicamentos.

In this chapter, the main characteristics of pharmaceutical distribution and retail pharmacy are described. The author analyses the structure of this sector, the agents operating in it -wholesalers, hospital pharmacy services and chemists- and the very few modifications introduced in it in the recent years, focusing on the incentives of its current structure and their consistency with health aims. On the basis of this analysis, the author outlines some possible ways to redefine the sector, which should focus on the promotion of desirable health objectives rather than on the survival of the inefficacies that hinder its evolution. The author pays special attention to the need to modify the inadequate existing retribution system and to substitute it for a different one, which focuses on the professionalism of the service provided, rather than on the profit margin or the sales.

Factors related with prescription requirement to dispense in Spain.

PURPOSE: To identify factors associated with prescription requirement to dispense. METHODS: We carried out a cross-sectional study on a sample of 166 pharmacists in North-West Spain. The following independent variables were collected through a personal interview: pharmacist's education and speciality, characteristics of the pharmacy, and its socio-economic environment. We constructed multiple regression models using as dependent variables: requirement of prescription to dispense five drugs which have to be dispensed with a prescription; and opinion on whether a prescription should be required to dispense these drugs. RESULTS: The response rate was 98.8%. A proportion of 65.9% of pharmacists dispense antibiotics without any prescription. This proportion is 83.5% for nonsteroidal anti-inflammatory drugs, 46.3% for ACE inhibitors, 13.4% for benzodiazepines and 84.8% for oral contraceptives. A higher requirement prescription was found to be associated with the antecedent of a speciality training of the pharmacist (p = 0.028) and his or her age (p < 0.001). A low prescription requirement is associated with the condition of being owner of the pharmacy (p = 0.032), with a high economic level of the population attended (p = 0.016) and with the size of the pharmacy (p = 0.045). CONCLUSIONS: The proportion of pharmacists who dispense drugs without a prescription is extremely high. Our results suggest that in order to increase quality of dispensing, it is necessary to increase pharmacist education and direct efforts of awareness primarily at pharmacists in charge, who are young and work in large pharmacies.

Lessons from Korea's pharmaceutical policy reform: the separation of medical institutions and pharmacies for outpatient care.

In Korea, until recently, both physicians and pharmacists were allowed to prescribe and dispense drugs for outpatient care. Along with other deep-rooted structural problems, this worked against the quality and efficiency of the health care system. To rectify this problem, the Korean government launched a drug policy reform in July 2000. However, the drug policy reform was more drastic than initially intended--driven by political factors, the reform ended up bringing about complete separation of medical institutions and pharmacies. Also, unlike in many other countries, Korea did not take a gradual approach, but instead, it implemented the reform all at once and nation-wide. As a result, the reform has faced criticism and protests, thereby generating unprecedented social turmoil and even strikes by physicians. Still, it is not clear what benefits Korea gained from this reform, when we look at the price which has had to be paid, including greater inconvenience, worsened access to medical care, increased drug spending, increased market share for multinational drug producers, and a greater deficit in the budget of the Korea's national health insurance system. Based on Korea's costly experience, we attempt to draw some policy implications for the future development of a better health care system.

Implementing competition in the pharmacy sector: lessons from Iceland and Norway.

The pharmacy market in many European countries is characterised by individual, privately-owned pharmacies that operate under tight government control regarding barriers to entry, scope of activities and profit margins. In Iceland, many of these restrictions were relaxed in 1996 in the hope of stimulating competition. Similar changes were introduced in Norway in 2001. In both countries, the new structural conditions led to horizontal mergers and coalitions between pharmacies; and in Norway, the emerging pharmacy groups integrated vertically with wholesalers. The number of independent decision units decreased and the markets rapidly transformed into oligopolies with remaining institutional barriers to entry. The rapid change took both governments by surprise, and intervention was needed to prevent monopolies from emerging. Additional intervention to strengthen competition may be needed in the future to prevent unfavourable developments, and the tradition of maintaining equal access of services may prove more difficult to uphold. Experiences in both Iceland and Norway highlight the complexity of reforms that fundamentally influence competitive behaviour.

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

UNLABELLED: France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.