Drug shortages affect patient care

Post-op painkillers, such as Tramadol, have been unavailable in hospitals in Dubai.

Patient care is being compromised by a critically low supply of some licensed drugs, according to a hospital doctor.

Medication such as Tramal Retard, used as a post-operative painkiller, is unavailable at hospital pharmacies in Dubai and there has been no explanation of why, said the orthopaedic surgeon.

"It hasn't been available in Dubai for several weeks," said the surgeon. "We have a short-acting drug which is only good for a few hours.

"The situation is better in this part of the world than it was many years ago when we would go to work and ask what drugs were available. That shouldn't happen today."

The surgeon said Tramadol had a "bad reputation" in the press but was safer than other post-operative painkillers, such as morphine.

The shortfall has yet to be reported to the Ministry of Health (MoH), the only regulatory body that can license medication, said Dr Fatima Al Braiki, director of the registration and drug control department. "There have been no inquiries and no complaints," she said.

The lack of necessary medication is a "growing concern", said Dr Mohammed Abu Elkhair, the section head of drug and medical products regulations at the Health Authority - Abu Dhabi (Haad).

"Because these drugs are classified as narcotics, their usage is very low. This could result in not many companies wanting to register them."

"Drug shortages are frustrating for patients and healthcare providers. They can result in a patient's treatment being delayed."

While no operations have been delayed, said the surgeon, introducing new medication was time-consuming and could also threaten a patient's recovery.

"When those main agents aren't available, there is a new teaching exercise as to how we are using the alternative medication and why," said the surgeon. "Basically, you're compromising the quality of care."

Dr Abu Elkhair said Warfarin 1mg, an anticoagulant used to reduce the risk of strokes, was also in short supply.

Since last May, all drug distributors, hospitals and pharmacies in Abu Dhabi must send monthly updates to Haad listing medication that is unavailable or has low stocks.

A 2008/2009 survey by Haad - the most recent - revealed that only 4,036 out of 7,039 registered drugs were available on a regular basis. The rate at which drugs are manufactured, cases of recalls, a complete withdrawal from the market or low demand could all be factors in medicines becoming scarce, said Dr Abu Elkhair.

Supply problems could also be linked to a ministry campaign against drug abuse, said one British expatriate whose prescribed supply of Oxycodone pills ran out last week. "It's rumoured that people are taking these pills more for leisure, so I'm concerned that the health authorities are restricting supply," said the Dubai resident. "This is affecting people in pain."

The retired Briton was told about the lack of Oxycodone two weeks ago. The alternative medication he was given - for complications from a double hip replacement almost 18 months ago - does not give enough pain relief. It also has side-effects, such as mood swings.

More communication is needed between the authorities and hospitals, said the surgeon.

"There is a very strong tendency to shift the blame. Is it the distributor's fault? I'm led to believe they are not the problem," the surgeon said. "Is there a big shipment sitting in customs? Does the MoH have an agenda to slow down this drug because of problems with abuse?"

For patients, the lack of answers is equally frustrating. "There is no answer as to when this problem will be resolved," said the Briton.