SIX PROBLEMS INVOLVING MEDICATION
Six primary problems regarding medications arise in austere medical situations. In some cases, more than one of these exist simultaneously. You can have (a) no medications; (b) medication, but have no clue what it is for or how to use it; (c) some medication, but not the primary choice for the condition you need to treat; (d) medication, but in the wrong form; (e) only outdated medication; or (f) medication that might have been contaminated or that has degraded. Each of these is discussed separately.
If you have no medication, you will have to use local herbal remedies, physical treatments (osteopathic manipulation, thermal treatment, surgery), street drugs, or donated medications.
When clinicians face medication and intravenous (IV) fluid shortages, pharmacy supervisors should not only communicate understandable information about the shortages to clinicians, but also build safeguards into their system. Use standard triage terms such as red, yellow, and green to categorize the severity of the shortage and its probable effect on clinical practice. Pharmacists should also help clinicians safely use unfamiliar substitute medications, including compounding medications and drips in the pharmacy.1
After disasters and in developing countries, the management of drug donations becomes extremely important. The key issue is to specify what you want and need, how much, and when it should arrive. Managing large quantities of unwanted and unneeded pharmaceuticals consumes valuable personnel time and space. After Hurricane Katrina, for example, the area was awash not only in water but also (figuratively) in cartons of ridiculously inappropriate donated medications. Safely disposing of this mountain of useless pharmaceuticals became an unwanted headache.
Similar problems occur across the globe. A Harvard School of Public Health study found that about 30% of donated medications had an expiration date <1 year from the time they were shipped; 6% had <100 days left before they (officially) expired. Up to 42% of the drugs were not on either the country’s list or the World Health Organization’s (WHO) list of essential drugs, nor were they therapeutic alternatives for the essential drugs.2
To help lessen problems with international drug donations, WHO has developed the following Guidelines for Drug Donations3:
All drug donations should be based on an expressed need and be relevant to the disease pattern in the recipient country. Drugs should not be sent without prior consent of the recipient.
All donated drugs or their generic equivalents should be approved for use in the recipient country and appear on the national list of essential drugs, or, if a national list is not available, on the WHO Model List of Essential Drugs (www.who.int/medicines/publications/essentialmedicines/en/), unless specifically requested otherwise by the recipient.
The presentation, strength, and formulation of donated drugs, as much as possible, should be similar to those of drugs commonly used in the recipient country.
All donated drugs should be obtained from a reliable source and comply with quality standards in both donor and recipient country. The WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce (...