The Bhutanese Leading the way.
The controlled drug, Morphine, will be airlifted along with other drugs and reach Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) within 10 to 15 days of this month.
Morphine was out of stock in JDWNRH, which led to the collection of morphine tablets from the other hospitals. The cancer patients were given substitute painkillers for one or two weeks, which are not as effective as morphines, causing inconvenience to the patients and also impacting the service.
The clinical pharmacist of JDWNRH said they expect the morphine to reach the hospital by mid December. The pharmacist said the airlifting of the drugs will fasten the delivery time, which otherwise would take four to five months because of all the procedures required to move controlled drugs by road from New Delhi, India, and each Indian state has a different custom clearance.
The main hindrance was to get clearance from International Narcotics Control Board (INCB). Although Bhutan Narcotics Control Agency (BNCA) immediately looks into the matter but it is the process that takes too long. This is the main reason for taking time to bring in morphine and other controlled Drugs (CD) in the country.
The local supplier managed to get all clearance from INCB otherwise it is not possible to get it this soon. Pharmacist said the supplier has asked to give them 10 days from now.
During the emergency cases, when in dire need, the controlled drugs are airlifted otherwise it is very expensive and it is usually brought by road.
He said the procurement process is working out fine, but there are many things to look into because it is an annual procurement where the controlled drugs are procured just once in a year.
“But we never know what happens in the middle. There will be an interruption. So there is need for alternative procurement system. Otherwise a monthly procurement of controlled drugs, if possible,” he said.
The clinical nurse of Oncology Ward of JDWNRH, Kinley Wangchuk, said there were no issues as such, but they were told to use morphine judiciously and not to mobilize controlled drugs to other wards, and so it there was strict monitoring. Patients were prescribed reduced doses too.
There are an average of 200 patients going through chemotherapy but they do not all take morphine except for those in pain.
He said the patients were very understanding as the understood there is a shortage. However, hospital did not let patients leave without the medicine they needed, said the pharmacist.
Meanwhile, the Health Minister, Lyonpo Dechen Wangmo, said the ministry will look at procurement rules and regulations, and look for ways to have a separate procurement at least for procuring the essential drugs.
She said the ministry will look into supplies coming on time, without compromising the lives of the patients.
