The illegal sale of controlled drugs at local pharmacies will be stamped out by the coming drug safety reform, a senior health official says. Sandra Lee Suk-yee, permanent secretary for food and health, said that over-the-counter sales of prescription drugs put patients at risk and the government was determined to 'plug the loophole'. Local pharmacists have criticised the reform package as too weak, saying Hong Kong should amend the law to make all new pharmacies majority-owned by pharmacists - giving the profession ultimate control over the sale of drugs. At present they are just employees of pharmacy owners and cannot do much about illegal sales. It has been easy for customers to buy controlled drugs, such as antibiotics and steroids, at some pharmacies or drug stores without the doctor's prescription required by law. Trade insiders said it was an open secret that some doctors were also involved in the illegal distribution of controlled drugs. A minority of private doctors get supplies from pharmaceutical companies at a low price, then sell the products to drug stores for profit, they said. Quite often, pharmaceutical companies provide so-called bonus medicine to private doctors, such as two extra packs for every 10 packs they buy. The bonus packs are not shown on the order or delivery forms. Many orders are made by phone without any documentation. 'Doctors sell those invisible drugs to drug stores, which can later sell to patients over the counter. There is no trace of those drugs on records, and the Department of Health cannot get any evidence of the illegal sale,' one insider said. Lee said the government was aware of various malpractices in the industry, and drug safety reform could plug the loopholes by making written drug orders mandatory. The measure, one of the 75 recommendations made by the government-appointed drug safety review committee last week, could make it easier to trace products, she said. But the measure faces strong opposition from some private doctors, worried about the added inconvenience. Lee said: 'I hope the professionals won't see written orders as a bureaucratic process. With written orders, traceability will be enhanced. We will know who orders the drugs and where the drugs go to.' She said the reform would target 'triangular transactions' involving drugs. 'In some situations, A sells the drugs to B, but B has no record of ordering the drugs. Then B sells the drugs to C without any records. We also know that some people can get the controlled drugs without a doctor's prescription in the market. We have to plug these loopholes; we have to make sure drug safety reaches a really high standard.' Mandatory written orders would also help the government organise recalls in case of problems. 'Once we have written orders, we know which pharmacies got a particular batch of drugs. Stock control will be so much better,' Lee said. The committee also recommends that pharmacists be present as long as a pharmacy is open, instead of the current two-thirds of business hours. The government hopes this arrangement will lead to better supervision of the sale of controlled drugs. Some drugs can be sold only in the presence of a pharmacist. 'The pharmacists tend to feel they are the underdog. The whole point of the review committee is to tell them: 'look, if you uphold a high professional standard, we will work with you',' Lee said. But the Practising Pharmacists Association has been against such measures, saying safety will not be improved by making pharmacists work longer hours. It called on the government to require all new pharmacies to be majority owned by pharmacists, a practice in European Union countries and Australia. Association president Iris Chang Yee-man said: 'The sale of counterfeits or controlled drugs over the counter is a serious problem. However, pharmacists - in their current role as employees - have no power to interfere in their employers' practices. Their hands are tied,' Lee said making pharmacies majority-owned by pharmacists would not be practical because it would mean the end of small, independent pharmacies. The Doctors Union - which is against making written drug orders mandatory - and the Practising Pharmacists Association will hold a press conference today to explain their objections to the reform package. In view of the negative responses, Lee said the reform was a 'turning point' for everyone in the health care sector, and community pharmacists should accept a greater role in drug education and safety. 'They should do more than they are doing now,' she said. 'They should reach out more to the patients, giving them advice instead of just giving out drugs.' The reform would also require all shops selling drugs to get a licence, including convenience stores that sell vitamins or painkillers. Lee stressed that the licensing system would be simple and would not cause a nuisance to the market.
