Non-Prescription Dispensing of Controlled Medicines at Drug Outlets in Pakistan: Findings and Implications to Improve Future Health Care

Abstract Introduction: Non-prescription sale of controlled medicines is a growing public health problem, especially amongst low-middle-income countries, not helped by weak regulatory enforcement. Consequently, controlled medicines continue to be purchased without a prescription, exacerbating misuse and increasing morbidity and mortality. Currently, little is known about this in Pakistan. Therefore, this study aimed to evaluate the prevalence of non-prescription dispensing of controlled medicines in Pakistan. Materials and Methods: A multicentre, cross-sectional study using simulated clients (SC) was conducted in Lahore, Pakistan. SC visited 378 drug outlets (285 pharmacies and 93 medical stores) to purchase controlled medicines without providing a prescription. Data about dispensing, interactions and grounds for refusal were acquired. Results: About 61.9% of outlets dispensed controlled medicines without a prescription. The most commonly dispensed controlled medicines were tramadol (29.5%), followed by codeine (26.1%) and alprazolam (23.1%). There was no significant difference in non-prescription dispensing between pharmacies and medical stores. However, outlets lacking licenced personnel were significantly more likely to dispense controlled drugs without a prescription ( P = 0.049). Refusals were mainly due to prescription requirements (55.6%) or product unavailability (44.4%). Conclusions: There was appreciable dispensing of controlled medicines without a prescription, greater when licenced personnel were not present. Enhanced regulatory enforcement and increased presence of certified personnel are necessary going forward.