TEN-YEAR RETROSPECTIVE STUDY OF DIAZEPAM CONSUMPTION IN INDONESIA
Objective: This study aimed to evaluate annual consumption during 2004-2013 of diazepam, an essential medicine which is controlled under the 1971 Convention on Psychotropic Substances in Indonesia and to investigate factors influencing its use in health facilities.
Methods: This was a case study with quantitative and qualitative approaches. Annual consumption was calculated from the quantity of exports and imports. The use of diazepam was calculated from consumption deducted by 20% buffer stock. The consumption and use of diazepam were presented in kilogram and also in defined daily doses for statistical purposes (S-DDD). In-depth interviews were conducted to investigate factors that influence the use of diazepam. Triangulation was conducted to confirm the qualitative and quantitative findings.
Results: The annual average consumption in 2004-2006 was 530 kg. Furthermore, it decreased 38% during 2011-2013 to 329 kg. Calculated use of diazepam also decreased. The average consumption for the 10-year period of diazepam was 470 kg, and the calculated use was 376 kg (0.45 S-DDD). Considering the approximate need of diazepam to treat various health problems, its use should ideally be around 1-2 S-DDD. Therefore, the calculated use of diazepam was considered too low as confirmed by frequent stockouts. The interviews revealed that among the factors influencing its use was its limited production. There was an increased use of alprazolam, but it was unlikely to compensate for the diazepam stockouts.
Conclusion: Consumption and use of diazepam for medical purposes in Indonesian decreased over 10 years, and stockouts are often reported. The government should improve its availability and correct impediments for adequate production and supply of diazepam.
2. Ministry of Health of Indonesia. Decree of the Minister of Health No. HK 02:02/Menkes/320/2015 on Essential List of Medicines 2015. Jakarta: Ministry of Health; 2015.
3. Management Sciences for Health. MDS-3 Managing Access to Medicines and Health Technologies. Arlington: Management Sciences for Health; 2012. p. 27.6-8.
4. World Health Organization. Equitable access to essential medicines: A framework for collective action. WHO Policy Perspectives on Medicines. Geneva: World Health Organization; 2004.
5. United Nations Office on Drugs and Crime. The International Control Conventions. New York: United Nations; 2013.
6. Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology. 12th ed. New York: Mc Grow-Hill Medical; 2012. p. 373-87.
7. Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: A systematic review of the literature. Eur Addict Res 2012;18(5):228-45.
8. Jann M, Kennedy WK, Lopez G. Benzodiazepines: A major component in unintentional prescription drug over doses with opioid analgesics. J Pharm Pract 2014;27(1):5-16.
9. International Narcotics Control Board. Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes, Indispensable, Adequately Provide and not Unduly Restricted. New York: United Nations; 2016.
10. International Narcotics Control Board. Psychotropic Substances
Statistic for 2013 Assessments of Annual and Scientific Requirements. New York: United Nations; 2014.
11. International Narcotics Control Board. Psychotropic Substances, Statistic for 2009 Assessments of Annual and Scientific Requirements. New York: United Nations; 2010.
12. International Narcotics Control Board. Psychotropic Substances, Statistic for 2005 Assessments of Annual and Scientific Requirements. New York: United Nations; 2006.
13. Indonesian Ministry of Health. Riset Kesehatan Dasar Tahun 2013 (Basic of Health Research 2013). Jakarta: Ministry of Health; 2013. Available from: http://www.depkes.go.idin. [Last accessed on 2016 Dec 20].
14. Petrushevska T, Velik Stefanovska V. Use of Medicines from the group of benzodiazepines in the Period of 2003-2013 year in the republic of Macedonia. Open Access Maced J Med Sci 2015;3(1):151-7.
15. Markovic-Pekovic V, Stoisavljevic-Satara S, Skrbic R. Outpatient utilization of drugs acting on nervous system: A study from the Republic of Srpska, Bosnia and Herzegovina. Eur J Clin Pharmacol 2010;66(10):177-86.
16. Vrublevska K, Rukmane J, Burmistrs R, Sipols J, Muceniece R. Dispensing of psychotropic drugs to adults in community pharmacies in Latvia. Pharm World Sci 2008;30(6):934-9.
17. Lee K, Kinson R, Ang L, Wong K. Outpatient prescribing trends of Benzodiazepines and Z-drugs in general hospital in Singapore. Eur Psychiatry 2015;30(1):832.
18. Sabu L, Yacob M, Mamatha K, Singh H. Drug utilization pattern of psychotropic drugs in psychiatric outpatient department in a tertiary care teaching hospital. Asian J Pharm Clin Res 2017;10(1):259-61.
19. Vettikkadan A, Jith A, Krishnaveni K, Kumar S. Study utilization pattern and drug interactions of antiepileptic drugs in private hospital. Asian J Pharm Clin Res 2014;7(5):164-6.
20. Ilyaz MD, Baig MM, Ramakrishna R, Quadir MA, Fathima M, Khan SA. Drug utilization study of antipsychotics and its common ADRâ€™S in the psychiatry OPD of OHRC. Int J Pharm Pharm Sci 2014;6(9):162-5.
21. Mekonnen AB, Bhagavathula AS. Inappropriate medication use in the elderly population attending Gondar University Hospital: A preliminary assessment. Int J Pharm Pharm Sci 2014;6(10):540-3.
22. Syaripuddin M, Susanty AL, Sari ID. Potensi penghematan biaya obat di lima rumah sakit umum daerah DKI Jakarta (The potential savings in medicine costs of five district hospitals in Jakarta). Bull Penelitian Kesehatan Masyarakat 2014;17(1):27-33.
23. Indonesian Ministry of Health. Kebijakan Obat Nasional (National Medicine Policy). Jakarta: Ministry of Health; 2006.
24. McBain RM, Norton DJ, Morris J, Yasamy MT, Betancourt TS. The role of health system factors in facilitating access to psychotropic medicines: A cross-sectional analysis of the WHO-AIMS in 63 low-and middle-income countries. PLOS Med 2012;9(1):1-13.
25. Barbui C, Dua T, Kolappa K, Saraceno B, Saxena S. Access to psychotropic medicines in low-resource settings. Lancet Psychiatry 2016;3(10):913-5.
26. Padmanathan P, Rai D. Access and rational use of psychotropic medications in low- and middle-income countries. Epidemiol Psychiatr Sci 2016;25(1):4-8.
27. Ambarsari DW. Faktor yang mempengaruhi pasien dalam mengambil benzodiazepin yang diresepkan (Factors affecting patients in taking prescribed benzodiazepine). Thesis Mastersâ€™ Degree Program in Public Health, Faculty of Medicine. Yogyakarta: Universitas Gadjah Mada; 2017. Available from: http://www.libmed.ugm.ac.id.
28. Islam MM, Conigrave KM, Day CA, Nguyen Y, Haber PS. Twenty-year trends in benzodiazepine dispensing in the Australian population. Intern Med J 2014;44(1):57-64.
29. Kurko TA, Saastamoinen LK, Tahkapaa S, Tuulio-Henriksson A, Taiminen T, Tiihonen J, et al. Long-termuse of benzodiazepines: Definitions, prevalence and usage pattern - A systemic review of register-based studies. Eur Psychiatry 2015;30:1037-47.
30. Holm E, Fosbol E, Pedersen H, Jensen TB, Nielsen M, Weeke P, et al. Benzodiazepine use in Denmark 1997-2008. Eur Geriatri Med 2012;3:299-303.
31. Pollmann AS, Murphy AL, Bergman JC, Gardner DM. Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: A scoping review. BMC Pharmacol Toxicol 2015;16:19.
32. Suryawati S. Improving access to narcotic analgesics: The international control system and option for quantification method. J Manajemen Pelayanan Kesehatan 2011;14(1):3-10.
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