Background
World health organization (WHO) estimate that, more than half of all medicines are not prescribed, dispensed, or sold correctly [
1]. Lack of strong policies, authorities to monitor drugs use and collaboration among health care workers contribute significantly to the irrational use of drugs [
2]. The misuse of drugs such as sedative-hypnotics (mostly barbiturates and benzodiazepine), opioids, cocaine and analgesics have been growing years after years [
3,
4].
Diazepam has higher abuse potential than other members in the benzodiazepine (BDZ) group because of its long duration of action, affordability and availability [
5]. But misuse of diazepam as well as other psychotropic substances easily lead to physiological and psychological addiction [
6] and can be fatal [
7]. The risk is especially high when an individual combines diazepam with other central nervous system (CNS) depressants such as alcohol, opioids and barbiturates [
4].
The drug abuse by adolescents was reported to be around 5 to 12% in Tanzania. Like many other countries, the Commission responsible for drug control; fights against the illicit drugs. The drugs and prevention of illicit traffic in drugs act, 1995; restricts the importation of chemicals that can be used for the manufacturing of illicit drugs, it imposes strong punishment for anyone involved [
8]. In Tanzania, diazepam is one of the controlled drugs that should be dispensed under prescription only and kept at lock and key in the community pharmacies.
There have been some shreds of evidence on the misuse of diazepam by drug addicts including those attending methadone clinics which could be due to its affordability and accessibility [
9]. This compromises the great efforts in the management of drug addicts. In this study, we aimed at exploring the availability and dispensing practices of diazepam in the community pharmacies in Dar es Salaam region.
Discussion
The study assessed the availability of diazepam tablets and its dispensing practice in community pharmacies in Tanzania. Diazepam was highly (91%) available in community pharmacies, with the poor dispensing practice among dispensers. High availability of diazepam in community pharmacies could reflect its need in the community as well as its accessibility. Other studies have reported diazepam to be among the most found and dispensed BDZ [
13]. Availability of diazepam in the community pharmacies is of paramount importance because they are highly used and very effective in the short term treatment of anxiety, panic disorder, insomnia and some forms of epilepsy [
14]. However, if misused for long time could bring devastating effect such as dependence and withdrawal symptoms which can aggravate panic attacks, anxiety, agitation, acute psychosis and increases the risk of non-fatal and fatal overdoses when concomitantly used with opioids (for opioids users) and other drugs that depresses the central nervous system [
4].
The study also demonstrated poor dispensing practices of diazepam in which the majority (70%) of them dispensed diazepam without requesting a prescription. Diazepam as other psychotropic substances must be prescribed and dispensed by authorized personnel and all dispensers are restricted by the laws not to dispense without prescription [
9]. The study conducted in Addis Abba, Ethiopia reported a high rate of dispensing prescription-only medicines without the buyer presenting a prescription [
15]. The poor dispensing practice could be an indicator of self-medication and irrational medicine use by people living in Kinondoni district, the state of which is amplified by its haphazard availability in community pharmacies. A study conducted in Thailand reported diazepam to be most misused and abused of other BDZs for about 71.2% [
16]. The poor dispensing practice of diazepam in community pharmacies could be due to the lack of direct supervision by registered pharmacists. In Kinondoni district, the majority of community pharmacies do not have pharmacists who work on a full-time basis (unpublished data).
The misuse of diazepam increases the danger of drug addiction and dependence [
4]. Efficacy, fast onset with prolonged action, availability and affordability could be the main reasons as for why diazepam is mostly abused compared to other psychotropic substances [
17]. Poor dispensing practice observed in this study could be due to high demand from drug addicts who jeopardize government fight against illicit substances. Some drug addicts and people on methadone (opioids substitution treatment) use BDZs to treat withdrawal symptoms or enhance the effect of opioids medications [
3,
4]. Other factors which contribute to poor dispensing practice could be because most of the dispensers in community pharmacies in Tanzania are not pharmaceutical personnel [
18]. Nevertheless, low knowledge and skills of dispensers on good dispensing practices could be a factor which contributed to the observed poor dispensing practice in these settings [
18]. Furthermore, pressure from proprietors who are highly profit-oriented may explain the failure of dispensers to abide in good dispensing practices concerning drug of abuse [
19].
Following these observations, the regulatory authorities such as the Pharmacy Council of Tanzania and Tanzania Food Drugs Authority should take a measure to control the practice of dispensing diazepam in community pharmacies in Tanzania. Routine sensitization and inspections should be conducted in community pharmacies and strong laws should be enacted about the dispensing of controlled drugs.
Limitations of the study
The study used simulated client approach and we couldn’t obtain some of the demographic characteristics of dispensers including their level of education, profession and experience.
Conclusion
Diazepam was highly available in registered community pharmacies in Kinondoni district, Dar es Salaam. Surprisingly, despite the presence of laws and regulations on controlled drugs, the majority of the dispensers dispensed diazepam without prescription which is against the good dispensing practice. The practice encourages unlawful use of diazepam among clients who buy this medicine in community pharmacies. This increases the community’s risk of drug dependence and addiction.
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