Replies to LegCo questions
LCQ2: Cough medicines containing Codeine
Following is a question by the Dr Hon Kwok Ka-ki and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (May 24):
Question:
Some medical practitioners have reflected to me that local drug importers or
wholesalers can reap more profits by selling cough medicine containing Codeine
to pharmacies than selling it to doctors. These importers or wholesalers often
propose unreasonable conditions and high prices on this ground when negotiating
on the sale of the drugs concerned with family doctors. Besides, the number of
reported abusers of cough medicine containing Codeine was on the rise in the
past five years. In this connection, will the Government inform this Council:
(a) whether the authorities have investigated if such practice of drug importers
or manufacturers has caused the continuous rise in the number of abusers of
cough medicine containing Codeine; if they have, of the investigation results
and the follow-up actions taken by the authorities; and whether they will
consider amending the law to require importers or manufacturers to report to the
Department of Health (DH) information on the business units or institutions to
which the relevant drugs are sold, and to empower DH to step up the monitoring
of and follow-up to the sale of drugs in Hong Kong;
(b) of the numbers of test-purchases conducted and prosecutions instituted
against the sale of cough medicine containing Codeine in each of the past five
years; and whether it has assessed if test-purchases and prosecutions can
effectively prevent cough medicine abuse; if it has, of the assessment results,
and whether more measures will be adopted to prevent such abuse; and
(c) of the measures to ensure that family doctors can obtain adequate cough
medicine for prescription to patients in need of it?
Reply:
Madam President,
At present, the vast majority of cough medicines containing Codeine available in
the market are produced by local manufacturers with imported Codeine materials.
Codeine is a narcotic drug. Its import ceiling is strictly controlled by the
United Nation's Single Convention on Narcotic Drugs. The primary aim of the
Convention is to strike a proper balance between the global supply of narcotic
drugs and their medical and scientific uses. In the past few years, Hong Kong
imported about 1,600 kg of Codeine materials annually. We have not received any
report that the supply of cough medicines containing Codeine in the local market
is inadequate to meet the medical needs of patients.
In Hong Kong, pharmacies usually purchase medicines from drug manufacturers in
small package (retail package) whereas medical practitioners and hospitals
usually buy in bulk (wholesale package). This is also the case in respect of
cough preparations containing Codeine: those ordered by pharmacies are generally
packaged in 120ml bottles while those ordered by medical practitioners and
hospitals are usually packaged in 3.6L bottles. In a free market, the price of a
medicine, like many other consumer products, is usually lower in wholesale
package than in retail package for the same volume. It is a business decision
for medical practitioners or pharmacies to decide the type of package, price and
sales targets of the medicine to be purchased. As health authorities, our duty
is to ensure an adequate supply of effective medicines for public use. We do not
intend to interfere with any business decisions.
My reply to the Hon Kwok Ka-ki's question is as follows:
(a) Suppliers of medicines containing Codeine are required to hold a Wholesale
Poisons Licence in accordance with the Pharmacy and Poisons Ordinance. Under the
licensing requirements, the licensing authority (i.e. the relevant licensing
committee under the Pharmacy and Poisons Board) may, when the need arises,
require a licensee to provide information on the sale of certain medicines
locally for monitoring purpose. While the licensing committee does not seek such
information on a regular basis, it obtained from the manufacturers in 2005 the
statistics on the distribution of medicines containing Codeine for 2002, 2003
and 2004 as shown in Table 1.
At present, regulatory regimes are in place to regulate the import, manufacture
and wholesale of medicines (including cough medicines containing Codeine) to
pharmacies, clinics or hospitals respectively. These regulatory regimes are
considered effective. According to experience, law enforcement and public
education are effective measures to control drug abuse. We will monitor the
situation and study actively how to further curb drug abuse through regulatory
and other measures.
(b) The numbers of test-purchases of cough preparations (targeting at cough
preparations containing Codeine) conducted by DH and prosecutions instituted
between 2001 and March 2006 are shown in Table 2.
Test-purchases impose a certain degree of deterrence. A pharmacy in breach of
the law will be prosecuted. Upon conviction, the pharmacy and the registered
pharmacist involved in the case will be subject to disciplinary inquiry by the
Pharmacy and Poisons Board. This may result in a warning to the pharmacy or even
cancellation of its licence, while the pharmacist involved may be censured or
suspended from practice.
We amended the Pharmacy and Poisons Regulations in November last year to
reclassify substances containing not less than 0.2% of Codeine as prescription
drugs and to provide that their sale must be with the support of prescription of
a medical practitioner under the supervision of a registered pharmacist. DH also
stepped up the frequency of test-purchases during the time but no pharmacies
were found to be in breach of the law in the 610 test-purchases carried out in
the first quarter of this year. The Administration and the Pharmacy and Poisons
Board will continue to monitor the situation of drug abuse and will review the
existing measures where necessary.
In addition to enforcement actions, the Administration will continue to adopt a
multi-modality approach in combating drug abuse (including abuse of cough
syrups).
As regards general preventive education, the Administration will continue to
work closely with the Action Committee Against Narcotics and other
non-governmental organisations to promote a positive attitude towards life among
members of the public and enhance their awareness of the harmful effects of drug
abuse through various channels such as school courses and publicity programmes
like anti-drug talks, promotional pamphlets and announcements of public
interest. To further promote a correct understanding and appropriate attitude
towards drugs among youngsters, the Administration has stepped up its anti-drug
education for parents and teachers. Through enhancing their understanding of the
problems related to drug abuse, we hope to empower them to disseminate
anti-drugs messages to our younger generation.
We also draw reference from the research findings of academia and other
institutions on cough syrup abuse, and incorporate the relevant information into
our publicity and education materials. Such information has been shared with
front-line anti-drug workers, social workers and health care personnel so as to
enrich their understanding of cough syrup abuse and equip them to handle cases
of cough syrup abuse.
(c) Regarding the supply of cough medicines, we consider it of utmost importance
to ensure that there is generally an adequate supply of medicines in the market
for patients' use. As mentioned above, we have not received any report that the
supply of cough medicines containing Codeine in the local market is inadequate
to meet the medical needs of patients. At present, apart from clinics, patients
can also buy medicines in their community with the support of prescriptions. If
they deem it necessary, family doctors may prescribe medicines for their
patients who could in turn purchase them from community pharmacies.
Ends/Wednesday, May 24, 2006
Issued at HKT 13:14
NNNN
Attachment:
Tables to LCQ2