Psychotropic Drugs Become Scarce

The Food and Drug Organization has confirmed that emergency imports and alternative supply channels have not fully met the country's need for certain antidepressants. The clarification follows a warning from the Psychiatrists' Association about worsening shortages of essential medicines. These shortages have been accompanied by price increases and, according to physicians, are limiting treatment options for patients and prescribers.

The Food and Drug Organization has confirmed that emergency imports and alternative routes have not fully met the country's need for some antidepressants. This explanation was published after the Psychiatrists Association warned about the worsening shortage of essential drugs; The shortage, which is accompanied by an increase in price and according to doctors, limits the choice of treatment for the patient and the prescriber.

According to Ambassador Arjan's report, quoting from the Ministry of Health, the Food and Drug Organization has confirmed that emergency imports and alternative routes have not fully met the country's need for some antidepressants. This explanation was published after the Psychiatrists Association warned about the worsening shortage of essential drugs; The shortage, which is accompanied by an increase in price and according to doctors, limits the choice of treatment for the patient and the prescriber. Mohammad Hashemi, the spokesperson of the Food and Drug Organization, has introduced the suspension of direct flights from India after the start of the war in March 1404 and the refusal of the Indian side to send cargoes by Iranian planes as factors of disruption. According to him, indirect transfer has covered part of the need, but the higher cost of imported drugs has put more pressure on patients.

In a letter to the Minister of Health, Seydohid Shariat, the head of the Scientific Association of Psychiatrists of Iran, wrote that the reports of psychiatrists, medical centers and families from different provinces indicate the continuation and expansion of the shortage. His range of warnings includes drugs for mood disorders, psychosis, and attention-deficit/hyperactivity disorder. According to the association, there has been a history of reduced production and irregular distribution, but the situation has become more worrying in recent months. Hadi Ahmadi, the spokesperson of the Association of Pharmacists, spoke about the problems of raw materials, currency restrictions and the difficulty of transportation in an interview published on 13 Mehr. He presented a more hopeful assessment in the report of Mehr Jahansanat on 18th of October: raw materials have been better supplied in the last one or two months, factories are producing and the shortages are mostly temporary or regional. Ahmadi has also estimated the resilience of supplying some items for more than one year. This assessment depends on the availability of the same items and cannot be considered as a guarantee of access to all psychiatric drugs. Improving production does not necessarily mean that the required product reaches the pharmacy where the patient lives.

Before Mehr's warnings, Arman Ahmad Nasrullahi, the CEO of Subhan Daro, said in Khordad about the lack of items such as sertraline, clonazepam, risperidone and chlordiazepoxide in the country. He considered the stock of the company's active ingredients to be enough for four to five months and announced that the cost of transportation would double or triple. This history shows that the disruption had also affected the market before the recent announcement by the Food and Drug Organization. The production of tablets in an Iranian factory does not eliminate the dependence on the import of the active ingredient, auxiliary materials and some production requirements. Mohammad Abdezadeh, a member of the Board of Directors of the Syndicate for the Production of Human Medicines, explained in an interview with the world of economy, that raw materials from India and China are facing difficulty in transportation. Air transportation or Turkish route are expensive alternatives, and for bulky cargoes, it is not possible to quickly replace the sea route. He says, the function of providing foreign currency has become more regular, but the problem of transportation and the need of companies for riyals still remains.

Abdezadeh considers the accumulation of producers' claims from insurance and medical centers as another factor. The factory must pay wages, packaging, energy, and raw materials, while sales revenue returns with a delay. This distance makes it difficult to purchase raw materials for the next shipment, even with production capacity. Bahman Sabour, the deputy chairman of the board of directors of the Greater Tehran Medical System, also said about the delays of 9 to 10 months in the payment of some claims. In such a situation, increasing the selling price alone does not create liquidity; The money should really go back into the pharmaceutical chain. In this way, problems at the end of the treatment path are transferred to the beginning of production.

Sabour has announced an increase in the price of some medicinal items between 50 and 400%; A domain related to various items, not all psychotropic drugs. He attributed part of this increase to the exchange rate change and criticized the delay of one to two months in registering new prices in the insurance system. For the patient, this time interval means paying more when the prescription is delivered. Compensation of cost increase through insurance is considered effective protection when it is applied at the same time as the new price. Amirhossein Jalalindoshan, the spokesperson of the Psychiatrists Association, said that some patients want a cheaper drug and the doctor sometimes abandons his initial choice due to the price or lack of the drug. According to him, some antidepressants are also not covered by insurance; A cost that has become more noticeable for the family.

According to Ahmadi, the Food and Drug Administration reviews the inventory based on the generic name. Therefore, the absence of a brand may not be recorded in the shortage statistics if there is another example. He has mentioned the number of about 40 to 50 items of vital medicine that are in short supply; A number related to the collection of vital drugs, not just psychiatry. Jalalindoshan emphasizes, it is not always a matter of preferring a foreign brand; Sometimes the internal product used by the patient becomes scarce. He warns about the possibility of instability of some patients after changing the treatment. This concern does not mean that generic drugs are generally inappropriate: in the US Food and Drug Administration standard, an approved generic must demonstrate equivalence and similar therapeutic benefit. Choosing the right alternative depends on the product and the patient's condition. The Nice Institute's depression treatment guide also warns that sudden discontinuation or a missed dose can cause withdrawal symptoms. Therefore, an imposed interruption due to deficiency is different from a planned decision to end treatment.

Ahmadi has warned about the formation of an informal market and the necessity of tracking rare drugs. Hashemi also considered it necessary to check the license, authenticity, contract, delivery time and storage conditions in response to the proposal to provide medicine at a 10-20% lower price. Reducing the price without ensuring the quality and continuity of supply is not a guarantee of treatment. On 20 Mehr, Amirhossein Jafari, the head of Rozbeh Hospital, described the social stigma, the high cost of services, and the lack of medicine as simultaneous pressures on patients. From his point of view, mental health is also related to work, education and family relationships. The consequence of the disorder in the treatment also reaches these areas. Jalalindushan said about the possibility of increasing the need for hospitalization and demanded to check consumption changes with insurance data. Sustainable supply must be measured against patient access: timely delivery of the appropriate drug with insurance coverage applied prior to purchase. A delay in this path transfers the cost from the factory and insurance to the life of the patient.

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