KARACHI: Amid a growing number of Covid-19 cases and serious pressure on hospitals across Pakistan because of them, the country’s health system faces yet another crisis as dozens of cost-effective medicines used for treatment of psychiatric illnesses, neurological disorders and mental sicknesses are no longer available in the market after several pharmaceutical companies have stopped their production either due to lack of business viability or regulatory hiccups, officials and industry sources have said.

They said the essential medicines, which were once regularly and commonly used by patients but were currently not readily available, included psychoactive drugs, antidepressants, mood stabilisers, anticholinergics, antihistamines, sedatives and anticonvulsants.

“These medicines are generally prescribed to people having mental health issues and neurological disorders because they are cost-effective and in the reach of a common man,” said a senior health practitioner on condition of anonymity.

Market sources said the disappearance of basic medicines needed by those suffering from mental health problems was actually due to their non-production by the companies concerned, which found it difficult to maintain their supply chain as the drugs were no longer economically viable. Because of the unavailability of these medicines people have been forced to buy expensive alternatives.

Business reasons, regulatory issues behind the problem, say experts

“The people facing mental health issues like schizophrenia, bipolar disorder and depression need to take medicines for years,” said a local supplier. “So it is very important that the medicines they use are cheap and cost-effective.”

He said there were business reasons behind the crisis. “For instance, 1,000 Phenobarbital tablets were available for just Rs20 in Pakistan. Now this medicine is not available. Unofficially, the pharmaceutical companies argue that it’s not feasible for them to produce them at such a low price after devaluation of the rupee and increase in the cost of production,” he said.

The issue was raised by the Pakistan Psychiatric Society (PPS), which approa­ched Special Assistant to the Prime Minister on Health Dr Faisal Sultan to intervene in the matter before the crisis deepened.

In a letter to Dr Sultan, the PPS mentioned 15 different tablets, four injections and a capsule which were once very cheap and easily available all over the country but were not available now. “The pandemic has resulted in a massive burden... but non-availability of the following commonly used cost-effective drugs in psychiatric practice has further deepened this burden,” said the letter sent by PPS President Prof Dr Muhammad Iqbal Afridi.

The sources said that despite the hike in prices of several medicines, rates of a large number of drugs were not revised, leaving unattractive margins for manufacturers. “For example, Tegral is not viable to manufacture at the current price,” said Ayesha T. Haq, the executive director at Pharma Bureau, a representative body of multinational pharmaceutical companies.

“The company has been requesting DRAP to allow its manufacturing but that request is still pending. So it’s not business alone, there are several issues which are needed to be expedited at the regulatory forums to cope up the crisis.”

Published in Dawn, December 24th, 2020