N EAR anarchy in the country's private sector pharmaceutical industry has meant as much pain as gain for Cambodia's sick. Drugs that are illegally manufactured, improperly stored or even banned in several countries are sold freely across the counter here, according to pharmacists, doctors, foreign health experts and Health Ministry officials.
There is no laboratory in the country equipped to analyze drugs and check their content, so there is little hard evidence to back the suspicions that large numbers of drugs are spurious. But a limited survey of pharmacies by the Post found that drugs which have been banned by the Royal Government itself are freely available in Phnom Penh.
Dam Sovanny, assistant to the head of the Department of Pharmacy in the Ministry of Health, said that the Ministry banned three drugs a year ago because their hazardous effects had been proven across the world. The Post, however, found that at least two of them are easily available across the counter, and few pharmacists seem to even know of the ban.
Analgin and its variants, which have been banned, are extremely popular drugs and are sold under their own names as well as brand names like Novalgin and Baralgan. They are used for pain, inflammation and fever and have been found to cause agranulocytosis, a blood disease in which the bone marrow fails to produce white blood cells needed to fight disease. It can be fatal according to the List of Banned And Bannable Drugs published by the Voluntary Health Association of India (VHAI), 1989. This document is used by the Cambodian Ministry of Health as a benchmark in making decisions on banning drugs.
A second drug banned by the Ministry, Oxyphenbutazone and its variants, were also on sale at pharmacies the Post visited. Again it is used for inflammation, pain and fever. The drug has also been found to cause effects similar to Analgin, as well as liver and kidney damage. Clioquinol, the third drug banned by the Ministry of Health, seems to be less easily available. It was only on sale in one of the drug stores the Post surveyed. It is used to treat diarrhoea. The VHAI document says the drug was banned because it causes a nerve disease which can lead to limb paralysis, blindness and incontinence.
The fact that there are virtually no regulations means that the country is an easy market for drugs which have been banned, withdrawn or restricted in other countries.
Drugs come into Cambodia from at least 12 different countries, according to Dam Sovanny, and there are no official figures on how much of the trade is legal. Interestingly, some drugs in the market have been imported from countries which have themselves banned them from their domestic markets.
For example, the Post found that Amidopyrine, used for fever and inflammation, is imported from Thailand among other countries. It is however, banned in Thailand and countries like Australia, Finland, Chile, Singapore, Philippines and Germany because it has effects similar to Analgin.
Oxyphenbutazone was found to have been imported among others, from Canada, which has itself banned the drug. Injectable Chloramphenicol, used to treat typhoid, is imported from several Western countries, including France, which have severely restricted its use or banned it, especially for children, because it also causes agranulocytosis. Another drawback with Chloramphenicol is that patients very quickly develop resistance to it, hence dosages are increased. It is manufactured in tablet form in the country.
"This happens very often, drugs which come from Western countries and others like Taiwan, India and Thailand are not sold in those countries. We have no way of knowing how much of it is legally imported," Sovanny said.
Other drugs banned or restricted widely elsewhere but freely sold here, according to the Post survey, included Phenacetin, used for pain and fever, and combinations of two varieties of Ergot, used separately for migraines and hemorrhage after childbirth, which should not be sold as a combination. An overdose of Ergot can cause gangrene and loss of limbs.
Some anabolic steroids like Stanozolol and injectable Free Testosterone are also available across the counter. World-famous for their use by athletes as a body-building drug, the VHAI document also points out that they are used to stimulate growth in children but warns that it can ultimately damage bone and sexual development.