Psychotropic drugs in Nepal: perceptions on use and supply chain management

Summary & key facts

Researchers asked about 65 people in three districts of Nepal who make, sell, regulate, prescribe or use psychotropic drugs what they think about those drugs and how they get to patients. Most people said these drugs are needed, are available in big towns, and work for treating mental health problems, though they can have side effects. The study also found stigma makes patients hide their use, and respondents worried that misuse and commercial incentives from drug companies are common. The authors say more public education and stricter monitoring are needed as mental health care expands in Nepal.

Key facts:

• The study talked with about 65 people from three districts in Nepal who work in different parts of the drug system: about 22 producers and sellers, 8 policy or government actors, 21 health service providers, and 14 service users or family members.
• Respondents said psychotropic drugs are needed for treating mental, neurological, and substance use problems, even though the drugs can cause side effects.
• People in the study reported that these drugs are generally available in major regional centers, but not necessarily everywhere.
• Many respondents believed the drugs are effective for treating mental health problems; this report describes those as perceptions rather than independent proof.
• Stigma around mental illness leads patients and families to hide when they use psychotropic drugs, according to respondents.
• The supply chain for psychotropic drugs follows the same basic steps as other medicines, but it has stricter pre-approval, limits on how much can be produced or imported, and mandatory record keeping.
• Respondents said misuse of psychotropic drugs appears widespread and that pharmaceutical companies sometimes give incentives to prescribers and retailers to keep their brands selling.
• Because Nepal is trying to put mental health into regular primary healthcare and drug use is rising, the study's authors recommend large-scale education and tighter monitoring to try to prevent misuse.

Abstract

BACKGROUND: Psychotropic drugs play an important role in the treatment of mental, neurological and substance use disorders. Despite the advancement of the use of psycho-pharmaceuticals in the developed countries, the psychotropic drug production and supply chain management in low- and middle- income countries are still poorly developed. This study aims to explore the perceptions of stakeholders involved in all stages of the psychotropic drug supply chain about the need, quality, availability and effectiveness of psychotropic drugs, as well as barriers to their supply chain management. The study was conducted among 65 respondents from the Kathmandu, Chitwan and Pyuthan districts, grouped into four categories: producers, promoters and distributors (N = 22), policy makers and government actors (N = 8), service providers (N = 21) and service users/family members (N = 14). RESULTS: The respondents reported that psychotropic drugs, despite having side effects, are 1) needed, 2) available in major regional centers and 3) are effective for treating mental health problems. The stigma associated with mental illness, however, forces patients and family members to hide their use of psychotropic drugs. The study found that the process of psychotropic drug supply chain management is similar to other general drugs, with the exceptions of strict pre-approval process, quantity restriction (for production and import), and mandatory record keeping. Despite these regulatory provisions, respondents believed that the misuse of psychotropic drugs is widespread and companies are providing incentives to prescribers and retailers to retain their brand in the market. CONCLUSIONS: The production and supply chain management of psychotropic drugs is influenced by the vested interests of pharmaceutical companies, prescribers and pharmacists. In the context of the government of Nepal's policy of integrating mental health into primary health care and increased consumption of psychotropic drugs in Nepal, there is a need for massive education and awareness as well as strict monitoring and supervision to avoid the misuse of psychotropic drugs.

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