[Column] Self-injectable drug abuse, is SPD the answer?

Professor Lee Pyoung-soo at CHA University Department of Healthcare Industry

Self-injectable obesity treatment Saxenda has been under fire constantly, because the obesity treatment has been abused as a weight management injection generating not only safety concerns but also questionable profit for the interest group.

 

Apparently, the government said it would provide answer to it in November.

 

Some likely suggestions are individual unit packaging and separation of prescription and dispensing (SPD) system.

 

Undue profit generated from abusing Saxenda?

 

Demands for Saxenda has soared when the words got out that the injection is great option for controlling obesity.

 

Accordingly, frequency of prescription and administration showed steep growth since then.

 

However, it is questionable if the users in need of Saxenda are taking appropriate procedure to acquire the treatment at a moderate price.

 

Before a medical profession makes a decision on the necessity of Saxenda administration and dose, user’s demand can make decisions first.

 

As a result, inappropriate prescription of the injection raises concern of adverse reaction and safety.

 

Other than the user’s demand, it also has been meddled with prescriber’s interest in profit.

 

Abnormal amount of financial profit has been generated when prescribing and dispensing the injection, and such push in profitability has been pointed out as a reason for the abuse.

 

Also it is problematic that some of the healthcare institutes and drug distributors are illegally supplying the treatment for the sake of financial gain.

 

Besides making illegal profit, illegal supply of drug could bring serious safety issues.

 

Is Saxenda abuse preventable?

 

Plenty of reasons can be suggested for the abuse.

 

But the user’s perception is the biggest reason.

 

Drug users seeing Saxenda as a weight loss tool for esthetic purpose, rather than a health condition treatment, is one of the main reasons.

 

And doctor’s perception is as problematic.

 

The doctors are the ones to judge the necessity of the treatment use, and a drug prescription and frequency are decided by them as well.

 

The doctor could be prescribing the treatment to the users to increase patient visit frequencies and profit.

 

The user’s abuse can be shifted or prevented by educating and raising awareness of the risk.

 

But doctors need more than a mere training and public service announcement; they need proper regulatory management.

 

The health regulator could intervene doctors with insurance-covered medical service fee review, and pharmacist with the SPD system.

 

Illegal drug supply can worsen the situation and its severity level.

 

Countermeasure on illegal distribution is necessary not only to prevent drug abuse, but also to secure the order in distribution process and to stabilize medical expenditure in the National Health Insurance.

 

Is SPD the answer to prevent self-injectable drug abuse?

 

There are a number of suggestions to prevent drug abuse.

 

Preventing and managing drug abusing by changing the perceptions of user and prescriber has limitations.

 

This is why the regulatory management is needed.

 

Besides the review procedure of insurance-covered medical service fee, the regulator could take account of SPD system as one of options for the regulatory management.

 

The purpose of SPD system is to appropriately integrate economic feasibility and safety of drug use.

 

Moderate use of drug consists of economic feasibility, safety and convenience.

 

And it is the reason the injection was exempted from the SPD system.

 

If an injection were to be dispensed at a pharmacy, the user would have to take it to a healthcare institute to get a shot.

 

But self-injection is an exception and it can be shot either by a medical profession or the user themselves.

 

However, the dual option of administration has become a loophole and it has created a side effect of drug abuse.

 

Therefore, the regulator should positively consider applying SPD system on self-injectable items as well.

 

The treatment was labeled ‘self-injectable’ for the sake of convenience, given the safety is guaranteed.

 

To keep safety and economic feasibility from drug abuse, a handful of drug users should deal with inconvenience of administering the injection at a healthcare institute.

 

The SPD system is not the only measure to prevent and manage self-injectable drug abuse.

 

The government and insurer should endeavor to educate users and prescribers to change their drug use behaviors, while regulatory amendments on review and evaluation, and illegal distribution management are made, simultaneously.

 

The interest group may additionally demand for increased dispensing fee and other means of compensation for SPD.

 

But we should count on the interest groups to logically and reasonably handle the situation.