The Ministry of Health is still working on legislation to replace a nearly 40-year-old Pharmacy Law that, among other things, does not prevent people from using different doctors to obtain multiple prescriptions for the same drug.
Health Ministry Chief Officer Jennifer Ahearn told the Compass that her ministry “is hoping to have a draft law submitted to Caucus before the end of the year.” Government has made attempts to update the law since the early 1990s, to no avail.
“In the meantime, there are likely risks to patients,” states a 2017 performance audit on Cayman’s healthcare system, criticizing the pharmacy legislation as being “seriously out of date.”
The audit report did not identify prescription drug abuse as a major problem here, and the available statistics do not suggest that, either. However, prescription drug abuse is a growing problem in the United States and elsewhere, to the point of being deemed a “crisis” and an “epidemic” by multiple U.S. federal government agencies.
According to the 2017 audit report, there are no legislated regulations for pharmacies in Cayman. The industry has a standards-of-practice code developed by the Pharmacy Council that establishes boundaries and expectations for pharmacies, but it is voluntary to follow the code.
As a result of the loose legislation, “there are no shared information systems to ensure that patients are not receiving multiple prescriptions from different physicians and obtaining drugs from multiple pharmacies,” according to the audit report, which notes that all Cayman physicians can prescribe drugs.
Additionally, “we were not able to identify any other policies or guidelines in place to help ensure appropriate quality and safety protocols for prescribing pharmaceuticals,” states the report.
In one instance, the Auditor General’s Office said it found a prescribed drug issued with no information in English on the label.
The audit report also identifies difficulties government has in keeping track how many drugs are imported here.
The eight-page Pharmacy Law 1979 gives the chief health officer the right to inspect pharmacies’ records and places of storage, and the audit report states that the chief pharmacist is responsible for monitoring statistics on expected inventory and importation requirements. However, this monitoring does not account for the drugs that are brought in by people who travel off-island for medical purposes and likely bring back medications, the report states.
“There are currently no requirements for medications to be declared at customs,” the report states.
Efforts have been made since at least the early 1990s to update the Pharmacy Law, but none have resulted in new legislation.
In 1991, a new law was drafted after a review was conducted on the pharmacy sector. That law was passed by legislators, but was never enacted and is not in force.
In 2011, a Pharmacy Council subcommittee submitted suggestions for revisions to the law, but those suggestions were not incorporated into the legislation, according to the audit report.
Last year, Health Minister Dwayne Seymour said in the Legislative Assembly that efforts were being made to update the legislation to “provide for prescription drugs monitoring.”
This is “a matter of particular importance, as there is evidence that suggests the misuse and abuse of prescribed drugs,” Minister Seymour said in his November 2017 speech.
When asked about the need for updates earlier this year, Ms. Ahearn told the Compass that the pharmaceutical industry has drastically changed since the current law was implemented in 1979.
“A number of different things in terms of putting in place clearer guidelines and controls around the importation of pharmaceuticals and medicinal products,” she said. “It’s looking at whether there are some things that should be restricted to be sold only in a pharmacy as opposed to, for example, a gas station.
“We’re incredibly fortunate we have a group of very professional pharmacists who have practiced very conscientiously within a self-regulating code of conduct. The pharmacies are run very well. But it’s really about updating and putting in place some clearer protections and clearer guidelines, and just responding to how things have changed.”
In Cayman, the available statistics on prescription drug abuse are limited, but do not suggest that the issue is an overwhelming problem here.
According to the National Drug Council’s 2016 survey on student drug use, 2.7 percent of students reported using prescription drugs for non-medical reasons during their lifetime, while 1 percent of them said they are currently using such drugs.
The survey noted that while the percentage of students abusing prescription drugs is small, the drug council has seen a notable increase in the number of users over the years.
According to the U.S. National Institute on Drug Abuse, the abuse of prescription pain relief in the United States caused 19,354 deaths by overdose in 2016, which is more than double the number of such deaths in 2002. Overall, opioid abuse – including non-prescription drugs such as heroin – caused 72,306 deaths by overdose in 2017, a roughly 3.1-fold increase from 2002, the institute’s statistics show.