Drug Problem or Medicrime? Distribution and Use of Falsified Tramadol Medication in Egypt and West Africa
Drug Problem or Medicrime? Distribution and Use of Falsified Tramadol Medication in Egypt and West Africa
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毒品问题还是医疗犯罪？
DOI：
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发表时间：
2019
影响因子：
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通讯作者：
A. Klein
中科院分区：
文献类型：
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作者：
A. Klein
曲马多是一种合成阿片类药物，广泛用作中到中等强度疼痛的止痛剂。据估计，曲马多的效力约为吗啡的十分之一，因此在中毒或依赖方面被认为是相对安全的。然而，越来越多的报告称，曲马多在北非和西非的非医疗消费普遍存在。埃及政府已要求联合国麻醉药品委员会将曲马多置于国际控制之下。这将对发展中国家的急性和慢性疼痛的治疗产生深远的影响，在这些国家，曲马多往往是唯一可用的止痛剂，因为卫生保健从业者无法获得受控物质。在医疗机构外销售的曲马多通常是掺假和不合格的，这是大规模假药交易的一部分，其破坏性可能远远超过享乐主义使用精神活性物质。然而，现有的控制医疗产品的国际机制薄弱，对Medicrime的处罚仅次于贩毒犯罪。文章建议，国际控制需要重新评估其优先事项，将重点放在人类和患者的福祉上。需要进一步转变，从针对消费者的压制措施，转向对药品和医药物质的生产和分销进行更严格的监管。这必须涉及广泛的利益相关者，包括卫生保健从业者、制药业、药剂师、患者协会和广大公众。
Tramadol is a synthetic opioid that is widely used as an analgesic for alleviating pain of moderate to medium intensity. With potency estimated to be about one-tenth that of morphine, tramadol is considered as relatively safe with regard to poisonings or dependency. Yet there are increasing reports of widespread non-medical consumption of tramadol in North and West Africa. The Egyptian government has requested the UN Commission of Narcotic Drugs to put tramadol under international control. This will have profound implications for the treatment of acute and chronic pain across developing countries where tramadol is often the only available analgesic, because controlled substances are impossible to obtain for health care practitioners. The tramadol sold outside of medical establishments is often adulterated and substandard, part of the massive trade in falsified medicines that is possibly far more devastating than the hedonic use of psychoactive substances. Yet the international machinery in place to control medical products is feeble and the penalties for medicrime are modest next to drug trafficking offences. The article suggests that international controls need to re-assess their priorities to focus on human and patient well-being. A further shift is needed away from repressive measures against consumers, to tighter regulation in the production and distribution of medications and pharmaceutical substances. This must involve a wide range of stakeholders, including health care practitioners, the pharmaceutical industry, pharmacists, patients associations, and the public at large.