It is estimated that each Iranian takes 339 units of different medications on average per year, which is four times the global rate. The per capita use of injectable medicines is 11.4, four times that of developed countries.
The average number in each prescription is at least three or four drugs, while it is two around the world. This is while chronic non-communicable diseases such as cardiovascular ailments, cancers and mental illnesses have seen an increase and constitute a serious challenge to the health authorities.
The arbitrary use of medication, especially antibiotics and painkillers, appears to have become a part of Iranian culture, argues an article in Salamat weekly.
Dr. Noushin Mohammad Husseini, who is in charge of education at the National Committee on Rational Drug Use, giving her views on the issue, however, said drug use in Iran “is not excessive, it is irrational.”
Many patients with chronic illnesses such as diabetes, high blood pressure and cardiovascular ailments take less than the prescribed dosage, leading to more problems at a later stage, while antibiotics and painkillers are widely consumed even when not needed, she noted.
Referring to the high figures in per capita drug use (obtained from dividing sales of medicines by the population) she said they may not be 100% accurate, “as there is no way to ensure that the medications have been consumed by the purchasers.”
Medicine is quite affordable in Iran and generally bought in large quantities, but this does not necessarily mean that they are consumed. Many even buy medicine to store at home which they may never take.
“Unlike food, the figure for per capita drug use cannot be acquired from the sales of medicine.” Other variables such as the prevalence of illnesses and referrals to doctors must be taken into account.
Many people take antibiotics when the first symptoms of a cold appear or pain relievers for the slightest ache; medicines for these two conditions are not harmless. The biggest threat, however, is from the overuse of antibiotics as it causes antimicrobial resistance.
Painkillers too have a negative impact as they delay the process of diagnosis and treatment by concealing the symptoms in a health problem. “Both medicines also negatively affect the liver and kidneys,” said the specialist.
Admitting that Iran is one of the biggest consumers of pharmaceutical products in Asia, she said in some Asian countries like China, many people still opt for alternative medicine and this is why their use of chemical drugs is relatively low.
Dr. Rahbar Mojdehi Azar, head of the Iranian Association of Pharmacists, dismissed criticism about overuse of drugs in the country, saying that although the cost of medication is lower in Iran than neighbouring countries like Pakistan and Turkey, consumption is not higher.
He affirmed the irrational use of drugs but admitted that “doctors prescribe medicines in excess”.
“We have proposed that a medical protocol should be in place, based on which doctors would not be able to prescribe more than the required medicine,” said Mojdehi Azar.
Even though self-prescription in use of drugs has declined over the years due to increasing prices, expansion of insurance coverage and consultancy provided by pharmacies, it still remains a problem in the society, he said. “Iranians use less of the drugs prescribed and more of antibiotics and painkillers.”
In 2014, the Iranian pharmaceutical market was estimated at $2.3 billion and it is predicted to reach $3.3 billion in 2019, with a CAGR (compound annual growth rate) of 7.5%.
Reaffirming that high medicine consumption rates have been recorded among Iranians, a report on the website of the ILIA corporation states that with every citizen using approximately 340 units on average per year (almost one medicine unit each day) this makes Iran the second largest consumer per capita in Asia and the 20th in the world.
The average number of medicines per doctor’s prescription internationally is 2 units, whereas in Iran it is 3.5 units.