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LCQ2: Cough medicines containing Codeine

    Following is a question by the Dr Hon Kwok Ka-ki and a reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (May 24):


     Some medical practitioners have reflected to me that local drug importers or wholesalers can reap more profits by selling cough medicine containing Codeine to pharmacies than selling it to doctors.  These importers or wholesalers often propose unreasonable conditions and high prices on this ground when negotiating on the sale of the drugs concerned with family doctors.  Besides, the number of reported abusers of cough medicine containing Codeine was on the rise in the past five years.  In this connection, will the Government inform this Council:

(a) whether the authorities have investigated if such practice of drug importers or manufacturers has caused the continuous rise in the number of abusers of cough medicine containing Codeine; if they have, of the investigation results and the follow-up actions taken by the authorities; and whether they will consider amending the law to require importers or manufacturers to report to the Department of Health (DH) information on the business units or institutions to which the relevant drugs are sold, and to empower DH to step up the monitoring of and follow-up to the sale of drugs in Hong Kong;

(b) of the numbers of test-purchases conducted and prosecutions instituted against the sale of cough medicine containing Codeine in each of the past five years; and whether it has assessed if test-purchases and prosecutions can effectively prevent cough medicine abuse; if it has, of the assessment results, and whether more measures will be adopted to prevent such abuse; and

(c) of the measures to ensure that family doctors can obtain adequate cough medicine for prescription to patients in need of it?


Madam President,

     At present, the vast majority of cough medicines containing Codeine available in the market are produced by local manufacturers with imported Codeine materials.  Codeine is a narcotic drug.  Its import ceiling is strictly controlled by the United Nation's Single Convention on Narcotic Drugs.  The primary aim of the Convention is to strike a proper balance between the global supply of narcotic drugs and their medical and scientific uses.  In the past few years, Hong Kong imported about 1,600 kg of Codeine materials annually.  We have not received any report that the supply of cough medicines containing Codeine in the local market is inadequate to meet the medical needs of patients.

     In Hong Kong, pharmacies usually purchase medicines from drug manufacturers in small package (retail package) whereas medical practitioners and hospitals usually buy in bulk (wholesale package).  This is also the case in respect of cough preparations containing Codeine: those ordered by pharmacies are generally packaged in 120ml bottles while those ordered by medical practitioners and hospitals are usually packaged in 3.6L bottles.  In a free market, the price of a medicine, like many other consumer products, is usually lower in wholesale package than in retail package for the same volume.  It is a business decision for medical practitioners or pharmacies to decide the type of package, price and sales targets of the medicine to be purchased.  As health authorities, our duty is to ensure an adequate supply of effective medicines for public use.  We do not intend to interfere with any business decisions.

     My reply to the Hon Kwok Ka-ki's question is as follows:

(a) Suppliers of medicines containing Codeine are required to hold a Wholesale Poisons Licence in accordance with the Pharmacy and Poisons Ordinance.  Under the licensing requirements, the licensing authority (i.e. the relevant licensing committee under the Pharmacy and Poisons Board) may, when the need arises, require a licensee to provide information on the sale of certain medicines locally for monitoring purpose.  While the licensing committee does not seek such information on a regular basis, it obtained from the manufacturers in 2005 the statistics on the distribution of medicines containing Codeine for 2002, 2003 and 2004 as shown in Table 1.

     At present, regulatory regimes are in place to regulate the import, manufacture and wholesale of medicines (including cough medicines containing Codeine) to pharmacies, clinics or hospitals respectively.  These regulatory regimes are considered effective.  According to experience, law enforcement and public education are effective measures to control drug abuse.  We will monitor the situation and study actively how to further curb drug abuse through regulatory and other measures.

(b) The numbers of test-purchases of cough preparations (targeting at cough preparations containing Codeine) conducted by DH and prosecutions instituted between 2001 and March 2006 are shown in Table 2.

     Test-purchases impose a certain degree of deterrence.  A pharmacy in breach of the law will be prosecuted.  Upon conviction, the pharmacy and the registered pharmacist involved in the case will be subject to disciplinary inquiry by the Pharmacy and Poisons Board.  This may result in a warning to the pharmacy or even cancellation of its licence, while the pharmacist involved may be censured or suspended from practice.

     We amended the Pharmacy and Poisons Regulations in November last year to reclassify substances containing not less than 0.2% of Codeine as prescription drugs and to provide that their sale must be with the support of prescription of a medical practitioner under the supervision of a registered pharmacist.  DH also stepped up the frequency of test-purchases during the time but no pharmacies were found to be in breach of the law in the 610 test-purchases carried out in the first quarter of this year.  The Administration and the Pharmacy and Poisons Board will continue to monitor the situation of drug abuse and will review the existing measures where necessary.

     In addition to enforcement actions, the Administration will continue to adopt a multi-modality approach in combating drug abuse (including abuse of cough syrups).

     As regards general preventive education, the Administration will continue to work closely with the Action Committee Against Narcotics and other non-governmental organisations to promote a positive attitude towards life among members of the public and enhance their awareness of the harmful effects of drug abuse through various channels such as school courses and publicity programmes like anti-drug talks, promotional pamphlets and announcements of public interest.  To further promote a correct understanding and appropriate attitude towards drugs among youngsters, the Administration has stepped up its anti-drug education for parents and teachers.  Through enhancing their understanding of the problems related to drug abuse, we hope to empower them to disseminate anti-drugs messages to our younger generation.

     We also draw reference from the research findings of academia and other institutions on cough syrup abuse, and incorporate the relevant information into our publicity and education materials.  Such information has been shared with front-line anti-drug workers, social workers and health care personnel so as to enrich their understanding of cough syrup abuse and equip them to handle cases of cough syrup abuse.

(c) Regarding the supply of cough medicines, we consider it of utmost importance to ensure that there is generally an adequate supply of medicines in the market for patients' use.  As mentioned above, we have not received any report that the supply of cough medicines containing Codeine in the local market is inadequate to meet the medical needs of patients.  At present, apart from clinics, patients can also buy medicines in their community with the support of prescriptions.  If they deem it necessary, family doctors may prescribe medicines for their patients who could in turn purchase them from community pharmacies.

Ends/Wednesday, May 24, 2006
Issued at HKT 13:14