The country of the victorious State Drug Control Service. Part 3

End. Start here .

Before you fulfill your promise and tell us - what is it like for them, in the countries of “decaying capitalism”? - a little more Russian reality.

What violations can doctors commit when working with narcotic drugs - version of the State Drug Control Service

In order to steal narcotic drugs, medical workers usually carry out the following actions:

2) replace a dry drug or other potent substance with a substance similar in appearance, tablets similar in appearance;

3) from ampoules containing non-narcotic substances, the original inscriptions are removed and false ones are applied;

4) the patient is injected with analgin with diphenhydramine or other drugs instead of the drug;

5) create the appearance that ampoules with drugs fell and broke or were accidentally crushed.

Let's look at it in order

1) part of the liquid narcotic substances is removed and the stolen substance is replaced with another substance (isotonic solution, water, etc.), while the patient is given a half dose of the drug;

It seems that the authors of the methodological letter do not know the real working conditions of doctors. The prescription and administration of drugs is not carried out “by one person”. The doctor prescribes the drug, records this fact in the prescription sheet (anesthesiology record) and gives the order to the nurse, who administers the drug to the patient. In the operating room, the anesthesiologist and nurse anesthetist work together and the administration of any anesthesia drug is carried out by the nurse under the supervision of a doctor! This means that it is practically impossible to pour it out unnoticed (by the way, where?) and dilute the remainder with any other solution; to implement such a grandiose plan, the doctor and the nurse must be, to put it mildly, in cahoots. And the value of fentanyl, the most widely used narcotic analgesic in anesthesiology, as a means of satisfying the needs of a drug addict is negligible. Its duration of action is only 15-20 minutes; what drug addict would be interested in such a short-acting drug?

2) replace a dry drug or other potent substance with a substance similar in appearance, tablets similar in appearance;

I wonder how you can change the drug unnoticed ? For intravenous administration, drugs are produced in the form of solutions, and it is impossible to replace the solution without compromising the integrity of the ampoule (see point 1). And replacing the dry substance in a sealed bottle (or tablets in a blister) will inevitably lead to damage to the integrity of the packaging. No doctor or nurse will work with an ampoule (bottle, blister) that has external damage.

3) from ampoules containing non-narcotic substances, genuine inscriptions are removed and false ones are applied
4) instead of a drug, the patient is injected with analgin with diphenhydramine or other medications;

This is how I imagine it - an underground syndicate of medical workers, under the cover of darkness, peels off the labels from drug ampoules and re-sticks them with analgin. It's not even funny...(see point 2).

5) create the appearance that ampoules with drugs fell and broke or were accidentally crushed.

Let it be known to the authors that all used ampoules are subject to strict accounting with their subsequent commission disposal (yes, every hospital creates a special recycling commission, don’t be surprised). And do the learned men who wrote their imperishable work imagine what they will do to the team for a broken or lost ampoule? I responsibly declare that the living will envy the dead. You can safely write a letter of resignation and be happy if you are fired on your own. Not only the loss of an ampoule, but even the inscription on a drug ampoule partially erased as a result of work is already a subject for the most rigorous investigation with organizational conclusions.

What awaits the doctor who unwittingly violates at least one of the draconian rules of working with drugs? Here is one example

An anesthesiologist with 40 years of experience, an Honored Doctor of the Russian Federation, was sentenced to 6 years for violating the rules for the disposal of ketamine

I don’t want to discuss the degree of guilt of the doctor and nurse here. Yes, they violated the rules by not handing over the remainder of the drug for disposal. But bring them under criminal charges with a real, rather than suspended sentence? - please tell me which drug dealers were exposed... an entire drug cartel on the territory of the hospital, no more, no less...

And now what was promised - how are they doing ?

Here's what colleagues who visited the USA say:

“In a hospital, prescribing drugs for a doctor is NOTHING different from prescribing other drugs. It is possible to prescribe orally, including from home by telephone, but in this case you must sign the telephone prescription in the morning (this applies to any absentee prescriptions).
No approvals, additional consultations, obtaining second signatures from higher management, etc. are required to prescribe drugs. That is, the time from the decision to discharge to discharge = 0 minutes.
Any licensed doctor (that is, any working doctor), regardless of specialty, can prescribe drugs. Even a physical therapist.
Naturally, there are no “permits” to drugs (which I talked about last time - author’s note).
"Severe violations, such as prescription trading, are investigated by the FBI and may result in permanent license suspension, but these are exceptional cases."

For a minute I imagined an FBI department checking ALL US doctors and nurses for “trustworthiness” - it felt absurd...

And here’s what it’s like to receive and write off drugs when working in an operating room:
"Before the operation, the anesthetist receives from the senior nurse (narcotic drugs - author's note), after the operation he gives her empty ampoules, the senior nurse brings them to the scanner with a bar code, the code is read... AND THAT'S ALL! The ampoules are sent to the TRASH (which Can Russian doctors imagine this?) No magazines, no commissions for the disposal of EMPTY AMPOULES"

No bureaucracy in the form of a huge number of income and expense journals, no army of inspectors... And somehow they work...

What does the increasingly stricter rules for prescribing drugs lead to? Here's what the experts say:

“According to foreign experts, the use of narcotic drugs for medical purposes in medical organizations in Russia is tens and hundreds of times lower compared to the economically developed countries of Europe, the USA, and the former USSR.
As a result, in 2011, sales of narcotic analgesics by manufacturers of these drugs amounted to 64% of the declared need for injectable forms, and 35% of the declared need for non-injectable forms. In 47 regions of the Russian Federation, non-invasive prolonged forms of morphine (tablets) are not used in medical practice, and in 19 regions dosage forms of narcotic analgesics in the form of transdermal therapeutic systems (TTS) are not used."

What is 64% of sales of declared injection forms of NS? This means that 36% (more than a third) of patients who needed drug pain relief did not receive it. But unrelieved pain during surgery and in the postoperative period is not only physical suffering. It has been scientifically proven that inadequate pain relief leads to the launch of a complex mechanism of pathological processes in the body, which can result in the development of severe, sometimes fatal complications in the postoperative period. The numbers for tablet forms look even worse. 65% (i.e. two thirds) of patients were unable to obtain complete pain relief. But most often these are cancer patients who die in agony and pain. Maybe at least these depressing statistics will force us to at least slightly reconsider the rules for prescribing drugs? I don’t think that the number of abuses among doctors will increase sharply after some weakening of the control regime, but perhaps this will help, if not save, then at least alleviate the suffering of thousands of needy patients.