THE STUDY OF THE CURRENT STATE OF DISPENSING NARCOTIC, PSYCHOTROPIC DRUGS AND PRECURSORS BY PRESCRIPTION IN UKRAINE

The analysis and generalization of the provisions of normative legal acts (NLA) regulating prescription and OTC drugs circulation in Ukraine have been conducted. The causes of violations in dispensing drugs by prescription are the problem of the healthcare system on the whole and the problem of the lack of control over the professional activities of doctors and pharmacists, and it requires a comprehen-sive approach to this issue by the government. It has been determined that the current legislation requires a clear regulation of the issues dealing with prescribing. In order to regulate the circulation of prescription narcotic drugs, psychotropic substances and their precursors it is necessary to strengthen the responsibility of pharmacists for dispensing of prescription drugs without prescriptions, and the responsibility of doctors for prescriptions written incorrectly. The attitude of health professionals to dispensing drugs by prescription in Ukraine has been studied in the article. According to the questioning of pharmaceutists (pharmacists) it has been found that the vast majority of professionals are bound constantly to dispense prescription drugs without prescriptions during their work. At the same time they understand the social danger that is caused by breaking rules of dispensing drugs, which are excessively used by addicts, from pharmacies. The expert opinions concerning the causes of breaking rules in dispensing drugs from pharmacies and the frequency of inspections of pharmacies by law enforcement authorities have been assessed.

The analysis and generalization of the provisions of normative legal acts (NLA) regulating prescription and OTC drugs circulation in Ukraine have been conducted. The causes of violations in dispensing drugs by prescription are the problem of the healthcare system on the whole and the problem of the lack of control over the professional activities of doctors and pharmacists, and it requires a comprehensive approach to this issue by the government. It has been determined that the current legislation requires a clear regulation of the issues dealing with prescribing. In order to regulate the circulation of prescription narcotic drugs, psychotropic substances and their precursors it is necessary to strengthen the responsibility of pharmacists for dispensing of prescription drugs without prescriptions, and the responsibility of doctors for prescriptions written incorrectly. The attitude of health professionals to dispensing drugs by prescription in Ukraine has been studied in the article. According to the questioning of pharmaceutists (pharmacists) it has been found that the vast majority of professionals are bound constantly to dispense prescription drugs without prescriptions during their work. At the same time they understand the social danger that is caused by breaking rules of dispensing drugs, which are excessively used by addicts, from pharmacies. The expert opinions concerning the causes of breaking rules in dispensing drugs from pharmacies and the frequency of inspections of pharmacies by law enforcement authorities have been assessed.
Narcotic drugs, psychotropic substances and their precursors (NPP) are substances of the natural and synthetic origin. They are dangerous for human health and can cause the state of dependence, a depressing or stimulating effect on the CNS, perception and behaviour disorders, etc. [1,14,19].
At the same time it is impossible to identify the concept of narcotic (psychotropic) drugs [15]. According to the reference book written by M.D.Mashkovsky (1977), only 5 subgroups can be referred to the main group of "Psychotropic drugs": neuroleptic and sedative medicines, tranquilizers, antidepressants and medicines stimulating the central nervous system.
Circulation of prescription and OTC drugs are an integral part of pharmaceutical provision of the population [20].
Unfortunately, nowadays commercial activities of the pharmacy dominates in Ukraine. Physicians seldom write out a prescription, and pharmaceutists get a list of medicines written by the physician on a sheet of paper, but not on the prescription form or simply a patient tells them what drug he wants. Taking this into consideration pharmaceutists often offer the most advertised and expensive medicine [16][17][18].
That is why unreasonable prescription and uncontrolled drug intake is an important current socio-economic and healthcare problem in Ukraine.
Analysis of the latest investigations and publications. Many Ukrainian scientists such as A.S.Nemchenko [5,6], A.A.Kotvitska [2], A.P.Gudzenko [5] and others paid their attention to different directions as to the problems of dispensing of prescription and OTC drugs.
Highlighting the issues unsolved previously. A comprehensive consideration of the problem is practically absent.
The aim of our research was generalization of the provisions of normative legal acts (NLA) concerning the regulation of prescription and OTC drugs circulation and the study of healthcare professionals' attitude to dispensing of prescription drugs in Ukraine with subsequent determination of efficient ways of solution.

Materials and Methods
Analysis and generalization of NLA regulating prescription and OTC drugs circulation in Ukraine; the questionnaire survey of professionals (pharmaceutists, pharmacists), statistical, mathematical and graphical analysis were used in the research.

Results and Discussion
The list of NPP was approved by the resolution of the Cabinet of Ministers of Ukraine (CMU) from 06.05.2000, No. 770 [11] (with amendments) in order to regulate the activity and control the circulation of this group of substances, including volume of quotas, within which manufacturing, storing, import into Ukraine and export from Ukraine of narcotic drugs and psychotropic substances for medical and scientific purposes and medicines containing NPP in the amount that does not exceed the permissible limit. Comparing NPP quotas within the period from 2012 to 2014 the conclusion can be made that, in general, within the period from 2012 to 2013 the volume of quotas for NPP manufacturing increased. Within the period from 2013 to 2014 the volume of quotas, on the contrary, decreased. This will help to reduce the level of narcomania in the country.
According to order of the Ministry of Health of the USSR No. 175 (1982) "On measures on further improvement of drug provision of the population and medical preventive institutions" for the first time 3 types of prescription forms were introduced: form No. 1 -for dispensing drugs at full cost (for psychotropic drugs) valid for 10 days and stored 1 month at the pharmacy; form No. 2 -for prescribing drugs free of charge or on preferential terms; form No. 3 -a special prescription form of a pink colour for dispensing narcotic drugs, which were additionally certified by the signature of the head physician of the medical preventive institutions (MPI) or by the head of the department and by the round stamp of the hospital valid for 5 days from the day of prescribing and stored at the pharmacy for 1 year, later the date of expiry increased to 5 years.
After the expiry date of storing prescriptions of form 3 and orders (requests) for narcotic (psychotropic) drugs they are destroyed according to the procedure established by the legislation.
The circulation of prescription and OTC drugs in Ukraine is regulated according to the following NLA: Unfortunately, at present the most pharmacies are bound to sell prescription drugs without prescription. The budgets of MPI do not include costs for making prescription forms. Physicians have to write out prescription drugs not on the special forms according to the Order of the Ministry of Public Health of Ukraine "On approval of the Rules of prescribing and order requirements for medicines and medical products …" from 19.07.2005 No. 360 [7], but on ordinary paper sheets certified by the doctor's personal seal or advertising samples in the form of prescriptions. The exception is prescription of drugs subjected to control, physicians always write out prescriptions on them according to the current legislation. Thus, physicians, pharmacists and pharmaceutists become hostages of the situation (a physician is bound to prescribe treatment, and a pharmacist can not refuse a patient in purchasing the necessary drugs). With the aim of determination of the professionals' (pharmaceutists, pharmacists) attitude to the current problems of dispensing NPP by prescription the questioning of pharmaceutists one of the cities of Ukraine has been carried out. In this questioning 98 specialists of all qualification levels with the length of work from 1 to 39 years took part. The most respondents (73%) have a higher pharmaceutical education.
The questionnaire developed has met all modern ethical requirements, namely confidentiality of the information received; the questions, which do not affect the respondents' dignity; appeal to a respondent with the specific goal of the research; the absence of questions with confusing statements.
According to results of the research conducted it has been found that 95% of professionals are bound constantly to dispense prescription drugs without prescriptions during their professional activity. The moral principles of specialists, management and owners of pharmacies are one of the most important factors concern-ing dispensing drugs abused by drug addicts without prescription.
Administration of 60% of the pharmacists questioned reminds the staff about their responsibility of breaking rules of dispensing prescription drugs, but in most cases attention is focused on drugs that cause drug addiction.
96% of the respondents understand the social dangers, which breaking rules of dispensing drugs abused by drug addicts from the pharmacy cause.
At the next stage of our research the causes of breaking rules of dispensing drugs by pharmacists were determined (Fig. 1).
Unfortunately, according to the data obtained 56% of the respondents answer that their salary depends on the sale volume, and they don't care if a patient buys drugs causing narcotic dependence without a prescription.
52% of the respondents motivate their actions in such a way: "if I don't sell -they will buy it in another pharmacy and I will lose a part of my salary". During the research it has been found that 36% of the respondents refuse to dispense socially dangerous drugs without the physician's prescription. 28% of the pharmacists questioned justify their actions saying that everyone does this.
It should be noted that in goods in stock of every pharmacy there are some drugs, which are within the area of interest of drug users, but these drugs are different and depend on such factors as the chemist's loca- tion, management and owner's attitude to this problem, changes in legislation, etc.
The most of the professionals questioned (62%) work at the pharmacies where NPP sales are 10-25% (Fig. 2).
Taking into consideration a high social danger of narcomania and toxicomania pharmacies as one of the source of suppling potential dangerous drugs are subject to various inspections by law enforcement authorities. These inspections are aimed at revealing violations of the current legislation concerning the order of dispensing prescription drugs. It can be control purchase, drugs circulation check, check the availability and storage rules of prescriptions of the drugs dispensed, compliance with the rules for storing these drugs, accordance of actual availability of drugs to report, compliance with license terms, etc.
As to periodicity of such inspections the respondents answer as follows: 60% -checks are once a year, 28%they occur once in three month (Fig. 3). CONCLUSIONS 1. NLA regulating prescription and OTC drugs circulation have been analyzed. It has been determined that the current legislation requires a clear regulation of the issues dealing with prescribing. In order to regulate the circulation of prescription narcotic drugs, psychotropic substances and their precursors it is necessary to strengthen the responsibility of pharmacists for dispensing of prescription drugs without prescriptions, and the responsibility of doctors for prescriptions written incorrectly.
2. With the aim of determination of the professionals' (pharmaceutists, pharmacists) attitude to the current problems of dispensing NPP by prescription the questioning of pharmaceutists in one of the cities of Ukraine has been carried out. According to results of the research conducted it has been found that 95% of professionals are bound constantly to dispense prescription drugs without prescriptions during their work, and 96% of the respondents understand the social danger that is caused by breaking rules of dispensing drugs, which are excessively used by addicts, from pharmacies.
3. The expert opinions concerning the causes of breaking rules in dispensing drugs and the frequency of inspections of pharmacies by law enforcement authorities have been assessed.