Pharmacists can do without addicts, but addicts cannot live without pharmacists. There are several levels of this ambiguous and often dangerous relationship, from sedatives, to medicines for withdrawal symptoms, to the syringes used by heroin addicts and even the eye drops used by hashish addicts to avoid being caught by parents or security patrols.

Sealing off and release

 Pharmacists can do without addicts, but addicts cannot live without pharmacists. There are several levels of this ambiguous and often dangerous relationship, from sedatives, to medicines for withdrawal symptoms, to the syringes used by heroin addicts and even the eye drops used by hashish addicts to avoid being caught by parents or security patrols.

Sealing off and release

In May 2016, two unlicensed warehouses belonging to Dr. M, the owner of Mustafa pharmacy chains – the largest in the city of Suez – were discovered. Huge quantities of contraband drugs, banned medicines, and ecstasy tablets were found.

The Suez Prosecution Office (SPO) released Dr. M against an L.E. 20,000 (US $2,250) bail after he submitted a list of the confiscated drugs with documents indicating their legal obtainment as part of his pharmacies’ allotments.

The SPO closed and sealed the stores with red wax. It also ordered to set up a committee comprised of pharmacists in coordination with the Ministry of Health (MoH) and the Egyptian Pharmacist Syndicate to examine both the smuggled drugs and banned medicines to determine their risks, actual value and treatment effectiveness. The security drive seized 201 types of drugs, including 21 types of sedatives totaling 6,570 tablets; 122 types of smuggled drugs of an unidentified source; 14 drugs of the Health Insurance Organization; and seven types of expired medicines.

We do not sell Tramadol

A few hours after his release, Dr. M posted a video on several social networking sites in which he explained that the seized drugs were imported medications needed by many patients who could only find them at his drug stores. These products, he said, are used for cancer treatment and as ovulation stimulants. He further claimed that the seized drugs contained neither narcotics nor sexual stimulant products.

“My main objection to the way the media has dealt with the issue is the inclusion of Tamol among the seized drugs because Tamol is Tramadol which we do not sell,” he said. “Ask every pregnant woman in Suez what she uses as an antiemetic other than Navidoxine. This medicine is basically not registered in Egypt. The pertinent law was enacted in 1941, and until 2016, no reviews have been made to look into its negative aspects. My case has been overblown, while it is basically a procedural matter concerned with the fact that the warehouse is an apartment rather than a shop annexed to the pharmacy.

Besides, the warehouses of all other major pharmacies in Egypt should have been subjected to the same action. Should import laws be changed, prices of imported medicines would be sold at half the present prices. Ask Suez residents is it a good thing to close Mustafa drug stores. After thirty years of delivering needed services for Suez people, I did not expect to be rewarded like that.”

Neither the first nor the last

After less than a month of the Mustafa Pharmacy case, chief of Asyut Security Department was informed that 664 boxes of psychotropic drugs and narcotics were seized from Moussa Pharmacy, including 69 expired tablets, ampoules and capsules. Another pharmacy in Giza had been closed a few days earlier, raising the number of closed pharmacies to 10. Reports against 22 other violating pharmacies were filed and their owners were referred to court for appropriate legal action. According to the MoH, these actions only happened in the second quarter of 2016.

Self-harm a personal freedom

A.L., a 33-year-old petroleum engineer who is a regular customer at Mustafa pharmacy, and also struggles with an addiction, expresses great regret for the problems they faced. “Are not addicts patients?” He wonders. “Should they fail to find what they are looking for, would not that cause dire consequences that affect everyone? Would not these consequences also lead to addicts causing harm to themselves and to others?”

As in Sergio Leone’s masterpiece ‘The Good, the Bad and the Ugly,’ A.L. divides pharmacists into the understanding, the greedy and the reserved. According to him, the understanding are those who  the person standing before them and know whether s/he is a criminal or a mere addict who understands the drugs that impact people’s mood, including their doses, effective substances and side effects, and they believe that self-harming, if considered so, is a personal freedom so they dispense the requested drug. Greedy pharmacists sell drugs at several times their actual price. As for the reserved, they refuse to dispense drugs without a doctor’s stamped prescription. “They are the worst kind of all,” he says.

A.L. believes that the problem goes far beyond pharmacy chains and that it is a global crisis relating to wars among pharmaceutical companies. He also sees that the solution is to legalize the circulation and consumption of cannabis given its greater effectiveness and less harm based on proven medical research.

No new trend

Dr. Ibrahim Sayyed, a psychiatrist and an addiction rehabilitation consultant says buying drugs from pharmacies is by no means new, and the period from the early 2000s until now is the age of chemistry – narcotic drugs – par excellence. This age, he says, is impacted by the global economic changes, like inflation and dollar crisis. It is impossible to determine the volume of this trade because it is after all concerned with medicines, and it is difficult to give conclusive evidence as to whether these drugs reach those eligible or not.

Awaiting relief

The relationship between addicts and pharmacists has become a storylline for Egyptian television dramas as well as works of literature, like ‘Law of Inheritance’ by Egyptian writer Yasser Abdullatif who lives in Canada:

“Each 10 millimeters contains: Chlorpheniramine maleate  3 mg, Phenylephrine-hydrochloride  5 mg, Ephedrine-hydrochloride 5 mg, Dextromethorphan-hydrobromide 15 mg. When he read the leaflet included in the Tussivan-N Syrup, Dr. Muwaffaq, the owner of Rahmeh pharmacy, raised his eyebrows. He folded the leaflet back inside the box and said with surprise: ‘Six bottles at one go? Are you having a big party tonight?’ He did not know that we were six and it was my turn that day to approach him. Outside, there were five emaciated people; some of them leaned against the car, others sat on the sidewalk, while others looked around not knowing what to do with their bodies, waiting for the result of the dealing with a new pharmacist and his willingness to be lured into the trap, collaborate with us, or totally refuse the deal, and then we would have to continue the agony of trying with other pharmacies.”

Adventures with experienced pharmacists

Abdullatif highlights yet another aspect of this addict-pharmacist relationship in the same chapter titled ‘The Absurd Schedule …or Maadi Summer 88’: “There remained a problem that concerned us. How could we supply needed drugs for the journey? We had only little money, and the collaborating pharmacies must have closed. The owner and staff of the only remaining nightshift pharmacy had honesty and integrity enough to distribute to all neighborhood pharmacies. He knew well the tricks played by youngsters like us about how to cheat others.

Sharif, who came a few days earlier from Luxor where he was studying at a hotel management school, said he learned that a strange drug called Parkinol and basically used by Parkinson’s disease patients caused intense hallucination very much similar to the effect caused by L.S.D. Therefore, it should be dealt with with great caution and it was very cheap where a whole jar cost one Egyptian pound, with enough tablets to immerse users in dreams for days on end.

It was a good idea, given that the drug was not yet popular among addicts and was not a drug sold with prescription, thus facilitating the cheating of the honest owner of the nightshift pharmacist. As usual, we distributed tasks amongst us, so one group was assigned to buy the drug from the nightshift pharmacy and it left while the other was left behind.

At last, the first group turned up, and we saw Sharif playing with that magical tablets jar. We congratulated each other for the success of our adventure, knowing that Sharif must have contrived a well-thought trick to cheat the experienced pharmacist. After that, the arrangements of our planned journey were easy.”

Changing mood

“What draw my attention the most is the difference of the drugs which were popular then compared to those popular now,” said Abdullatif when asked about the difference between the situation in the late 1980s and early 1990s; namely, the period dealt with by the novel, and now. “Back then, the popular drugs were those containing Codeine or Dextromethorphan-hydrobromide, in addition to Benzodiazepines known for their inhibition effects. At present, Tramadol sedative derivatives are most common, and most people basically use them as sexual enhancements. This points to a big change of market and mood tendencies.”

The most dangerous roles ever

“Pharmacists in this respect are divided into two types,” says Dr. Ahmad Abdullatif, a psychiatrist and an addiction rehabilitation consultant. “The first is those who do not dispense psychotropic drugs without prescriptions and these perform their duties properly. “The other type is the pharmacists who dispense the same drugs for ineligible individuals, thus depriving real patients of therapy. These pharmacists can be classified into four types: those who act in good faith, psychopaths or community foes, addicted pharmacists, and those who distribute their drug allotments to relatives, close friends and connections. The most dangerous pharmacists however are dishonest counselors.”