Essential psychiatric medicines: wrong selection, high consumption and social problems

Area of Science:

• Pharmacoeconomics
• Public Health Policy
• Psychiatric Pharmacy

Background:

• National and global essential medicines lists often differ due to availability, cost, quality, and disease prevalence challenges.
• Brazil utilizes federal, state, and municipal (REMUME) lists for government-funded medications.
• The discrepancies between municipal, state, national, and WHO essential medicines lists, particularly for psychiatric medications, require investigation.

Purpose of the Study:

• To evaluate the selection process for essential psychiatric medicines on Brazil's municipal lists (REMUMEs).
• To assess the utilization of antidepressants and benzodiazepines listed on REMUMEs compared to reference lists.
• To use the World Health Organization Essential Medicines List (WHO-LIST) as a benchmark for evaluating municipal drug selection.

Main Methods:

• Interviews with municipal health secretaries regarding REMUME selection processes.
• Analysis of antidepressants and benzodiazepines included in REMUMEs and established reference lists.
• Calculation of drug usage based on defined daily doses (DDD) per 10,000 inhabitants for drugs on and off reference lists.

Main Results:

• REMUMEs were developed by local professionals lacking specific training or explicit selection criteria.
• A significant proportion of drugs on municipal lists were absent from reference lists (7 drugs, 8 products).
• Unlisted antidepressants accounted for 25.1% of usage (60.9 DDD/10,000 inhabitants-day), and unlisted benzodiazepines for 14.7% (18.5 DDD/10,000 inhabitants-day).

Conclusions:

• Brazilian municipal drug selection processes lack rigor.
• A substantial volume of essential psychiatric medications used in Brazil are not included in established reference lists.
• The use of unlisted essential psychiatric medicines contributes to public health and social problems.