PROBLEMS WITH DRUGS IN CROATIA

Croatia has 4.8 million inhabitants, 11,800 physicians, 2000 pharmacis ts, two now shareholding, pharmaceutical companies (about 6500 employe es, total sales of about $350 million). There are a number of problems due to the war (GNP fell from $3800 to about $1500), occupation of 25 % of its territory, 0.5 million refugees and lack of resources (US$139 /capita for health, about $40 i.e. 30%!! for drugs)-about three times less than before the aggression. The drug situation is controlled with the help of: (1) donations (approximate value of $600 million since 1 991 from Europe and US), (2) (essential) drug formularies-250 for outp atients, and 580 generic names for various levels of hospital use, (3) special efforts to purchase drugs of good quality at a reasonable pri ce (a kind of tender), (4) control of prescribing (prescriptions, spec ialists referral) especially by GPs. A new Medicines Act is in prepara tion and about 1000 generic names are on the market. Drug education-Ph armaca: the Croatian journal of pharmacotherapy has been published sin ce 1962, then are several Drug bulletins (one published since 1975); s pecial chapters on clinical pharmacology in textbooks, translation of three editions of Laurence's textbook with special commentary and adap tation to local needs; ADR spontaneous and intensive monitoring (WHO p rogramme) with a personal feedback to the reporters and regular articl es on drug use in a number of periodicals. Data on drug consumption in dicates that there is room for improvement of prescribing. There is an enthusiasm for vasoactive drugs'-after dipirydamole came oxpentifylli ne and antimicrobials are always overprescribed, All these problems wi ll hopefully decrease when the war finally stops and when industry (es pecially tourism) starts being fruitful again. In any case the importa nce of teaching of pharmacotherapy at the under-and postgraduate level should be recognized. (C) 1997 by John Wiley & Sons, Ltd.