Nöroloji uzmanı Bülent Boz yazdı: Polikliniklerdeki Pregabalin Bağımlılığı Sorunu

Polikliniklerde madde bağımlılarının hekimleri ilaç yazmaya
zorlaması, uzun zamandır bilinen bir sorundur. Bu sorun büyük hastanelerden çok,
hastaların hekimlere daha kolay ulaşma imkânı bulduğu, güvenlik önlemlerinin
daha düşük olduğu periferdeki ve küçük hastanelerde rastlanmaktadır. Son birkaç
seneye kadar hekimler, hastane yönetimleri ve alınan güvenlik önlemleri ile kısmen
idare edilebilir olan bu durum, günümüzde değişik bir boyuta taşınmıştır.

Önceden toplumda benzodiazepin, amfetamin grubu ilaçlar ve
kenevir türevlerinin bağımlılığı daha sık görülürken, geçen yıllarda ABD
destekli çeteler ve terör örgütleri eliyle narkotik analjezik kullanımı (başta Eroin
olmak üzere) katlanarak artmıştır. Bu durumla paralel olarak, poliklinikleri
Lyrica jenerik ismine sahip Pregabalin molekülünü yazdırmak için taciz eden
yeni bir madde bağımlısı grup gelişmiştir (ilaç firma tarafından ağrı kesici ve
anti-epileptik olarak pazara çıkarılmıştır).

Literatür incelendiğinde, Lyrica’nın eroin bıraktırma
tedavisinde başarılı olduğunu gösteren çalışmalara rastlanabileceği gibi, bundan
daha büyük oranda, eroin bağımlılarının Lyrica kullanma davranışı da
geliştirdikleri, dahası Lyrica kullanımının Eroin’e geçiş öncesi bir basamak
olduğu görülecektir. Bunun yanı sıra, Lyrica kapsüllerinin açılarak damar
yoluyla enjeksiyonunun yapıldığı, sahadaki hekimler tarafından bilinmektedir.
Kısacası, 19. yüzyılın sonunda icat edilen ve akabinde Bayer firması tarafından
legal şekilde pazarlanan Eroin ilacının, bağımlılık ve ölüm bildirimlerinin
artması üzerine devletler tarafından yasaklanmasına benzer bir sürecin başında
olduğumuzu söyleyebiliriz (ilaç firmalarının yüzyıl öncesinden daha nüfuzlu
olması gibi bir ayrıntı hariç).

Geçen günlerde bir meslektaşımızı poliklinikte boğazından
yaralayan kişi de yine Lyrica ve Eroin bağımlısıdır. Bu haberin birçok haber
kanalında “sağlıkta şiddet” başlığı altında tartışılması yanlış olmuştur.
Sağlıkta şiddet elbette toplumda var olan ve çözümü için birçok kurumun
işbirliği yapmasını gerektiren bir olgudur. Buradaki sorun ise sağlıkta şiddet
başlığına indirgenemez, madde bağımlılığı ve ikincil toplumsal etkileri belki
onunla komşu bir sorundur ama sebepleri ve çözümü kabul edilmelidir ki daha farklıdır.

Madde bağımlılığı ile mücadelenin, polisiye tedbirler,
terörle mücadele, AMATEM ve rehabilitasyon merkezlerinin sayısının
arttırılması, genç işsizliğinin azaltılması, eğitim programları gibi birçok
ayağı vardır. Ancak piyasada kolayca bulunan bir ilacın, etkileri ve sonuçları
biliniyorken kısıtlanması da şüphesiz ki gereklidir.

Bu amaçla son zamanlarda Sağlık Bakanlığı çeşitli önlemler
aldı. Lyrica önce normal reçete kapsamından çıkarılarak kırmızı reçete
kapsamına alındı. Daha sonra sadece üçüncü basamak hastanelerde (eğitim
araştırma hastaneleri ve üniversiteler) 3 aylık rapor düzenlenerek
yazılabilmesi halinde geri ödeme kapsamına alındı. Bu önlemler kesinlikle doğru
adımlardır. Ancak yeterli değildir. Madde bağımlılarının polikliniklerdeki
tacizlerine son vermesi için, ilacın kesinlikle yazılamıyor olduğunu bilmeleri
gerekir. Ancak ilaç hala ilgili branşların uzman hekimleri tarafından renkli
reçete sistemine yazılınca, SGK tarafından karşılanmasa da kişiler tarafından
eczanelere bedeli ödenerek alınabilmektedir. Zaten birçok madde bağımlısı,
güvenceli bir işte çalışmıyor olduğundan, ilacı eskiden de hekime yazdırıp
parayla satın alma şeklinde temin etmekteydi.

Atılan adımların sonuç verici olması için, ilaç üzerinde
daha yoğun bir kısıtlanma uygulanmalıdır. Belki reçete kapsamından çıkarılması
ya da en azından sadece seçilmiş merkezlerde yazılabilmesi gibi önlemler
faydalı olabilir. Çünkü ağrı tedavisinde, narkotikler de dahil olmak üzere
birçok alternatif molekül bulunduğu gibi, ilaç bugün epilepsi tedavisinde
neredeyse hiç kullanılmamaktadır. Toplumsal bir sorun apaçıkken, bunu
derinleştirecek ve polikliniklerde başka sorunlara yol açacak bir ilacın
üzerindeki denetim oldukça önemlidir.

İşin bundan sonrası Sağlık Bakanlığı ile uzmanlık
derneklerinin ortak yaklaşımına düşmektedir. Çok yakın bir zamanda, Türk
Nöroloji Derneği, bazı ilaçların SGK tarafından geri ödeme kapsamına alınması
için Danıştay’a haklı bir dava açmıştır; ancak bu davanın kapsamını
incelediğimizde ne yazık ki Pregabalin’in geri ödeme kapsamına alınma talebinin
de bulunduğunu görüyoruz. Türk Nöroloji Derneği yönetim kurulu üyeleri, tahmin
edileceği üzere, büyük, güvenlikli ve hastaların zor ulaştığı merkezlerde
çalışmakta ve yarı yalıtık halleriyle sorunu yakından tanımamaktadır. Sahadaki
binlerce Nörolog, FTR uzmanı ve Ortopedi doktoru ise madde bağımlılarının
yarattığı tehlikenin ortasında ve korumasızdır. Hiçbir polikliniğin kapısında
polis kontrol noktası bulunmaz. Dolayısıyla davacı konumundaki derneğimiz
şikayetini gözden geçirmeli ve Lyrica için Sağlık Bakanlığı’nın uyguladığı
kısıtlamayı desteklemeli, hatta arttırılmasından yana olmalıdır.

Öte yandan Nöroloji, FTR, Ortopedi uzmanlık dernekleri, AMATEM yetkilileri ve Sağlık Bakanlığı’nın ilgili kurulları ortak bir masa oluşturmalı, toplumda büyüyen narkotik madde bağımlılığı ve şüpheli ilaçlar konusunda bir yol haritası çizilmelidir. En son meslektaşımız Kadir Songür’ün bir bağımlı tarafından yaralanmasıyla yeniden gündeme gelen bu sorunun çözümünde artık vakit kaybedilmemelidir. Meslektaşımıza geçmiş olsun dileklerimizi gönderiyor, yeni hadiselerin yaşanmaması için harekete geçilmesini umuyoruz.

Bülent Boz

Nöroloji Uzmanı

Yorumlar

Danielkaw (doğrulanmamış) Per, 20/06/2024 - 09:05

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- 體育博彩
- 彩票遊戲
- 真人荷官遊戲

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- 可通過電腦或移動設備訪問
- 常提供優惠活動和獎金來吸引玩家

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- 部分平台可能接受加密貨幣

4. 法律狀況:
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- 許多線上娛樂城實際上是在國外註冊運營

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- 存在詐騙和不公平遊戲的可能性
- 可能導致賭博成癮問題

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- 監管機構試圖遏制這些平台的發展,但效果有限

重要的是,參與任何形式的線上賭博都存在風險,尤其是在法律地位不明確的情況下。建議公眾謹慎對待,並了解相關法律和潛在風險。

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