Retail Pharmacy Practice Differences in Iran

On a recent trip to the beautiful country of Iran, I decided to pop into a neighborhood pharmacy to purchase some artificial tears and also check out the pharmacy practices. Within a few minutes, I noticed some striking differences with retail pharmacy practice at home in the United States.

• No labels. When dispensing medications, there is no system to type up the prescription and generate a label. The medications are dispensed in the unit-dosed manufacturer packaging.
• More OTC. Most medications are available without a prescription. One exception to this general rule is opioids. However, in speaking with some local residents, it’s not impossible to obtain opioids without a prescription.
• Cheaper drugs. The medications are MUCH cheaper. For example, the bottle of artificial tears I purchased cost approximately 1000 rials, which is about 25 cents. One dose of emergency contraception (levonorgestrel 1.5 mg) costs the equivalent of $1.30 in US dollars, compared to the US price tag of $40-50 for the same medication.
• Family planning. I noticed condoms on the countertop immediately. Condoms are also called “condoms” in Iran where the official language is Persian. When I asked if they carried something that can be used to prevent pregnancy after sex in the Persian language, the pharmacist asked me in English “morning after?” and grabbed a box of levonorgestrel 1.5 mg. I inquired about the ease of obtaining hormonal contraceptives from some local residents and they explained these medications used to be available for free and only recently must be paid for. Generally the residents I spoke to found birth control to be widely available and accessible. This is in line with the family planning program successes in Iran. Their unintended pregnancy rate is ~20%.¹ To put this in perspective, 45% of pregnancies in the US are unintended. Unfortunately, abortion is illegal in Iran.
• OTC kept behind the counter. All medications are kept behind the pharmacy counter. So clients ask the pharmacy staff to pull any medications they’d like to purchase. There was nothing on the client side of the counter (i.e., no personal care products, gifts, etc). Walking into the pharmacy was essentially walking into a U-shaped counter.
• No injections. The pharmacists are unable to administer vaccines and other injectables. Patients can go to the pharmacy to pick up their vaccine, but then must take it to a clinic to be administered by another health care professional.
• No white coats. None of the pharmacy staff were wearing white coats or badges.

After speaking to local residents, pharmacy is a desirable career for the earning potential since most pharmacists own independent pharmacies. On the other hand, it’s not desired among other health careers due to the extent of training and limited scope of practice. There did appear to be a general sentiment of wanting to do more with their training and skills among pharmacists. Despite some differences in our pharmacy systems, there do appear to be some similarities in training and expanding clinical practices.

It’s possible that some of my observations cannot be generalized to pharmacy practices across the entire country of Iran. I was in the southern city of Shiraz. This city has a population of about 1.5 million, making it the sixth most populous city in Iran.

Reference

Erfani, A. Levels, trends, and determinants of unintended pregnancy in Iran: the role of contraceptive failures. Stud Fam Plann. 2013 Sep;44(3):299-317.