뜨거운 감자 ’닥터나우’. 거부할 수 없는 세계 흐름인가 아니면 국민 보건을 위협하는 무법자인가?

 ‘닥터나우’는 원격 진료 및 약 배달 서비스를 제공하는 앱이다. 이 중, 약 배달의 경우 현 약사법을 위반하는 서비스이기 때문에 많은 논란을 불러일으키고 있다. 

 

 ‘닥터나우’는 2020년 7월 ‘배달약국’이라는 이름으로 첫 서비스를 선보인 이후 약사법 위반 등의 원인으로 사업을 잠시 중단했었다.  정부가 병원 내 코로나 19 전파를 막는다는 목적으로 한시적으로 전화 상담 및 처방, 대리처방을 허용하면서 2020년 11월 ‘닥터나우’는 서비스를 재개하였다. 현재 월간 활성 사용자 수(MAU)가 10만 명, 누적 이용자 수는 30만 명으로 구글 플레이스토어 전체 앱 인기 순위에서 다섯 손가락 안에 든다. 

  

 최근 약사 단체는 약사법 위반 등을 이유로 ‘닥터나우’ 제휴 약국 대규모 탈퇴 운동과 보건복지부 항의 방문 등 집단 행위에 나섰다. 약 배달 서비스가 약사법에서 금지된 이유는 향정신성의약품 등을 비롯한 약 오남용 문제로 인해 국민 건강이 위협당할 수 있기 때문이었다. “향정신성의약품”이란 인간의 중추신경계에 작용하는 것으로서 이를 오용하거나 남용할 경우 인체에 심각한 위해가 있다고 인정되는 약물로 ‘마약류 관리에 관한 법률’에 의해 정해져 있다. 

 

표 1. 마약류 관리에 관한 법률을 참조한 향정신성의약품 종류

향정신성의약품 종류
가목	의료용으로도 쓰이지 않아 사실상 마약과 마찬가지인 약물들이다.	고메오 (5-Meo-DiPT), 크라톰, LSD
나목	암페타민 계통의 약물들이 주종을 이룬다.	메트암페타민, 메틸페니데이트, 살비아 디비노럼, 암페타민, 케타민, 펜사이클리딘, MDMA
다목	바르비투르산, 바르비투르산의 이성질체 및 그 염류 일체, 그리고 소수의 벤조디아제핀	바르비탈, 플루니트라제팜
라목	벤조디아제핀을 비롯한 안정제, 수면제, 마취제 등	벤조디아제핀, 카틴, 프로포폴, GHB, 졸피뎀, 덱스트로메토르판, 펜터민

 

 닥터나우에서 코로나 19와 같은 비상시가 아닐 때 배달할 수 있는 의약품의 경우, 안전상비의약품 정도로 한정될 것이다. 안전상비의약품은 허가 받은 24시간 무휴점포에서도 처방전 없이 구매할 수 있는 의약품이다. 안전상비의약품은 현재 해열진통제 5종, 종합감기약 2종, 소화제 4종, 붙이는 소염진통제 2종으로 총 13개 품목이 있다. 

 

표 2. 안전상비의약품 목록. (출처: 보건복지부)

효능군	품목명
해열진통제	타이레놀정 500mg, 타이레놀정 160mg, 어린이용타이레놀정 80mg, 어린이타이레놀현탁액, 어린이부루펜시럽
감기약	판콜에이내복액, 판피린티정
소화제	베아제정, 닥터베아제정, 훼스탈골드정, 훼스탈플러스정
파스	제일쿨파프, 신신파스아렉스
계	13개 품목

 

 ‘닥터나우’ 는 글로벌 기업들과 경쟁을 하기 위해서 의료 분야에 남아있는 여러 오래된 규제들을 풀어주어야 한다는 입장이다. 닥터나우의 장지호 대표는 2021년 7월 9일에 “약사회에서 걱정하는 ‘기업형 약국’이 등장하기에는 우리나라가 약사만 약국을 개설할 수 있는 사회여서 어렵다고 생각한다. 또한 지금도 약국은 배송 업체로부터 약을 받기 때문에 도매로 약을 받을 때는 문제가 없고 환자들에게 배송해 줄 때는 문제가 있다고 보는 건 모순이다. “라고 인터뷰했다. 

 

 이러한 ‘닥터나우’의 주장에도 불구하고 ‘닥터나우’에 대해 의사회와 약사회는 반대하고 있는 입장이다. 원격 진료가 막을 수 없는 세계의 흐름이라고 하더라도 우리나라는 수가를 정부에서 정해주기 때문에 이러한 중개 플랫폼이 공적 영역인지 사적 영역인지도 생각해봐야 할 문제이다. 또한 의료는 국민 건강에 직결되는 분야이기 때문에 엄격한 규제가 존재하는 것인데, 무작정 세계화시키거나 혁신이 필요하다는 것은 섣부른 생각일 수 있다. ‘닥터나우’ 사측에서는 코로나 이후의 사업 방침에 관련해 아직 정해진 것이 없다고 하였다. 앞으로 ‘닥터나우’의 행보가 예측이 안가는 이유이다. 따라서 ‘닥터나우’의 추가 행보와 원격 진료 및 약 배달 서비스의 변화를 꾸준히 지켜볼 필요가 있어 보인다. 

 

A hot potato ‘Dr. Now’, an irresistible global trend or an outlaw who threatens public health?

 ‘Dr. Now’ is an app that provides telemedicine and drug delivery services. The drug delivery service is causing much controversy because it violates the current Korean pharmaceutical affairs Act. Since its first service under the name of ‘Delivery Pharmacy’ was introduced in July 2020, ‘Dr. Now’ has temporarily suspended its business due to violations of the Pharmaceutical affairs Act. Then in November 2020, Dr. Now resumed its service, allowing phone counseling, prescription and proxy prescriptions for a limited time to prevent the spread of Corona 19 in hospitals. Currently, the number of active users per month (MAU) is 100,000 and the cumulative number of users is 300,000, ranking among the top five in the popularity list of Google Play Store apps.

 

 Recently, pharmacist groups have launched mass acts such as a mass withdrawal movement from the ‘Dr. Now affiliated pharmacy’ and a visit to the Ministry of Health and Welfare to protest, citing violations of the Pharmaceutical affairs Act. The reason why drug delivery services are banned in the Pharmaceutical affairs Act is that the public's health can be threatened by problems of drug misuse, including psychotropic substances and other drugs. The term "psychotropic substances" is a drug that acts on the central nervous system of humans and is deemed to be seriously harmful to the human body if abused or misused, and is prescribed by the Narcotics control act.

 

Table 1. Types of psychotropic substances referenced to the Act on Narcotics control

Types of psychotropic substances
A type	These drugs are virtually the same as drugs because they are not even used for medical purposes.	Foxy, Mitragyna speciosa, LSD
B type	Amphetamine-based drugs are the main types.	methamphetamine, methylphenidate, Salvia Divinorum, Amphetamine, ketamine, phencyclidine, MDMA
C type	Barbituric acid, isomer of Barbituric acid and all of its salts, and a few benzodiazepines.	barbital, Flunitrazepam
D type	Benzodiazepines, stabilizers, sleeping anesthetics, etc.	Khat, benzodiazepine, Propofol, GHB, zolpidem, dextromethorphan, phentermine

 Drugs that Dr. Now can deliver in non-emergency cases will be limited to safety-related medicines. In the case of over-the-counter drugs, they can be purchased over the counter even at an authorized 24-hour convenient store. There are currently five types of anti-fever medicine, two types of general cold medicine, four types of digestive medicine, and two types of anti-inflammatory painkillers that are attached.

 

Table 2. over-the-counter drugs (Source: Ministry of Health and Welfare). 

Type of medicine	Species
antipyretic-analgesics	Tylenol 500mg tablet, Tylenol 160mg tablet, children’s Tylenol 80mg tablet, Children’s Tylenol suspension, Brufen Syrup for Children
Medicine for a cold	Pancol A Sol., Panpyrin-T Tab.
Digestive medicine	bearse, doctor bearse, festal plus, festal gold
Pain relief patch	Jeil coolPap, sinsinpas Rx
total	13 species

 

 ‘Dr. Now’ says “it should release many of the old regulations in the medical sector to compete with global companies.” Jang Ji-ho, CEO of Dr. Now, said on July 9, 2021, "I think it is difficult for Korea to open a corporate pharmacy which is a concern of the Korean Pharmaceutical Association, only because it is a society where only pharmacists can open one for a pharmacy. Also, since pharmacies still receive medicine from delivery companies, it is contradictory to think that there is no problem when receiving medicine wholesale and there is a problem when delivering it to patients."

 

 Despite of Dr. Now's claims, the doctors' association and the pharmacists' association are opposed to Dr. Now. Even if telemedicine is an unstoppable trend in the world, it is also a matter of considering whether such a brokerage platform is a public or private area as the government sets the price. Also, it may be premature to think that regulations against medical care should be globalized because medical care is a field directly related to public health. The "Dr. Now" management said nothing has been decided on the post-Corona business policy. This is why Dr. Now's move is unpredictable in the future. Therefore, it seems necessary to keep an eye on the additional steps of Dr. Now with changes in telemedicine and drug delivery services.