Self-medication habit becoming increasingly rampant
Self-medication practice which is the use of medications to treat self-diagnosed or self-recognised illnesses or symptoms without the prescription of healthcare professionals, is becoming a highly prevalent practice in Nigeria. All categories of people which include males and females, elders and youngsters, literates and illiterates, rich and poor, healthy and sick, etc., seem to engage […]
Self-medication practice which is the use of medications to treat self-diagnosed or self-recognised illnesses or symptoms without the prescription of healthcare professionals, is becoming a highly prevalent practice in Nigeria. All categories of people which include males and females, elders and youngsters, literates and illiterates, rich and poor, healthy and sick, etc., seem to engage in this practice. The practice involves purchase and administration of medicines without prescription; resubmitting old prescriptions to purchase medicines that were previously taken; sharing medication with family members, especially infants, children or elderly; using leftover medicines; self-selection of a medication for a chronic or recurrent condition, even if it is after an initial diagnosis and prescription by a physician.
In some instances, self-medication could be a responsible practice if it is limited to the use of non-prescription medicines called Over-The-Counter (OTC) drugs, or some essential medicines in rare cases. In these cases, safe, effective, and qualitative OTC drugs are used for minor illnesses such as headache, body ache, mild stomach discomfort, runny nose, mild constipation, and loose motion etc., which are easily self-diagnosed, or the use of other medicines, for example, salbutamol inhaler for recurrent conditions like asthma that have been previously diagnosed by a physician. If employed correctly, self-medication practice may have a positive impact on individuals and the healthcare system. It often provides a cheap, faster relief to the patient and convenient solution without overwhelming our already congested healthcare centres. Furthermore, medical resources could be saved from being used on minor conditions, and the funds can be redirected to more serious diseases.
However, the most common self-medication practices we are witnessing today in this country is not rational but rather irrational. All forms of medicines that include analgesics and antipyretics, gastrointestinal agents (antacids, laxatives), antibacterials, antimalarials, cardiovascular agents, traditional remedies, anti-allergics, cough medications, psychoactive agents, contraceptives and abortion pills, sexual performance medicines, among others, are being irrationally used extensively. Many people just walk to the pharmacies or other drug outlets to buy drugs for their self-recognised illnesses without consulting any healthcare professionals. Sometimes when selecting such medications, they rely on the advice of their friends or relatives who used a specific medicine to treat a symptom. This kind of practice is associated with several health risks such as adverse drug-drug and drug-food interactions as a result of concurrent administration of many irrelevant medicines for the treatment of a single disease; drug resistance especially with antibiotics (amoxicillin, tetracycline, ciprofloxacin, cephalosporin, etc.); wastage of resources; misdiagnosis leading to wrong medication like in the case of infectious diseases that have different causes (bacteria, virus, fungus, parasites) each requiring a specific treatment; serious health hazards including death as a result of masking of an underlying severe health condition and failure to seek medical advice promptly; failure to recognise contraindications, for example in pregnancy, allergy, ulcer, hypertension, impaired renal function, which some OTC and other drugs can worsen; risk of drug abuse and dependence; incorrect route or manner of drug administration; incorrect dosage or wrong duration of use; and risk of using expired or counterfeited drugs.
People may practise self-medication for a variety of reasons such as urge for self-care; sympathy for family members in sickness; absence of health services or long distance to a healthcare facility; the poor attitude of health workers (rudeness, corruption); misbelief; mildness of the illness; poverty; ignorance; re-treatment of similar illness; exposure to exaggerated advertisements of medicines; availability of medicines in establishments other than pharmacies or approved patent and proprietary medicine vendors (PPMVs). In most parts of Nigeria, medicines are still freely displayed for sale in unauthorised places such as markets, shops, roadside stalls, motor parks, and other public places by unqualified individuals that are not duly licensed. This has also aggravated the problem.
Several measures can be implemented to manage irrational self-medication practices. The government should ensure that essential medicines are available in appropriately functioning healthcare centres at required times, in sufficient amounts, in the proper dosage forms, in assured quality, and at prices which individuals and the community can afford. The cost of healthcare services should be reduced, and strategies should be put in place to ensure efficient healthcare services so that receiving quality healthcare becomes easily accessible and less time-consuming. This can be achieved by strengthening health insurance systems (NHIS and contributory health insurance schemes). The government should also ensure that advertisement of medicines delivers reliable and well-balanced information (including potential adverse reactions) to the patients. Medicines’ regulators such as Pharmacists Council of Nigeria (PCN), NAFDAC, NDLEA should ensure enforcement of rules determining drug supply chains, drug prescription and dispensing. There is also the need for legislation and enforcement of laws to discourage uncontrolled access to prescription-only medications while the OTC drugs should be used only when there is an absolute need. The pharmacists, as competent healthcare professionals of medicines, should lead in providing patients with sound advice on the medicine’s usage. Pharmacists should educate not only the patients but also the co-healthcare workers and the general public on the disadvantages and complications of self-medication. Such awareness should be made periodically and be supported by health ministries. The educational intervention to either (or both) the patients and the healthcare providers is one of the best strategies to deal with the issues of irrational self-medication practices. Physicians should prescribe the least complex drug regimen as possible to the patient, especially the older ones. These measures may help in mitigating the self-medication practices and its consequences to our communities.
Pharm. Nafiu Aminu, Ph.D., Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto [email protected]