Self-medication: the other side of the coin
There is ample anecdotal evidence pointing to the fact that the practice of self-medication ( which simply connotes the use of medication without medical advice) is widespread. It cuts across all cultures regardless of their level of development and the accessibility of healthcare. All types of medications are involved : pharmaceutical drugs, herbal preparations etc… etc…
Self-medication is an interesting subject for researchers in Rational Drug Use. It used to be the topic of my doctoral thesis back in 1986. As one of the manifestations of our right as human beings to act on our own bodies, self-medication has far- reaching psychological dimensions that cannot be encompassed here. Another interesting aspect is that self-medication can be as much active (when we are our own culprit) as it can be passive (when we take drugs on the advice of a lay person). Also, it is worthy to note that the practice correlates closely with the individual’s perception of his or her own symptoms (whether those symptoms are perceived as trivial or life threatening) and his/ her understanding of the pharmacological properties of the drug in question such as indications, contra-indications, side-effects etc… ( which is a function of his/her level of literacy). Not to mention the appropriate dosing regimen. Thus, a person is likely to self-medicate when he/she considers that there’s no need to see a Doctor for a particular problem. No matter the perspective from which it is viewed, self-medication can have deleterious consequences for our health.
The obvious question therefore can be formulated as follows : to self-medicate or not to self-medicate ?
That is the question. And as we’ll soon discover, attempting to answer that question only raises more questions.
But first of all, let us limit ourselves to pharmacy drugs only, since they are readily accessible and constitute the mainstay of our health delivery system.
Self-medication using over the counter drugs (i.e. non-prescription drugs) for a limited period of time is permissible though not always desirable. Because it is easy – and somewhat reasonable – to assume that relief provided by self-medication is likely to delay diagnosis and appropriate treatment of common ailments. Remember the dictum that always accompanies drug adverts :” if symptoms persist after three days, consult your Physician”. I would rather prefer : “if symptoms persist after one day, consult your Physician”. Because disease is a dynamic process and every single day counts. But even so, over the counter drugs are only considered relatively safe when they are not abused. Personally, I will not begrudge a patient for taking some pain-killers to relieve a headache while waiting to seek medical attention. Suppose I discover three days later that this patient has a history of peptic ulcer or asthma or kidney problems, then you can be sure I will raise eyebrows.
On the other hand, self-medication is frowned upon and indeed may pose health hazards when over the counter drugs are misused or abused or when prescription-only drugs are obtained illegally and used rightly or wrongly. Left over drugs from previous prescriptions as well as outright purchase of restricted drugs are the number one source of dangerous self-medication. The other aspect is when we decide to re-use an old prescription simply because “the medicine worked well for us the last time”. In a profit-driven economy, pharmaceutical ethics can easily be thrown to the wind and laws governing the dispensing of drugs easily flouted. Thus, it is relatively easy in our environment to obtain certain drugs without a Doctor’s prescription.
Another interesting twist to dangerous self-medication is when a person invents his/her own indication for a particular drug, a situation that may expose possible addiction. During my medical school days, it was common practice for “bad girls” to swallow large quantities of Chloroquine tablets in order to induce an abortion. Sadly, this practice never ended on a happy note. I don’t know the new recipe trending these days.
One of the most worrisome aspects of self-medication for public health practitioners is the misuse of antibiotics, a class of drugs used to fight infections in the body. Already, appropriate prescription of antibiotics is something that is governed by rigorous principles. Unlike other drugs, new antibiotics need to be developed every day and the dosage regimes of the existing ones need to be constantly reviewed. Meanwhile a drug for treating high blood pressure discovered over fifty years ago is still being used with excellent results. Why ?. Because most people are able to obtain by hook or crook antibiotics but fail to take them correctly. And so a phenomenon known as “ resistance” rears its head, forcing scientists to go back to the drawing board in order to come out with new drugs that can overcome the many resistance patterns identified. So, next time you take antibiotics (hopefully they are prescribed by a Doctor) for an infection (gonorrhea for example) and it is as if nothing has happened (your gonorrhea is still with you), consider the possibility that you might have been infected with a resistant strain of the germ that causes gonorrhea. Then you might equally consider the possibility that sometime somewhere in the community, some sufferers of gonorrhea, instead of seeking medical attention, have embarked on their own clinical trials using antibiotics indiscriminately and recklessly. This is how misuse of antibiotic drugs can become a public health concern.
So, clearly, some amount of health education is needed to ensure that self-medication is practised safely. Drug adverts must be regulated and rules and regulations governing the sale of drugs to the general public strictly adhered to. Policy makers and especially Pharmacists have a greater responsibility in this. Particularly, Pharmacists must ensure they only employ the services of trained pharmacy assistants to man their retail outlets.
To self-medicate or not to self-medicate ? The choice is yours !
Stephen Akangah, MD
[email protected] (for comments and contributions).
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