Introduction
The habit of self-medication according to Njoku (2010) is fast becoming a very common practice in many countries mainly due to easy availability of over the counter (OTC) drugs in market, lack of access to health care, lack of effect medication usage policy and poor drug regulatory practices.
In the opinion of Olufemi, Komene and Ayodeji (2013), self-medication is referred to as a situation where an individual self-administer drugs without a doctor’s advice. They also added that this situation include the use medications which may be recommended by a medical doctor to a family member or a friend for a similar ailment. The practice of self-medication was said to beattributed to lack of time to see a doctor; inability to get a quick appointment, illness may be too mild and long distance away. Too much information culled from textbooks, internet or magazines makepeople confident about treating their own illness or a doctor’s fees may be unaffordable.
Sanghani, Zaveri and Patel (2008) attributed the practice of self-medication to theperception on the consequences of medication which in most cases is accompanied with self-diagnosis.Perception on self-medication exposes people toseveral dangers include allergic reactions, damage to many organs, misuse and abuse of medications, treatment of symptoms instead of the main ailment, that may be severe or even fatal (Banerjee & Bhadury, 2010).
Perception on self-medication is greatly influenced by the understanding of the people on the concept of ailment and the attainment of good health which is determine by the individual level of education, socio-economic status, family background, access to health care facilities, etc.(Khantzian, 2007).
Conceptual framework
World Health Organisation(WHO) (2008) stated that self-medication involves the use of medicinal products by the consumer to care for self-recognized disorders or symptoms, or the intermittent or continued use of a medication prescribed by a physician for chronic or recurring health conditions.
Gupta and Jindal (2013) referred to self-medication as the care given to common health problems with medicines especially designed and labelled for use without medical supervision and approved as safe and effective for such use. Medicines for self-medication are often called ‘non-prescription’ or ‘over the counter’ (OTC) and are available without a doctor’s prescription through pharmacies. In some countries OTC products are also available in supermarkets and other outlets (Jain, 2011).
In the opinion of Khantzian (2007), self-medication is the use of non-prescription medicines by people through using their own initiative. It was also defined by Afolabi (2008) as obtaining and consuming medicationwithout professional supervision, which comprises of acquiring medicines without a prescription, purchasing drugs by resubmitting/reutilizing an old prescription, taking medicines on advice of relative or others, or consuming left-over medicines already available at home.
Historical perspective on self medication
Man has used drugs for various purposes from the dawn of history. The World Health Organisation (2008) stated that before 200 BC, herbal and other plant derived remedies were the most frequently used therapies worldwide. Plant-derived remedies can contain chemicals with potent pharmacologic and toxicologic properties (Mississippi Weekly Report, 2013).
Between 1438 to 1533 which was noted as the ancient civilization of South America came cocaine obtained from the leaves of Erythroxyl on coca which was chewed for pleasure and reduction of fatigue. Extracts of cacti and mushroom species, used for religious purposes among Central and North American Indians can be used as a hallucinogenic agent. In Africa, eserine, a component of miotic eyedrops develops from Calabar beans used in fetish practices. Bronchiodilatory effects of ephedra develops from ephedra plants species in ancients China while digitalis, a potent heart stimulant was developed from purple foxglove, an ingredient of herbal folk medicine in England (Olatunde, 2009).
In modern times, self-medication had also been derived from other sources outside plants. In the southern United States of America, certain foods are used to reduce the excess volume of ‘blood’ which was believed to cause the illnesses; in Latin America, certain foods are used to counteract ‘hot’ or ‘cold’ illness and to restore the body equilibrium(Hellman, 2011); in the majority of Xhosa speaking women of South Africa, indigenous healing practices are used for themselves and their babies because of the needto ‘strengthen’ the womb against sorcery.(Abrahams, Jewkes & Mvo, 2012).
Reasons for self medication
The common reasons could be to cure an ailment, suppress its cause indefinitely to give the body time to completely overcome it or for prevention, prophylaxis, palliation, convenience, postponing a natural event, out of habit or for special purposes (Olatunde, 2009).
Brownlee (2010) stated that in specific health condition like acute non-specificdiarrhoea, people self-medicated because the ailments were of short duration, can be managed symptomatically with non-prescription medications and adequate hydration and do not require a visit to the physician office. In addition he stated that in the case of chronic illnesses, it could be the cost of medication, patient’s psychological status, perceptions of the seriousness of their illness and vulnerability to complications. Afolabi (2008) stated that for antimalarials, self-medication with orthodox medication commonly used in comparison with traditional remedies because of their efficiency, popularity, cheapness and availability, distance and cost of seeking care from the formal health service and cultural beliefs.
Acute headache sufferers may care for themselves with OTC if they perceive it to be more adequate than prescribed drugs. Reasons for using psychoactive drugs among the young people range from insomnia, worry or depression to intoxication while smokers may self-treat negative effects like major depression with nicotine (Bock, Goldstein & Marcus, 2006).
Prevalence of self-medication practice
The practice of self-medication is widespread all over the world specially urban and educated population. Individuals tend to self-medicate to the extent feasible due to their knowledge about both diseases and drugs. Several studies have reported prevalence of self-medication varying from 55-78% (Sanghani, Zaveri & Patel, 2008).
Dupe (2008) in a study of undergraduates in Delta State University, Abraka reported a prevalence of 82% of self-medication among students which is somewhat higher than what was reported by Abay and Amelo (2010) who reported 77% cases of self-medication among medical, pharmacy and health science students in Gondar University Ethiopia and lower than reported by Badiger (2012) reporting 92% prevalence in a study of 200 medical students in South India.
The most important reason for variation in the prevalence of self-medication is easy availability of different categories of medicines both OTC and prescription drugs to consumers. Other factors favouring self-medication are acquired knowledge of medicines, convenience and saving time due to no need of consulting a doctor. It is also observed in that most cases of self-medication are for minor common ailments like fever, headache, cough, etc.
Risks associated with self-medication
The risks associated with self-medication as identified by Olatunde (2009) are:
- Delayed diagnosis
- Unfavourable side effects
- Recurring illness syndrome
- Drug intolerance
- Organ damage
- Delayed diagnosis: Self-medication can lead to serious side effects and unfavourable reactions. For instance, Jain (2011) asserted that self-medication therapy may be poorly suited for the illness in question, delay diagnosis and the beginning ofeffective therapy, increased inorganic risk(s) due to inadequate drug therapy or of unnecessary expenseand drug interaction between prescription and non-prescription drugs.
- Unfavourable side effects: Philip (2009) linked the side effects of self-medication with lack of knowledge about the drug prior to its usage. For example, insufficient curative care with chloroquine (CQ)for individuals who care for themselves for suspected malaria fever could result in resistance to plasmodium falciparum – the agent causing the ailment.
- Recurring illness syndrome: With respect to OTC medications, Halle and Sloas (2007) reported risks associated with the improper use includes addiction, gastric irritation, liver toxicity, rebound headache syndrome, milk alkali syndrome; dental caries from prolonged usage ofself-administered mineral supplement containing lactose; liver toxicity/failure following prolonged use of analgesic containing paracetamol for dental pain; peripheral neuropathy and subdermal vascular dermatosis following Vitamin B6 megatherapy; cholinergic excess, loss ofconsciousness and seizure following cutaneous application of Diazinon, an organophosphate insecticide for pubic lice.In addition, laxative abuse causing ammonium renal urate calculi, gastrointestinal fluid and electrolyte loss resulting in chronic extracellular volume depletion and intracellular acidosis had also been reported. Self-administered oral diuretics could result in pseudo-barter syndrome. Topical anaesthetic abuse of the cornea with subsequent fungal (candida) keratitis and severe toxic keratopathy had been reported (Rocha, Brunnette & Le-Francois, 2005).
- Drug intolerance: Sometimes, the side effect which could be dermatological tends to be the primary cause of drug intolerance. For instance, cutaneous manifestation of psoriatic arthritis could be exacerbated with ibuprofen self-therapy, fixed pigmented eruptions could be manifestation of such drugs, which if unrecognized, might be fatal if such a drug was repeated (Villette, Rybojad&Puissant, 2009).
- Organ damage: Among the elderly, adverse reaction to drugs are characteristically more frequent and severe as a result of factors including self-medication. In the case of substance abuse, depending on the substance used, it may result in organ damage, medical complications, vascular injury, less than satisfactory quality of life and depression. Among alcoholics, male and female fertility can be interfered with drug use before hospital admission is a source of potential drug toxicity and may obscure the diagnosis of infective illness and delay hospital stay. It has been shown that the five most common adverse events following self-medication related hospitalization were upper gastrointestinal bleeding, skin rashes, hypoglycaemia, hypercorticism and hepatitis (Afolabi & Adekanle, 2008).
Self-medication and dependency
The abuse of various self-medication compounds for chronic illnesses may or frequently lead to a state of dependency. Aspirin, acetaminophen and caffeine were the most frequently abused among chronic headache sufferers. Substance abuse and drug dependency have multiple causes ranging from poor instructions from the physician, improper diagnosis with gradual increase inamount consumed, a re-enforcement mechanism and brain stimulation effects. For instance, cocaine acts directly on the “pleasure centres” of the brain to release dopamine which triggers an intense craving for more of the drug otherwise a painful withdrawal change persist. It therefore produces pleasurable sensation of “reward” and physical dependence (Elkind, 2011).
Nicotine, the psychoactive ingredient in cigarettes is an addictive agent that can stimulate and relax the user. Hence, some smokers self-treat negative moods with it. Approximately, 30% of women from a study conducted in the United States, smoke cigarette during pregnancy despite its deleterious effect on the mother and foetus.The beverage, alcohol (ethanol) was so commonly consumed that it is seldom thought of as a drug. When consumed in small quantity, it induces a feeling of well-being and relaxation while in large amounts, intoxication is produced. It can therefore be used as a form of self-medication to achieve any of these states. It may also be used to cope with perceived problem of sexuality (Roman, 2008).
The relationship between self-medication and drug dependency was explained with the self-medication hypothesis of addictive disorders defined by Khantzian as motivation of patients to seek a specific drug (reinforcement mechanism) for relief of a particular set of symptoms for adaptive purposes. However, not all cases of drug dependencies follow this hypothesis because there are traits or changes which separate various groups of drug dependent individuals. As a result, Khantzian revisited his theory in 2013 and stated that there was growing clinical support for the significant relationship between substance abuse disorders and psychiatric disorders as opposed to simple personality. Hence, people who are not receiving proper mental health care are attempting to self-medicate for their disorders by using illicit substances (Elkind, 2011).
Solutions to the practice of self-medication
To curb the practice of self-medication, Sanghani, Zaveri and Patel (2008) suggest measures to reduce the practice of self-medication which include:
- Enforcement of drug dispensing laws
- Certification of drug store operators
- Availability of health care centres
- Affordability of health care services
- Health education
- Enforcement of drug dispensing laws: The government should ensure that there is proper enforcement of laws towards dispensing of drugs by drug stores and retailers by ensuring that drug are only dispensed to consumers based on prescription from a qualified medical practitioner.
- Certification of drug store operators:Government should put measures in place to ensure that only qualified pharmacists are allowed to sell drugs in drug stores.
- Availability of health care centres:Health care centres should be located in all community to bring qualified medical professionals nearer to the people especially in rural community, by building more health centres and equip it with basic health facilities.
- Affordability of health care services: One of the major promoters of the practice of self-medication is due to non-affordability of medical services. Government should make subsidize medical services to make it affordable for common man if the government cannot afford free health for all.
- Health education: The general public enlightened or educated by creating awareness the more through social/community mobilization on the dangers associated with self-medication and the need to desist from its practices (Elkind, 2011).
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