Introduction
Self-medication is the treatment of common health problems with medicines that are taken on patient’s own initiative or on advice of a pharmacist, without professional supervision. It is now becoming a common practice in many countries mainly due to lack of access to health care, easy availability of over the counter (OTC) drugs in market and poor drug regulatory practices (Kumari, Kumar, Bahl & Gupta, 2012).
Khandelwal, Deb, and Gonslaves (2013) defined self-medication as the use of drugs without a doctor’s advice. Medicines may be recommended by a family member or a friend or a pharmacist. Reasons for self-medication are 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 the internet or magazines make people confident about treating their own illness or a doctor’s fees may be unaffordable.
Banerjee and Bhadury (2010) warned that there are several dangers associated with self-medication which include habituation, allergic reactions that may be severe or even fatal. They further stressed that under-dosage may not cure the symptom while over-dosage can produce colossal damage to many organs. In addition people who engage in self-medication being unaware of the appropriate drugs for the particular illnesses, their doses, and adverse effects, the misuse of medications as prescribed by the pharmacist, or a family member, or anyone in general may lead to such people literally playing with their lives at their own mercy (Khandelwal, et al., 2013)
The concept of self-medication
According to WHO (2008), self-medication involves the use of medicinal products by the consumer to treat self-recognized disorders or symptoms, or the intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms. In practice, it also includes use of the medication of family members, especially where the treatment of children or the elderly is involved.
Gupta and Jindal (2013) referred to self-medication is the treatment of 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 ‘nonprescription’ 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. Medicines that require a doctor’s prescription are called prescription products (Rx products).
In the opinion of Khantzian (2007), self-medication is the use of non-prescription medicines by people through using their own initiative. It has also been defined as obtaining and consuming medication without 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.
The most widely self-medicated substances are OTC drugs such as dietary supplements, pain-killers, cough and cold remedies, anti-allergy medicines, vitamins and energy tonics. Although these medications are considered risk-free and useful for the treatment of common health problems, their excessive use can also lead to serious side-effects and unfavourable reactions. The psychology of self-medicating with psychoactive drugs is typically within the specific context of using recreational drugs, alcohol, comfort food, and other forms of behaviour to alleviate symptoms of mental distress, stress and anxiety, including mental illnesses and/or psychological trauma, is particularly unique and can serve as a serious detriment to physical and mental health if motivated by addictive mechanisms (Kirstin, 2010).
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).
Individuals acquire knowledge of drugs and skills of drug selection and prescribing through the use of medical books, recurrent usage, internet, seminars, internships, undergraduate training, etc. Some studies have reported prevalence and pattern of self-medication with varying results.
Supe (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, et al. (2012) reporting 92% prevalence in a study of 200 students.
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.
Contributory factors to the practice of self-medication
According to Omolase, Adeleke and Afolabi (2007), contributory factors to the practice of self-medication include a number of factors like socioeconomic factors, lifestyle, ready access to drugs, the increased potential to manage certain illnesses through self-care, and greater availability of medicinal products.
Solomon and Abebe (2013) stated that patient contentment with the healthcare provider, long waiting times, cost of the drugs, educational level, age and gender are the other important factors influencing self-medication. One of the most common reasons for indulging in self-medication includes high cost of private doctor’s consultations. The condition could be worst in rural or distant corners, where the people are deprived socially, economically and educationally with inadequate health facilities. In another study prior familiarity and the non-seriousness of the illness were the top two reported factors for self-medication and reading materials were the top reported source of information. The patient’s assessment of his ailment as been minor was also identified as one of the major factors for self medication in a study conducted in Nigeria (Omolase et al., 2007).
Common drugs used in self-medication
The most common classes of drugs used in self-medication in the are analgesics, in particular, Paracetamol, followed by Non-Steroidal Anti-inflammatory Drugs (NSAIDSs). Other common types of medications are antibiotics, cough syrup and antacids (WHO, 2008).
Omolase et al., (2007) reported that analgesics (non-narcotics) especially NSAIDs are the most common class of medications used in the self-medication practices in Nigeria. This according to their report is because such drugs are used to treat simple common illness, example, headache, fever and pain. This practice of using the afore-mentioned medication without doctor’s prescription is due to the general assumption that they can be safely used in self-medication without causing harm to the consumer. However, Baruzaig and Bashrahil (2008) warned that NSAIDs have their own possible adverse effects if they are misused and abused, mainly hepatic dysfunction and renal failure.
Consequences of the practice of self-medication
Mohan, Pandey and Verma (2010) stated that people who engage in the practice of self medication are usually exposed to several consequences which vary from one group of person to another depending on the type of drug used in self medication. The effect of self-medication where classified according to the nature of drug used in self medication as follows:
- Antibiotics: Self-medication using antibiotics exposes consumers to allergic reactions especially penicillin. Immediate, sudden incapacitation may occur with anaphylaxis or asthma. Less dramatic but still potentially dangerous effects such as skin rashes, photosensitivity reactions and urticaria too are known to occur. Bone marrow toxicity can also develop with some antibiotics, notably chloramphenicol. The resulting anaemia or decreased resistance to infection poses a risk to consumers since it may be appear after a while and may take time before being diagnosed. Also ototoxicity (toxic effect on inner ear) occurs primarily with the polypeptide group of antibiotics which are ordinarily reserved for more severe infections. Either hearing loss or disequilibrium may result and may result in disabling effect (Mohan et al., 2010).
- Pain relieving drugs:Most of the pain relieving drugs though by and large innocuous drugs, on occasions have been known to lead to serious effects especially when taken on empty stomach or in combination with alcohol. This could lead to serious bleeding from the stomach and intestines (Baruzig & Bashrahil, 2008).
- Anti-allergic drugs: Anti-allergic drugs are commonly used for relief from running nose or cold, cough or itching with rashes. Their adverse effects include drowsiness, inattention, confusion, mental depression, dizziness and impaired depth perception (Abay & Amelo, 2010).
- Nasal drops:Ephedrine nasal drops are commonly advised to relieve “stuffed or blocked nose”. Some people habitually use nasal drops to relieve airway obstruction. The lining of the inside on nostrils is very richly supplied with blood and medication quickly finds its way in the blood, which may result in side effects like palpitation, nervousness, tremors, lack of coordination and visual disturbances (Solomon & Abebe, 2013).
- “Pep pills”/”go-pills”: Stimulants such as Caffeine, Dextroamphetamine, etc., may be advocated for staying awake during at night; or by a few as “appetite killers” for weight reduction. Their use can be risky and the side effects include a sense of overconfidence, complacency, mental confusion, dizziness or headache (Omolase et al., 2007).
Solutions to the practice of self-medication
To forestall the practice of self-medication, Sanghani et al., (2008) suggest measures to reduce the practice of self-medication which include:
- 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 practitioners.
- 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 lay man should be enlightened or educated on the dangers associated with self-medication and the need to desist from its practices.
