Unsafe use of medicine a key global problem

It is estimated that more than half of all medication consumed is prescribed, dispensed or sold inappropriately. It is also estimated that half of all patients fail to take medication correctly (World Health Organisation. Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines No. 5 www.who.int/medicines).

Treatment with medication is one of the most cost effective medical interventions known, and takes up a large proportion of the total world health budget. It is therefore extremely unfortunate that such a precious resource is being used in an inappropriate way.

According to the World Health Organisation, rational use of medicines requires that “patients receive medication appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community” (World Health Organisation. The Rational Use of Drugs. Report of the Conference of Experts 1985).

Simply, medication can be defined as a chemical compound that alters body function, and can be used to treat disease or relieve symptoms of disease.

The irrational and inappropriate use of medication can be initiated by the patient, the caregiver, the medicine vendor, or a combination of all of them. This situation has resulted in wastage of scarce resources and widespread health risks to patients and communities.

There are many documented examples of inappropriate use of medication. One is use of too many medicines per patient also known as poly pharmacy or “machine gun” therapy.

This is not only very expensive to the patient; it also increases the side effects and interactions of these drugs. Heavy pill burden also leads to poor compliance and poor treatment outcomes.

Inappropriate use of antibiotics is a big problem today. Antibiotics are prescribed and consumed haphazardly for non-bacterial infections, for an inappropriate length of time and in inadequate dosage, and second and third line antibiotics are frequently prescribed without the acceptable criteria.

Ideally these drugs should only be used after the basic antibiotics have failed, and there is laboratory evidence of the same. Misusing antibiotics can be devastating. First, it is a gross waste of resources as these drugs are quite expensive. Second and perhaps more tragic is the emergence of superbugs, which are resistant to available antibiotics.

Prescribing injectable medicine, when suitable medicine can be taken through the mouth. Injection is an invasive procedure and a riskier route than oral administration. It requires trained personnel and is more expensive because of materials required such as syringes and needles.

Failure to follow set guidelines when prescribing medication has become prevalent in the medical fraternity. Guidelines are derived after long periods of research and study and are meant to unify and organise the management of medical conditions. Research papers are published to justify the use of these guidelines.

Inappropriate self-medication, often of prescription-only medication, in a bid to save on medical consultation costs, is a big problem. A patient spends a lot on money on inappropriate and expensive therapy, before finally seeking medical assistance after not feeling better.

Noncompliance to dosage regimens due to forgetfulness, intolerable side effects or as a cost-cutting measure. Noncompliance leads to treatment failure, and higher costs of retreatment.

Some medication can have intolerable side effects, like nausea, vomiting, headache, mouth dryness and even bleeding tendencies and kidney and liver problems Patients simply abandon the medication before checking with the doctor.

The simple guidelines below will help use medication in a rational and safe way.

1) First, always give your doctor a full drug history when you consult, including current medication and side affects you may have suffered in the past.

2) Do not transfer your prescription to another person, even if your symptoms sound similar.

3) If you do not feel better after a day or two of taking medication, please consult your doctor. This is true for prescription medication as well as over-the-counter medication. Do not self-medicate on painkillers for prolonged periods without medical advice.

4) Always complete the course of prescribed antibiotics, even if you feel better after just a few doses.

5) Always ask about possible side effects of medication. This will prepare you when they arise. If they are intolerable, please consult your doctor for alternatives. If the treatment cannot be changed, the doctor will prescribe something to manage the side effects of the medication.

6) Always label all medication clearly, and store it in a safe place out of the reach of children. Instructions to the caregivers should always be very clear, simple and in writing. Clear all common areas of unnecessary medication to reduce the risk of accidental poisoning.

7) Strictly follow the timing for the medication. It has an impact on the treatment. If you forget to take the medication, follow the guidelines you have been given, and ensure you do not take an overdose in the process.

8) Do not share eye, ear and nose drops with others, and always discard any unused drops one week after opening them.

Irrational use of medication is a serious, widespread and costly public health problem. Rational use of this scarce resource for all medical conditions is key to the provision of Universal Health Care and the achievement of Goal 3 of the Sustainable Development goals