By Dr Labeeb Mir
Self-medication is an important topic of discussion in a developing country like India. In simple words “self-medication” is use of medications for self-treatment without consultation of a physician for diagnosis and treatment. According to WHO guidelines “Self-medication is defined as medication taken on the patient’s own initiative or on the advice of pharmacist or any other lay Person”.
In Kashmir majority of the pharmacies sell drugs (medicines) to a customer without a proper prescription as is the case in many other states of India. Now when we talk about Self-medications a very common term comes to our mind, “Over The Counter” (OTC) drugs, that can be purchased without a valid prescription for some common minor ailments which can save time and money for the patients. Although OTC drugs are meant for self-medication, their improper use due to lack of knowledge can have serious side-effects. The growth in self-medications that we are seeing in Kashmir can be attributed to urge to self-care, feeling of sympathy towards family members in sickness, lack of health services, poverty, unawareness and easy availability of drugs.
Very commonly a patient with fever, cold, cough, diarrhoea, etc. will receive expert advices from his/her family members, neighbours or even total strangers about medications, specifically about usage of antibiotics. A very common practice we see in our homes is the urge of usage of antibiotics like Co-Amoxyclav 625 and Azithromycin, which have become household remedies for the treatment of common cold which more often than not is attributed to a viral infection expected to be self-resolving and requiring nothing more than good hydration. Sharing of prescriptions within the family, using the left over medications for somewhat similar symptoms is quite a common practices in our homes.
There are also people who do not take their illness seriously or people busy in their daily lives who do not see the need to consult a doctor and believe all they need to do is just book an appointment with Dr.Google and pop a few pills to get better.
They take anything ranging from cough syrups, anti-allergic medicines, and antacids to antibiotics without getting a professional opinion.
People need to understand that the dangers of treating Google as a doctor can be confusing and unlike a trained experienced professional it does not take into account clinical examination and factors like personal and Family history before making a diagnosis. In Kashmir, unfortunately pharmacists also play a role in aggravating the already existing problem. Many of them act as self-styled doctors (Quack) and do not hesitate to illegally prescribe drugs based on the symptoms of their customer.
At that particular time nothing untoward is expected to happen upon following such advice but it can still be quite dangerous going forward like development of drug resistance following irrational use of Antibiotics, Peptic ulcer Disease following the ludicrous use of NSAID’s (Pain Killers). Apart from other reasons, both clinical experiences and documented evidences attribute self-medication as one of the possible causes of Kidney damage leading to Kidney failure. From putting an individual at rare but severe adverse effects, self-medications also plays a big role in delayed diagnosis, failure to recognise contraindications and warnings, inadequate or excessive dosage, excessively prolonged use and risk of dependence and abuse.
There is a need for authorities to strengthen the existing laws regarding OTC drug sales to ensure their rational sale and use. The Drugs and Cosmetics Act, 1940, and the Drugs and Cosmetics Rules, 1945, have guidelines on the sale of Schedule H and Schedule X drugs. These can be sold only on prescription.
To put an end to ever increasing antibiotic resistance, antibiotic usage on the patient's own initiative should be completely banned. Further immediate actions are needed to prevent harms induced by Self-medication practices, such as enhanced accessibility towards medical services, coverage of health insurance by the government, and lowering the medical expenses.
Thus, education on the health impact of Self-medication practices should be initiated at the community level and regulations on the medication instructions must be reinforced by the regulating authorities and governing bodies. Healthcare authorities and governing bodies should educate the public about the adverse consequences of self-medication practices and cut down these practices. A forum or workshop should be organized for community pharmacists regularly to update and improve their knowledge. In simple ways, awareness about self-medication can be created through media such as newspaper, magazine and TV. Health professionals have to spend some extra time in educating patients regarding the same. Improved knowledge and understanding about self-medication may result in rationale use and thus limit emerging microbial resistance issues.
(Dr Labeeb Mir is PG Resident and can be mailed at email@example.com)