It’s surprising that many people see no problem with self-medication but the question remains; why would people engage in self-medication, are they aware of the dangers it poses on health? These medicines are often referred to as ‘over-the-counter’ or ‘non-prescription’, and are found in pharmacies, supermarkets and other outlets. Examples of over-the-counter medication include painkillers, like paracetamol, ibuprofen, low-dose codeine and aspirin, among others, and cough suppressants such as dextromethorphan, to mention a few. However, medical experts maintain that self-medication, which is basically buying medicine without a prescription from a doctor, is not a safe practice. Dr Floribert Biziyaremye, the in-charge of tuberculosis and other respiratory communicable diseases division at Rwanda Biomedical Centre, says that in most cases, people use over-the-counter medicine without a prescription, with one aim— to ease short-term mild-to-moderate pain. The ailments include headaches, cramps, muscle and joint ache and even toothaches. Some use them to lower a fever, for example, if one has a cold. WHAT YOU NEED TO KNOW People take drugs without the prescription of a doctor for a number of reasons. While some aim for a reduction in the time and cost of clinical consultation, others simply trivialise illnesses and resort to self-medication. Other factors could be due to personal insecurities and fear of job loss due to diagnosed disease, mental illness, quick relief of pain, depression or even ignorance. Dr Biziyaremye says research shows that self-medication can lead to adverse reactions and should be avoided at all times. It is risky for non-medical personnel to prescribe medication. He says self-medication is the use of medications without prior medical consultation regarding indication, dosage, and duration of treatment. He notes that people must know that self-medication is not free of risk, which can increase the burden and out-of-pocket expenses since it may result in adverse health effects that require medical intervention. He explains that when it comes to self-medication, it is potentially an unsafe practice with many risks. The risks, Dr Biziyaremye says, include incorrect self-diagnosis, delays in seeking medical advice when needed, infrequent but severe adverse reactions, dangerous drug-drug interaction, incorrect manner of drug administration, incorrect dosage, incorrect choice of therapy, masking of severe disease and risk of dependence and abuse, among others. Self-medication might seem right at first, but one needs to consider the potential side effects of such uninformed actions. Self-medication can also, allergy, habituation, worsening of ailment, or even disability and pre-mature death. IMPACT According to RedCare, a health information platform, a point to note is that pharmacists also play a huge role in the issue of self-medication. In a haste to make a lot of money, some pharmacists encourage people to buy their drugs without a doctor’s prescription. And in some cases, they even prescribe the drugs for their customers. This is wrong because the pharmacist is charged with the duty of dispensing drugs. It is the doctor who prescribes these drugs. The major risks caused by irrational self-medication, Dr Biziyaremye says, include poor diagnosis and incorrect drug selection and non-compliance with guidelines. “What happens is that many people rely on their own previous experiences, or their choices based on the recommendations from friends. This is one of the reasons one will prefer to self-medicate than seek a proper diagnosis,” he says. However, he points out that if the patient’s diagnosis of their condition is incorrect, their consequential drug selection may aggravate their condition, or even cause additional problems that may make subsequent medical intervention problematic. Dr Janvier Rusizana, a general practitioner at La Nouvelle Clinic in Remera, says the understanding of pharmaceutical properties of different medications is a critical basis for appropriate drug selection according to need. He says people may randomly prolong use, misuse medications, or combine treatment with other contraindicated drugs, leading to adverse interactions and reactions, inappropriate, incorrect, or undue therapy. This, according to Dr Rusizana, can as well lead to missed diagnosis, delay in inappropriate treatment, pathogen resistance, increased morbidity and dependence on some medicines. In cases of mere headaches, flu, fatigue, and other mild pains, Dr Rusizana says, most of the time, the feeling of physical pain is a sign of a given disease; therefore, it is advisable to seek medical attention from medical personnel to provide adequate medication. WHAT HAPPENS WITH SELF-MEDICATION? According to Dr Rachna Pande, a specialist in internal medicine, self-medication is not a good practice and should be avoided at any cost. She says people should know that many acute conditions like flu subside spontaneously and no medication is needed. Therefore, people should drop the habit of reaching for over-the-counter medicine without a prescription. For instance, she notes that in case one has the flu, on pharmacological interventions like steam inhalation, drinking warm water always provide relief in symptoms. “When one self-medicates, they inadvertently expose themselves to adverse effects of drugs, which may be severe at times,” she says. For example, she says some anti-vomiting drugs can lead to stiffness and deviation of one side of a face (dyskinesia). Whereas, anti-cold medication can cause excess somnolence. Dr Pande adds that for people taking cough syrups without prescription, it can lead to blurred vision, dry mouth, or drowsiness, among others. For people who like or prefer mixing various tablets, Dr Pande says this can increase the risk of drug interactions, whereas one drug influences another in such a way to affect its efficacy or increase its toxicity. Self-medicating on antacid drugs (used to reduce stomach acid) with anti-diabetic medicine, like glibenclamide, she says can increase its blood levels leading to low blood sugar. When self-mediation is applied, Dr Pande says one is likely to take an incorrect dose, thus not getting desired results or suffering more from adverse effects. Dr Francis Kazungu, a general practitioner in Kigali, warns against people self-medication, saying that a minor health issue which can easily be resolved with an expert’s advice may become a major problem over time. He says the problem with using over-the-counter medicine without a prescription is that the symptoms tend to diminish temporarily, but become difficult for a health practitioner to correctly diagnose and treat the problem later, when complications occur. Another serious problem when it comes to self-medication, he says, is that a person could as well become addicted to some drugs, such as antacids, cough syrups and pain relievers. He adds that some antibiotics, such as penicillin or sulpha drugs, can cause severe reactions in the body for some people. ANTIBIOTIC RESISTANCE Where antibiotics are concerned, Dr Biziyaremye says taking them when not necessary and or taking an incorrect dose, increases the risk of making the infectious microbes resistant to them; which according to him, is a serious global concern. He notes that antibiotic resistance occurs naturally, but misuse of antibiotics in humans and even animals accelerates the process. “The irrational self-medication leads to the abuse of antibiotics and consequently increases the risk of developing the resistance,” Dr Biziyaremye says. He further explains that suppressing the symptoms for acute conditions with self-medication may lead to a serious underlying condition and delay the diagnosis as well. For instance, Dr Biziyaremye says, one may take paracetamol for a fever and headache, which may be due to a serious underlying infection, like meningitis. Pande explains that with self-medication, it will reduce the pain slightly, thus delaying detection and timely treatment of the condition. “A person practicing self-medication in a bid to avoid visiting a doctor due to lack or fear of expenses in the hospital may end up being hospitalised, which will see them spending more and at the same time, in a critical condition,” she says. editorial@newtimesrwanda.com
