Self-care is not always effective, and this does not only apply to medication wrongly taken because it is left over from old prescriptions, or discontinued or changed in an arbitrary and inappropriate manner, but also self-medication or do-it-yourself medicines. Modern medicine is often excessive and increasingly leads to people taking medication without clear prescriptive instructions. The problems associated with taking medicines are a major cause of illness and mortality, and represent a significant burden on healthcare resources. Several studies have shown a high rate of adverse reactions among hospitalised patients,1-4 however, only a recent study5 has provided data on the rate of adverse reactions directly correlated to self-medication.
Do-it-yourself is contraindicated
A prospective study, which lasted eight weeks and was conducted in the Emergency Room of eleven university hospitals in France, involved all the adult patients who had arbitrarily used prescribed or non-prescribed medicines. Specifically, referring to the definition of the World Health Organisation according to which "self-medication is the selection and use of medicines by individuals to treat self-recognised illnesses or symptoms," the authors of the research asked all patients accessing the Emergency Room to answer a questionnaire, and included those who met the following categories:
- taking non-prescription medicines (non-prescription or OTC drugs, medicines left over from old prescriptions or prescribed for another person);
- arbitrary modification of medication;
- arbitrary interruption of medication.
Out of 4,661 patients surveyed, 3,027 met the inclusion criteria, with a median age of 43 years; 53.5% were women, 16 of which were pregnant. Of the 3,027 patients included, 59.9% claimed to take at least one form of medicine and 63.7% met the criteria of self-medication in the two weeks prior to fill the questionnaire. From a pharmaceutical perspective, 32.5% (n = 3,848) of 11,724 medicines declared was taken within the established parameters of self-medication and, of these, the most common were analgesics (n = 2,184, 75 %). Between the medicines involved in self-medication, the most frequently used were non-prescription or OTC (50.5%), followed by prescription medicine from a previous prescription (19.9%) or subject to conditions (14.5%), then medicine obtained in Internet (1.2%) or other sources (6.5%). Regarding the rate of adverse reactions recorded, 9.8% (n = 296) experienced an adverse reaction, which could only be correlated to the criteria of self-medication in 52 cases (1.72%). Adverse reactions related to non-prescription and OTC medicines affected 1% of all subjects who reported taking this type of medication (n = 1,927). The young age range and the categorisation of the medicine under medication group N (Central Nervous System) were independent factors associated with adverse reactions related to self-medication. Psycholeptics and analgesics were, in fact, the medication groups most involved and the most frequent adverse reactions to self-medication were neurological and psychiatric.
It is comforting that the study found the rate of adverse reactions related to self-medication to be relatively low: 17.6% of patients who had at least one adverse reaction (52/296), i.e. 1.7% of the study population (52/3,027) or 2% of patients meeting the self-medication criteria (52/2,556). However, the figures resulting from this research show that the risk of adverse reactions, which can be serious and result in hospitalisation (36.5%, 95% confidence interval from 24.5 to 50.1), should be weighed against the benefits that may derive from self-medication. Non-prescription and OTC medicines are useful, easily accessible to all citizens and represent important, readily available tools. Their consumption is difficult to control, partly because the advertising and marketing operations undertaken by pharmaceutical companies "attack" consumers, greatly increasing the attractiveness of medicines sold without a doctor's supervision, though taking them involves a number of risks, especially possible interactions with other medicines, foods and drinks. The risk of adverse reactions is increased through uncontrolled use of these categories of medicines, together with treatment based on medicines with a prescription that are inappropriate or unsound because they have been selected arbitrarily by the individual.
What can be done?
A useful and important action would be to trace the use of medicines after the adverse reactions were adequately disclosed, in order to ensure the most appropriate regulatory actions. Citizens are often unaware of the consequences of self-medication, including in terms of health care costs. It is necessary to work within the logic of integrated medicine management between health care professionals and the public, to raise awareness that do-it-yourself self-care is not always good, that medical advice should not be avoided under any circumstances, that the use of non-prescription and OTC medicines is not without risks and that appropriate medication is fundamental to the care itself.
University of Bologna, Department of Medical and Surgical Sciences, Unit of Clinical and Experimental Pharmacology
- JAMA 1998;279:1200-5. CDI NS
- Brit Med J 2004;329:15-9. CDI
- Intensive Care Med 2010;36:1033-7. CDI
- N Engl J Med 2011;365:2002-12. CDI
- Drug Saf 2013;36:1159-68. CDI