When you play your own doctor

Self-medication is a common practice globally, and includes the use of OTC, as well as both doctor- and paharmacist-prescribed drugs. — dpa

Many minor illnesses may be treated without the supervision of a healthcare provider.

These are common illnesses with little or no risk of permanent injury, e.g. the common cold, worm infestation and dandruff.

The World Health Organization (WHO) defines self-medication as “the selection and use of medicines by individuals to treat self-recognised illnesses or symptoms”.

Although there is no universal definition of self-medication, its practice is widespread globally and is a significant feature of many healthcare systems.

The medicines available for self-medication are over-the-counter (OTC) medicines, prescription-only medicines (prescribed by a doctor) and pharmacist-only medicines (with advice from a pharmacist).

Self-medication is influenced by multiple interacting personal, organisational and environmental factors.

The media, internet and advertisements by the pharmaceutical industry also play an influential role in self-medication.

Inadequacies in the healthcare delivery system like inaccessibility, inequitable distribution of medicines, insufficient healthcare professionals, long waiting times, high costs, patients’ attitudes toward healthcare providers and availability of medicines through the internet are some of the main drivers of self-medication.

A common practice

A 2021 study involving 562 respondents in the Klang Valley, published in the International Journal of Pharmacy Practice, reported the overall frequency of self-medication as 63.5%.

The medicines were obtained from pharmacies without consulting the pharmacist (68.6%), followed by leftover medicines at home (44.8%), and medicines from friends and family (16%).

The consequences of self-medication were viewed positively and may have been influenced by previous personal or shared experiences.

Another 2021 study involving 480 respondents in Kuala Lumpur, published in the Drug, Healthcare and Patient Safety journal, reported that the frequency of self-medication with antibiotics was 15.1%.

More than one in five (23.1%) of the respondents indicated that they had self-administered antibiotics at least once in the preceding six months.

Around two-thirds (64.8%) of the respondents had purchased the antibiotics from pharmacies.

The majority practised self-medication with antibiotics to save time (23.1%) and money (19.2%) .

The commonly-used antibiotics were amoxicillin-clavulanate (20.6%), ampicillin/cloxacillin (14.2%) and levofloxacin (8.3%).

Meanwhile, a 2018 study of 379 pharmacy students at the International Islamic University in Kuantan reported that 84% self-medicated when sick.

The medicines they used were based on information from previous doctors (62.8%) and pharmacists (60.6%).

The study, published in the Journal of Pharmacy Practice and Community Medicine, “revealed a poor knowledge among respondents about self-medication”.

The perceptions towards self-medication were to save time (88.8%) and money (73.7%).

The conditions that the students self-medicated for were sore throat (68.4%), headache (64.9%), fever (64.8%) and cold (60.9%).

The commonly-used medicines were health supplements (29.8%), antipyretics (23.9%) and analgesics (23.4%).

Almost all (90.7%) of respondents believed that self-medication can be practised when the illness is not too serious.

The authors of the above studies concluded that “efforts to educate the public while promoting a more proactive approach among healthcare professionals should be encouraged”; “authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of self-medication with antibiotics for the future” and “the majority of study participants have insufficient knowledge about self-medication. Early exposure to knowledge about self-medication during the undergraduate pharmacy course is imperative to ensure a proper and appropriate way to self-medication among students”.

In short, self-medication is prevalent in Malaysia, with many users having inadequate knowledge about its potential risks and the majority of the purchases being made from pharmacies.

Potential harm

The harms from self-medication include incorrect self- diagnosis, incorrect medicine dosage, worsening of the illness, the masking of more serious illness, adverse drug reactions (ADRs), antibiotic resistance, drug dependence and addiction, poisoning, incapacity, and even death.

Self-medication should not be carried out in several situations, including:

> Chronic health conditions

These include diabetes, high blood pressure, asthma and high cholesterol, among others.

Regular follow-ups are necessary to ensure the condition is well-managed and that the dosages of medicines are carefully adjusted, when necessary, to ensure severe side effects do not occur.

It is important to remember that sudden changes can occur that worsen these conditions.

> Bacterial infections

It is important to ensure that the appropriate medicine is chosen – one that is effective and will not cause harm.

> Certain population groups

These include infants, children and senior citizens.

These groups may be more prone to side effects from the medications, or may require special dosing adjustments.

Whenever self-medication is practised, immediate medical attention should be sought if there is:

• Altered consciousness
• Bluish discolouration of the lips
• Chest pain
• Pain or blood during urination
• Paralysis (i.e. inability to move the face, arms or legs)
• Persistent or severe bleeding or vomiting
• Signs of infection like swelling, redness, pain, heat or pus
• Speech difficulty, and
• Yellow eyes or skin.

Do note that the above list is not exhaustive.

Adverse effects

It is vital to remember that medicines are safe when used as prescribed or as directed on the label, and that there are risks in taking any medicine, vitamin or other types of supplement.

An ADR occurs when a medicine causes harm.

ADRs include allergic reactions, side effects, overmedication and medication errors – all of which have a serious public health threat.

ADRs are on the increase because of the ageing population, the development and use of new medicines, the discovery of new uses for older medicines, and the increased use of medicines for disease treatment and prevention.

Many ADRs are preventable patient safety issues.

It is important to know the name of the medicine used in self-medication and to inform one’s doctor about it as some medicines interact with others, rendering them less effective or increasing the risk of side effects.

Whilst the internet has facilitated self-medication, it is critical to ensure that the information one gets is accurate and current.

Such information is available from healthcare providers and the websites of health regulators or professional healthcare organisations.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.