A SURVEY STUDY OF SELF-MEDICATION: ABUSE LIABILITY AND SAFE USE OF OTC DRUGS IN UNDERGRADUATE STUDENTS.

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1 wjpmr, 2017,3(1), SJIF Impact Factor: WORLD JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH Research Article ISSN WJPMR A SURVEY STUDY OF SELF-MEDICATION: ABUSE LIABILITY AND SAFE USE OF OTC DRUGS IN UNDERGRADUATE STUDENTS. Rajesh Nawale*, Madhur Joshi and Ajinath Kale Government College of Pharmacy, Aurangabad , Maharashtra, India. *Corresponding Author: Dr. Rajesh Nawale Government College of Pharmacy, Aurangabad , Maharashtra, India. Article Received on 12/12/2016 Article Revised on 01/01/2017 Article Accepted on 22/01/2017 ABSTRACT The over-the-counter drugs are the drugs that are purchased without prescription. They are used for the management of minor ailments. Better information for patients could improve the safety of OTC medicines. Doctors, nurses, and pharmacists will respond to self-medication practices. Improved communication between doctors and pharmacists and the involvement of nurses could bring health care professionals into a new and more constructive interaction. Survey on self-medication, abuse liability and safe use of OTC drugs was conducted amongst the students of Government College of pharmacy, Aurangabad (Maharashtra), India. Participants are well aware about the OTC products. They also know the consequences faced after use of OTC drugs. Most participants consume OTC product for getting relief from pain. Majority numbers of participants are of opinion that OTC drug are moderate safe and must be used in emergency only. KEYWORDS: Over-the-counter drugs, OTC products, self-medication practices. INTRODUCTION The non-prescriptive drugs or over-the-counter drugs (OTCs) are the drugs that are purchased without prescription. [1] The need to save on healthcare spending and the trend to enhance self-care have led to more emphasis on patients taking their own responsibility for the management of minor ailments, including the use of medication that is available without a prescription. Today, a wide range of conditions can be treated using medications that are available over-the-counter (OTC). Some examples of categories of medicines that have been re-classified to non-prescription medication in many countries they are non-steroidal anti inflammatory drugs (NSAIDs), antifungal creams and laxatives. [2] Better information for patients could improve the safety of OTC medicines, but better systems need to be devised for reporting adverse reactions. "Collaborative Care" could bring financial benefits. Doctors, nurses, and pharmacists need to discuss how they will respond to self-medication practices, and ways of rewarding pharmacists for advising patients need to be found. Improved communication between doctors and pharmacists and the involvement of nurses could bring health care professionals into a new and more constructive interaction with each other and with the patient-or the changes required could split the professions as they each try to keep control of medicines. [3] According to the Consumer Healthcare Products Association (CHPA), there are more than 1,00,000 OTC drug products on the market today encompassing about 1,000 significant active ingredients. Out of these products, more than 700 contain ingredients and dosages that were available by prescription less than 30 years ago. [4] Inappropriate use of drugs of all kinds and by different age groups is a growing public health problem worldwide. Inappropriate use of drugs can be classified into either abuse ; typically defined as use of a medication for nonmedical purpose (i.e., experience a mind altering effect), or misuse ; which is the use of medications for a legitimate medical reason, yet in ways other than as directed, in most cases by alteration of either dose or duration of use. While the terms abuse and misuse are used interchangeably when talking about illicit drugs, differentiation between them becomes more important when talking about prescription or OTC medications. Research has shown that opioid analgesics, stimulants, psychotherapeutic drugs, antihistamines, stimulant laxatives and sympathomimetics were among the most widely misused and abused prescribed and OTC medications. [5] THERAPEUTIC CLASSES OF OTC MEDICATIONS Analgesics and antipyretics: Because of the widespread availability and perceived safety of OTC analgesics, selfmedication with these agents has become common place. Many patients are unaware of the potential for toxicity 421

2 and adverse drug interactions associated with the longterm and inappropriate use of OTC analgesics. The currently available analgesics include acetaminophen, aspirin, ibuprofen, and naproxen. Because many patients self-medicate with OTC analgesics and are unawareness of potentially dangerous drug interactions, proper counseling on the appropriate use of these agents can help minimize adverse effects and ensure positive clinical outcomes. [6] Cold, cough, and allergy products: These medications use to treat respiratory disorder characterised by excessive mucus production or increase nasal secretion. Drugs used include antihistaminics like chlorpheniramine, diphenehydramine and promethazine; bronchodilators like salbutamol, terbutaline etc. [7] Gastrointestinal products: They include antacids, antiemetics, digestants, drugs for constipation and diarrhoea. Antacids include sodium bicarbonate, proton pump inhibitors like omeprazole, rabeprazole used to treat acidity. Antiemetics used to treat emesis, motion sickness like ondansetron. Digestants like Unienzyme tab contain digestive enzymes. Antidirrhoeal drug like loperamide used to treat loose motions [7]. Dermatological products: It includes antifungal, antiinfective, anti-inflammatory creams, lotions, ointments. Antifungal creams contain terbinafine, clobestol. Antiinflammatory ointments contain salicylic acid, diclofenac etc [7]. form initially contains the basic information like gender, age, place of student, followed by the questioner related use of OTC products. The survey forms were distributed amongst students. Before commencement of session, basic information about survey was delivered to the students. The questionnaire contains personal information of participants and might be a critical issue for anyone, so for that following things are followed. Informed verbal consent was obtained from all the participants. Those who do not want to participate were not forced to do so. The atmosphere of class maintained free minded so that students can fill the private data in the forms. In the survey forms, anonymousness of the students is maintained for preventing identification of any students with their private information. Cardboard box were placed in the classroom for the collection of forms so that, further identification of the students were avoided, providing the safety and security of the personal information of the students. The forms from the students were collected, numbered and data from the forms was tabulated in MS Excel sheets and analyzed. Total 397 were students from Government College of Pharmacy, Aurangabad (Maharashtra), India participated in the survey. Others: Also, Other topical products (including dermal and vaginal antifungals, anorectal medications, head lice products, hair loss products, and otics), ophthalmic products, oral health care products, menstrual products, nicotine replacement products, weight loss aids, vaginal contraceptives and emergency contraceptives [8]. MATERIAL AND METHOD The present study was conducted in the month of Oct The objective of the present survey was to study the awareness about self-medication, abuse liability of over the counter (OTC) drugs and self-medication among pharmacy students. To determine the reasons behind use of OTC drugs above prescribed drugs. To study the different kinds of drugs those are used; conditions or disorders for which students prefer to take OTC drugs; side effects experienced; to explore students attitude, experience; to describe the ability of students to recognize suspected drug abusers and/or misusers and their potential suggestions and willingness to deal with the problem. This study adopted a cross sectional survey methodology using a self-completed validated anonymous questionnaire (Figure 1). Questionnaires were printed on blank pages along with the multiple choices answers and Yes / No objective answer type of options. [9] The survey 422

3 Figure 1: Survey form. OBSERVATIONS & RESULTS The present survey study was conducted amongst the students of Government College of pharmacy, Aurangabad (Maharashtra), India during the period of October, It was a cross sectional observational study where total 397 participated. All these participants were divided into three age groups. Age group years where 300 participants were from this age group (75.31%). Age group years where 39 participants were from this age group (9.82%). Age group 25 years onwards consists of 4 participants (1.0%). The average age of participants was years. There were 54 participants who have not mentioned their age in the survey form. Among 397 participants, 168 were males (42.31%) and 189 were females (47.60%). There were 40 such participants who have not mentioned their gender. In this survey 111 participants (27.95%) were from rural area and 199 participants (50.12%) were from urban area. Amongst all, 87 were such participants who have not 423

4 mentioned the place. The result obtained from survey indicates that 290 out of 397 participants knew about OTC drugs. (73.04%) and 98 participants did not ever know OTC drugs (24.68%), total 9 participants did not mention the answer. Total 201 participants (67.00%) of the age group years knew about OTC drugs while 91 participants (30.00%) did not know. From the age group years, there were 38 participants (99.0%) knew about OTC drugs, while one participant was not knowing about it. From the age group 25 and above 75% Participants known about OTC drugs and 25% were not known about OTC drugs. From 111 participants of rural area, 76 participants (68.46%) were known to OTC drugs, while 33 participants (29.72%) were not known. From 199 participants of urban area, 148 (74.37%) were known to OTC drugs, while 47 (23.61%) were not known. The participants were asked about for what they prefer to take OTC drugs (Figure 2). Out of 397 participants 83 (21%) preferred OTC drugs for general pain, 48 (12%) prefer to take OTC for acidity, 16 (4%) preferred for cough, 20 (5%) participants preferred OTC products for allergy, 71 (18%) participants preferred for cold or fever and 24 (6%) participants preferred the OTC for other reasons. 135 (34%) participants prefer to take OTC for multiple reasons like cough, cold, pain, fever or any other. On questioning the participants whether they check for the dose of OTC drugs before administration, of them 262 participants (65.99%) checked the dose before administration while 116 (29.12%) do not check the dose before administering OTC drugs. 19 participants haven t recorded any response. Figure 4 revels that total 231 participants preferred to take the OTC medication for 1-3 days, 20 participants chosen OTC drugs for 1 week, 10 participants take OTC for 2 weeks, 3 participants preferred OTC drugs for nearly one month, 90 participants prefer to take OTC drugs up to cure, while 5 participants administered OTC drugs continuously without any particular duration. Moreover, 15 participants prefer OTC for multiple durations of treatment. Figure 4: Duration of OTC products used. Use of any drug does have side effects, similarly 99 participants experienced side effects after using OTC drug products too i.e %, while majority of candidates (total 278) i.e % did not faced any side effects after using OTC drugs. 20 participants remained no responded. Figure 2: Number of individuals takes medicines for various purposes. Participants were asked about from where they get advice to take OTC medications (Figure 3). From total participants 73 got advised by physician, 27 from family members, 11 from friends, 87 got advice from pharmacists and 80 participants got self-medicated, while 8 participants got advice from other sources. 88 participants got advice from multiple sources like physician, pharmacist, family member, friends etc. Out of all those candidates who experienced side effects, only 17% candidates took advised by physician, Total 23% candidates suffered from side effects after being advised by pharmacist, while 35% candidates experienced side effects after taking advice from family member or friends or any other sources. Figure 3: OTC products advices / suggested. Figure 5: Relationship between side effects and advisers to take OTC medicine

5 Total 99 participants (24.93%) experienced side effects. Total 56 participants reported for suffering from gastric irritation or acidity, 39 suffered from nausea and vomiting, 19 faced the fatigue, 38 experienced sedation or drowsiness, 42 experienced euphoria (state of wellbeing), Most of the participants experienced multiple side effects. From figure 6, it reveals that the 27.51% female candidates experienced side effects after administering OTC drugs, while 67.72% did not. Whereas 22.02% male candidates experienced side effects after administering OTC drugs, while 72.02% did not. The participants who actually used the OTC product (291), total 8 participants used OTC because they like those drugs, 37 used for the feeling of pleasure while 21 used for any other reasons and 7 candidates used OTC drugs for multiple purposes. All the participants gave their opinion about the safety of OTC drugs. Of all the participants, 15 considers OTC drugs as very safe, 254 considers moderately safe, 75 considers OTC drugs as not safe, while 19 assumes that OTC drugs are dangerous for use. 34 candidates haven t recorded any response for this. Figure 6: Relationship between side effects observed and gender. It was found that 24.93% of the participants who have experienced side effects, 29% participants took the advice of physician after experiencing side effects. 7% candidates stopped the medication. 29% participants took the advice from pharmacist. 9% candidates changed the medication. 25% candidates took other measures to get rid of side effects. When we try to search for the factors that forces the participants to use OTC medicines out of 397 participants 44 preferred OTC drugs over prescribed drugs to avoid consultation fees, 66 preferred OTC for mild ailments, 50 candidates preferred OTC because of prior experience of self-medication, while 137 used OTC drugs in emergency use. 46 candidates preferred OTC for multiple reasons over prescribed drugs or advice of physician. Figure 8: Safety of OTC drug usage. Participants were asked whether they prefer to use OTC drugs in which type of emergency situations. Figure 9 indicates that total 17 participants were of opinion that they will use it for heart attack, 9 participants will use for high blood pressure, Only 2 participants are of opinion for use in low blood pressure, Total 6 participants for asthma attack, 34 for allergic reactions, 12 use for hypersensitivity and 168 participants might use for pain, while 46 participants use for any other emergency situations. 46 participants might use OTC drugs for multiple emergency situations like heart attack, high blood pressure, low blood pressure, asthma attack etc. Figure 9: Likely emergency situations where OTC drugs might be used. Figure 7: Factors that promotes the individual to prefer OTC drugs over prescription drugs. On questioning participants whether they have seen any case that faced any problem in using OTC drugs % candidates have seen such cases, while 54.91% candidates have not and 5.54% candidates have not recorded any response. All the candidates were asked whether they know the difference between drug abuse and misuse % candidates know the difference, 425

6 while 18.38% candidates don t. 4.3 % candidates have not recorded any response for this. Participants were asked whether they will advise others to take OTC drugs. 65 candidates will advise others to take OTC drugs. 97 will not advice others to take OTC. 159 candidates will advise others to take OTC drugs only in emergency situations. 35 candidates will not at all advice others to take OTC drugs. Total 111 candidates strongly agreed on the fact that OTC drugs must be dispensed through pharmacy only. 181 candidates agreed to this, but 65 candidates are not sure about this, and 18 candidates disagreed and 22 candidates have not recorded any response for this. Among all the participants 87 candidates have warned any one about not to use OTC drugs, while 116 have not. 140 candidates have warned others about not to use OTC for some time. 25 candidates have not at all warned others about not to use OTC drugs. CONCLUSION The percentage of candidates who were aware of OTC drugs was found to be more than the candidates who were unaware. The students were known about the OTC products but still they used it. In the age group of 25 years and above the percentage of candidates who were unaware about OTC drugs increased surprisingly. In rural area the percentage of participants who are aware about OTC was more than the participants who are unaware. Opposite was the case in urban area, the percentage of participants who are aware of OTC drugs was less than the participants who are unaware. Majority of candidates prefer to take OTC drugs for two reasons; cold/fever and pain. While another majority was found who prefer OTC drugs for multiple reasons like acidity, cough, allergy including pain and cold/fever. Numerous candidates use analgesics/antipyretic type of OTC drugs followed by antacid use and then anti-cold medicines. Large number of candidates got advice to use OTC drugs from pharmacist and a considerable number of candidates use OTC as self-medication. Apart from this, there are a group of participants who think that they can get advice by physician. Majority of participants check the dose of OTC drugs before administering, while a very less number of candidates were there who don t check. Large number of candidates uses OTC for 1-3 days only. A considerable number of group of candidates use OTC drugs up to cure. Majority of candidates who use OTC medicines did not face any side effects. sedation. There were a large number of candidates who took advice of physician after experiencing side effects; also majority was found who stopped the medication. Majority of participants might prefer to take OTC in emergency situations. Majority of population is of the opinion that OTC drugs are moderately safe. There were large number of candidates who are unaware of the difference between drug abuse and misuse. Large number of candidates agrees the fact that OTC medicines should be dispensed through pharmacy only. REFERENCES 1. Devang Parikh, B. M. Sattigeri BM, Ashok Kumar, Shruti Brahmbhatt, A survey study on use of over the counter (OTC) drugs among medical students, nursing and and clerical staff of a tertiary care teaching rural hospital. Int J Res Med Sci., 2013; 1(2): A E M Brabers, L Van Dijk, M L Bouvy, J D De Jong1, Where to buy OTC medications? A cross sectional survey investigating consumers confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers, BMJ Open., 2013; 3: e Colin Bradley, Alison Blenkinsopp, The future for self-medication, BMJ, 1996; 3(2). 4. Attitudes and Beliefs About the Use of Over-the- Counter Medicines: A Dose of Reality, A National Survey of Consumers and Health Professionals. 2002; 3 ( 5. Deema Jaber, Nailya Bulatova, Maysa Suyagh, Al- Motassem Yousef and Mayyada Wazaify. Knowledge, Attitude and Opinion of Drug Misuse and Abuse by Pharmacy Students: A Cross- Sectional Study in Jordan, Tropical Journal of Pharmaceutical Research, August 2015; 14(8): A Mark Fendrick, Deborah E Pan and Grace E Johnson. OTC analgesics and drug interactions: clinical implications, 2008 Fendrick et al; licensee BioMed Central Ltd. 7. K. D. Tripathi, Book of Essentials of Medical Pharmacology. Jaypee brothers Medical publishers, PVT. LTD. 2013; 7 th edition Over-The-Counter Medications: Use In General and Special Populations, Therapeutic Errors, Misuse, Storage and Disposal A Resource from the American College of Preventive Medicine, American College of Preventive Medicine. 9. Griffiths MD. A components model of addiction within a biopsychosocial framework. J Subst Use., 2005; 10: Those participants who have observed any side effects, majority suffered from gastric irritation/acidity. There are also a considerable number of candidates who suffered from nausea/vomiting and sedation/drowsiness. While second majority shows multiple side effects including gastric irritation/acidity, nausea/vomiting and 426