6.0Study findings 13
7.0 Discussions 24
8.0 Recommendations 32
9.0 References 32
10.0 Annexure(tools) 33
1.0 INTRODUCTION
Prescription Drug use is the intentional use of medication without prescription i.e in a way other than as prescribed or experience or feeling it causes. Factors responsible for Prescription drug use are lack of knowledge, careless attitude misperceptions about the safety, varied motivation, just to get a feeling of high, relationship difficulties, problems on the job and sedentary lifestyle.
Abuse of prescription drugs can produce serious health effects, including addiction. Commonly abused classes of prescription medications include opioids (for pain), central nervous system depressants (for anxiety and sleep disorders), and stimulants (for ADHD and narcolepsy). Opioids include hydrocortisone (Vicodin®), oxycodone (OxyContin®), propoxyphene (Darvon®), hydromorphone (Dilaudid®), meperidine (Demerol®), and diphenoxylate (Lomotil®). Central nervous system depressants include barbiturates such as pentobarbital sodium (Nembutal®), and benzodiazepines such as diazepam (Valium®) and alprazolam (Xanax®). Stimulants include dextroamphetamine (Dexedrine®).
Long-term use of Opioids or central nervous system depressants can lead to physical dependence and addiction. Opioids can produce drowsiness, constipation and, depending on amount taken, can depress breathing. Central nervous system depressants slow down brain function; if combined with other medications that cause drowsiness or with alcohol, heart rate and respiration can slow down dangerously. Taken repeatedly or in high doses, stimulants can cause anxiety, paranoia, dangerously high body temperatures, irregular heartbeat, or seizures.enidate (Ritalin® and Concerta®), and amphetamines (Adderall®).
Though not very common but it is becoming a major cause of concern in India. According to the study conducted by National Institute of Pharmaceutical and Educational Research (Punjab and Guhwhati) and College of Pharmacy, Indore Intentional drug abuse of prescribed and OTC medicines has climbed steadily. Data from the 2005 National Survey on Drug Use and Health demonstrated that 6.4 million (2.6%) people aged 12 or older had used prescription drugs for nonmedical reasons during the past month. Of these, 4.7 million used pain relievers, 1.8 million used tranquilizers, and 1.1 million used stimulants.
Internationally, the use of OTC medications has been reported as being on the rise. According to the Boston University¸The study, led by the director of Boston University’s Slone Epidemiology Center , looked at antenatal medication use among more than 30,000 women between 1976 and 2008. The authors found that first trimester drug use had increased by around 60% over the past three decades, with antidepressants accounting for the bulk of this rise and multi-drug use increasing even more dramatically.
We would assess the different patterns of prescription drug use among the residents of Dwarka and propose recommendationsfor awareness regarding safe usage of drugs.
2.0 RATIONALE OF STUDY
The use of drug without prescription is growing rapidly in India. The purpose of this study was to determine the prevalence of Prescription drug use and to assess patients’ perceived safety of these medications among citizens of Dwarka. The prevalence of over the counter drugs and other prescription drugs use was estimated and found substantial use of prescription drug use in our study. We recommend a strong patient education program and government legislative control over the sale of medications in the country. There are studies which have been done internationally but there is hardly any findings done that have been done in India. Hence this study is being proposed.
3.0 REVIEW OF LITERATURE-
The nonmedical use of prescription or over-the-counter (OTC) medications implies that the user is using them for reasons other than those indicated in the prescribing literature or on the box label. The abuse of these medications is a national issue. Intentional drug abuse of prescribed and OTC medicines has climbed steadily. Data from the 2005 National Survey on Drug Use and Health demonstrated that 6.4 million (2.6%) people aged 12 or older had used prescription drugs for nonmedical reasons during the past month. Of these, 4.7 million used pain relievers, 1.8 million used tranquilizers, and 1.1 million used stimulants. The nonmedical use of prescription drugs in the past month among young adults aged 18 to 25 increased from 5.4% in 2002 to 6.3% in 2005, primarily because of an increase in the abusive use of pain relievers. Physicians need to watch for prescription and OTC medication abuse. Treatment strategies include (1) inquiring about prescription, OTC, and herbal drug use at the initial examination (even though many individuals are drug-abuse savvy, some are naive and do not realize that OTC medications can be problematic); (2) inquiring about drug use during office visits; (3) providing disposal containers that patients can use to dispose of their unused or unneeded prescription or OTC medications; (4) treating pain aggressively and appropriately; (5) practicing careful record keeping of prescription refills and controls over prescription blanks; (6) referring patients who are addicted to medications to 12-step programs such as Alcoholic Anonymous, Narcotics Anonymous, and Pills Anonymous; and (7) considering detoxification
3.1 PRESCRIPTION DRUG ABUSE STUDIES INTERNATIONALLY
- According to Canadian Centre on Substance Abuse (CCSA) a report was prepared by Dr. John Weekes, Senior Research Associate, Research and Policy Division,Dr. Jürgen Rehm, Centre for Addiction and Mental Health and University of Toronto, and Rebecca Mugford, Research Assistant, Research and Policy Division, CCSA. It is intended to provide current, objective and empirically-based information to guide the discussion on prescription drug abuse in Canada.
Available evidence suggests that Canadians are among the heaviest consumers of psychotropic medication in the world.
However, there are few Canadian statistics on the number of people who use prescription drugs for nonmedical purposes. Indeed, there is minimal research information available regarding the extent of prescription drug diversion and abuse in Canada.
As a result, indirect inferences about the extent of prescription drug abuse in Canada are usually limited to examining distribution and sales statistics, and year-to-year trends in prescribing practices for specific classes of drugs. Forinstance, in 2002, Canada reported the fourth highest per-capita use of prescription narcotics in the world and the
second highest use of sedative-hypnotics (including benzodiazepines).
During that year, Canada was also among the top 15 countries in the use of prescription amphetamines. Although national and provincial prescription data may reveal a rise in the rate at which some psychotropic substances are prescribed in Canada, such information is not a direct indicator of the extent of abuse; rather, this increase could simply indicate changes in legitimate treatment of pain and other medical disorders.
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According to Australian Institute of Criminology, the National Drug Strategy Household Survey, a triennial survey that measures drug use trends in a random sample of Australian households. The 2007 National Drug Strategy Household Survey surveyed over 23,000 households and found that after cannabis (9%), non-medical pharmaceutical use (4%) was the most common illicit drug use category reported for the previous 12 months (AIHW 2008). Painkillers/analgesics (3%) followed by tranquillisers/sleeping pills (1%) were the most common types of pharmaceuticals used. Over half (53%) of those who had recently (in the previous 12 months) used painkillers most frequently obtained them from a shop or retail outlet, while recent users of tranquillisers most commonly nominated a ‘friend or acquaintance’ as their source of supply (40%). A national study of injecting drug users in Australia (n=909) showed that for 18 percent of the sample, morphine was the pharmaceutical opioid injected most often in the month prior to interview. Ten percent had injected pharmaceutical stimulants, including dexamphetamine and methylphenidate, and nine percent had injected benzodiazepines in the previous six months
- Prescription drug use remains a significant problem in the United States.
NIDA- In 2009, approximately 7.0 million persons were current users of psychotherapeutic drugs taken nonmedically (2.8 percent of the U.S. population). This class of drugs is broadly described as those targeting the central nervous system, including drugs used to treat psychiatric disorders (NSDUH, 2009). The medications most commonly abused are:
- Pain relievers - 5.3 million
- Tranquilizers - 2.0 million
- Stimulants - 1.3 million
- Sedatives - 0.4 million
Among adolescents, prescription and over-the-counter medications account for most of the frequently abused drugs by high school seniors (excluding tobacco and alcohol).Nearly 1 in 12 high school seniors reported nonmedical use of Vicodin; 1 in 20 reported abuse of OxyContin.
When asked how prescription pain relievers were obtained for nonmedical use, 59% of 12th graders said they were given to them by a friend or relative. The number obtaining them over the internet was negligable.Among those who abuse prescription drugs, high rates of other risky behaviors, including abuse of other drugs and alcohol, have also been reported.(3)
3.2 INDIAN STUDY ON PRESCRIPTION DRUG USE
J Am Board Fam Med. 2005 Mar-Apr;21(2):175 –Data from the 2005 National Survey on Drug Use and Health demonstrated that 6.4 million (2.6%) people aged12 or older had used prescription drugs for nonmedical reasons during the past month. Of these,4.7 million used pain relievers, 1.8 million used tranquilizers, and 1.1 million used stimulants.
The nonmedical use of prescription drugs among young adults aged 18 to 25 increased from 5.4% in 2002 to 6.3% in 2005, primarily because of an increase in the abusive use of pain relievers(4)
4.0 OBJECTIVES-:
4.1 GENERAL OBJECTIVE----
- To evaluate the different patterns of prescription drug among residents of Dwarka over the last one year and propose recommendations regarding safe usage of drugs.
4.2 SPECIFIC OBJECTIVES--
- To assess the different patterns of prescription drug use among the residents of Dwarka over a period of one year.
- To determine the awareness among people of Dwarka regarding safety drug medication.
3. To propose recommendations for awareness regarding safe use of drugs.
5.0 METHODOLOGY
5.1 Study Design: Cross-sectional, descriptive study.
5.2 Study Area: Residents of Dwarka
5.3 Study Population-:-
1.The people residing in Dwarka
2.Health care providers of Dwarka
3.Chemists of Dwarka
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Sampling size: 100
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Sampling method: simple random sampling
5.6 TOOL: a. Questionnaire b. Interview schedule
5.7TECHNIQUE: a. Giving close ended question b. interview
- STUDY FINDING
Demographic Profile of Respondant
TABLE: 1 GENERAL PROFILE FOR DWARKA RESIDENTS
The demographic variables indicate that prescription drug use practices are more prevalent among married males (58%) as compared to females(42%).. To a surprise one can observe that such practices are more commonly seen in well educated graduates i.e 64% . According to the results such practice is also more commonly seen in the employed people with a monthly earning of 30,000+ i.e 51% and least commonly seen in people with monthly income less than 10,000 i.e 2% .Of these 39% belong to the service class followed by the bussiness class i.e 24% which suggests that mostly this practice accounts to lack of time or a hectic schedule. In the families with 3-4 members the practice counts to 90% that is almost all members are participatory in this practice.
TABLE 2:REFERENCE FOR TREATMENT &PURCHASE DECISION
FIGURE 1:REFERENCE FOR TREATMENT
It is seen that in preference for private clinics is the most common i.e 75% while preference for government hospitals is least common i.e 16% . Also the people show an inclination towards consulting the local chemists i.e 55%. Local healer, ayurvedic & homeopathy are the least common preferences being 7%, 0% & 5% respectively.
FIGURE 2: PURCHASE DECISION
Purchase decision accounts to sometimes being 76% & never being 8%, this illustrates the extent to which taking drugs without prescription is common.
TABLE:3 COMMON AILMENTS ,GENERAL FREQUENCY OF INTAKE OF MEDICINE&NUMBER OF MEMBERS OF FAMILY PRACTISING PRESCRIPTION DRUG USE
FIGURE 3: COMMON AILMENTS
The above data reveals that most common ailment for which people take drugs without prescription is headache around 75% and then for fever which is 73%. Around 49% of people takes drugs without prescription for cold and cough and 37% of people for pain.
For acidity 21% of people take drugs without prescription and for vomiting 12% of people take drugs without prescription and only 7% for diarrhoea.
FIGURE4:FREQUENCY OF INTAKE IN A DAY
FIGURE 5: FREQUENCY OF INTAKE IN WEEK
FIGURE 6: FREQUENCY OF INTAKE IN MONTH
FIGURE 7: FAMILY MEMBERS TAKING DRUGS WITHOUT PRESCRIPTON
Regarding the frequency of intake of drugs in a day is highest upto 16%twice a day, followed by 14% which is thrice a day and only 5%people take drugs without prescription once daily. In a week ,the frequency of intake of drugs is highest upto 15%which is thrice a week, followed by 14% twice a week and only 4% once a week.Whereas in a month, the frequency of intake of drugs is highest upto 7% twice a month, then 5% 4times a month and only 2% thrice a month ,4% once a month.
Most of the people have nuclear families i.e all the 3 to 4 members of the family take drug without prescription which constitutes upto 50%.Then ,2members of the family take drugs without prescription constitutes 31%.more than 4 members takes drugs without prescription constitute 4% and only 1 member who takes drugs without prescription constitutes 2%
However no member in the family takes drugs without prescription constitutes 13%.
TABLE 4:- PREFERENCE OF THE MEDICINES AMONG PEOPLE OF DWARKA
The above table signifies the crocin is mostly preferred medicines by the residents of Dwarka in medical illness like fever and headache ,closely followed by disprin .Also antiallergics like cetrizine ,antacids and antibiotics are least preferred drugs by the residents
FIGURE 8:PREFERRED MEDICINES
TABLE 5-: FREQUENCY OF PREFERRED MEDICINES
The above table gives us the idea about the frequency of preferred medicines i.e disprin and crocin have the maximum consumption among the residents
FIGURE 9: FREQUENCY OF PREFERRED MEDICINES
TABLE 6- KNOWLEDGE OF DOSAGE
The above table signifies that majority of the people in Dwarka are ignorant about the knowledge of dosage about the various drugs and are consuming the drugs without any prior knowledge of their dosages.
FIGURE 10: KNOWLEDGE OF DRUGS
TABLE 7- KNOWLEDGE OF SIDE EFFECTS-:
Around 68% people state that they do not have knowledge of side effects of the drugs.also they state that the reason behind this practice is because of laziness to go to a doctor that is 52% followed by a hectic shedule that is 25%.
The influencing factor as seen by the results clearly indicate that 50% of people are into such practices under the influence of their family while 42% under their friends, and the least being 2% under the influence of their relatives.
TABLE 8:- CONSULTING DIFFERENT DOCTORS-:
According to the survey conducted by us 48 % of people prefer to consult different doctors for any ailment/disease.
FIGURE 11: PEOPLE CONSULTING DIFFERENT DOCTORS
Reasons for consulting different doctors for any ailment/disease
30 people out of 48% said that they do not find medicine effective then they prefer consulting different doctors
18 people out of 48% said that they prefer consulting different doctors for second opinion
7.0 DISCUSSIONS-:
FIGURE 12
FIGURE13:
FIGURE 14:
FIGURE 15:
FIGURE 16:
FIGURE 17:
The data was analyzed and the discussions are as follows-:
- The data was analyzed and the pattern of prescription drug use among people found the most prevalent in well educated graduates i.e 64% as compared to the not so well educated i.e 4%.
- Such practice is also more commonly seen in the employed people with a monthly earning of 30,000+ i.e 51% and least commonly seen in people with monthly income less than 10,000 i.e 2%.
- It is seen that in preference for private clinics is the most common i.e 75%.
- Most common ailment for which people take drugs without prescription is headache around 75% and then for fever which is 73%
and crocin being most preferred medicine closely followed by disprins.
- Majority of the people in Dwarka are ignorant about the knowledge of dosage AND its side effects.
- Also review of literature reveals that practices of prescription drug use is more common in married females where as in our study in Dwarka we found that it is more prevelant among married males.
-
Also in previous studies it is stated that mostly abused drugs are psychotherapeutic drugs and pain relievers where as in our study in Dwarka most of the people abused antipyretics
HEALTH CARE PROVIDERS-:
- When they were interviewed they said that they don’t encourage people to take drugs without prescription AND ask them to first undergo a physical examination as its not an ethical practice.
CHEMISTS-:
- When they were interviewed they said that the various reasons for people asking the drugs without prescription are-:
You know them personally and over the counter drugs for cough and common cold are sold most frequently as people know about these diseases and Because of lazyness,high fees of doctor,tight time schedule and unacceptable behavior of doctor people prevent going to doctors.They said that they were very well aware of the DRUGS AND COSMETICS ACT,1940 but the competition is so much that if one doesn’t gives it the other chemist would give the drug and a chemist can only earn by selling his medicines so they give drugs without prescription on the demand of customers.
LIMITATIONS
There are a number of limitations that flow from the sample size and research design.
- The population interviewed consisted of a sample of only 100 people and 2 chemists and 2 health providers, some of the patterns identified may have been under or overestimated.
- The calculations were based on reports provided by the interviewees, some of whom were very conscious during the questionnaires due to which levels of awareness among people could not be properly analyzed and there could be some biasness in the report.
- It was difficult to convince the hospital authority for conducting the survey of doctors during the hospital hours and once this hurdle was overcome, the doctors in hurry filled the questionnaire, due to which some patterns may be under or over estimated.
- Due to time constraints we could interview separately only 2 health care providers and 2 chemists due to which again some of the patterns may be under or overestimated.
8.0RECOMMENDATIONS
Recommendation suggested are--
- Awareness regarding side-effects and dosage of the prescription drug use
- To educate the people by making advertisement at commercial level by using banners, organizing cultural programmes, entertainment education regarding its ill effect on health.
- To conduct doctor education program on rational drug prescribing and consumer education on rational drug use
- We should develop and use a standardized ideal format for all prescriptions
- Irrational prescribing is a habit that is difficult to cure however prevention is possible by short problem based training programs in pharmacotherapy.
- The patients should receive evidence based cost effective treatments for their health problems
9.0 REFERENCES-:
-
director of Boston University’s Slone Epidemiology Center looked at antenatal medication use among more than 30,000 women between 1976 and 2008, American Journal of Obstetrics & Gynecology.
- Sgt. Tracy Busby, supervisor of the Calaveras County, Calif., Sheriff’s Office narcotics unit.(2007) Florida Department of Law Enforcement. ;website -
www.nytimes.com;
- WEBISTE- : www.drugabuse.gov o
- J Am Board Fam Med. 2005 Mar-Apr;21(2):175 , National Survey on Drug Use and Health
10.0.ANNEXURES-:
TOOL: a. Questionnaire b. Interview schedule
TECHNIQUE: a. Giving close ended question b. interview
APPENDICES
We, the students of IIHMR, Dwarka, New Delhi, are working on our research project entitled “Prescription drug use”.
Kindly give your genuine response to the statements for the relevant parameters. There are no right/wrong answers. Besides, your response will be kept confidential and will be used strictly for our academic work.
QUESTIONAIRE
TITLE OF THE STUDY
PRESCRIPTION DRUG USE i.e. intentional use of drugs without prescription.
Tool- Interview schedule-prescription drug use among residents of Dwarka.
1.Name 2.Age 3.Sex—M / F
4.Address 5.Occupation 6.Martial Status
7.Religion
8.Education:
1. Upto 4th grade 2. Upto 7th grade
3. Upto 10th grade 4. Graduate
5. PG or above
9. Monthly income:
10. Number of members in the family:
11.In case of illness who do you go to for treatment:
1 – Local healer
2 – Ayurvedic/Unani(ISM)
3 – Homeopathy
4 – Private clinic or hospitals
5 – Govt. hospitals
6- Chemists
12. Do you purchase medicine on your own?
A – Never
B – Sometimes
C -- Always
13. For which all ailments you take medicines without prescription?
Headache Vomiting Fever Acidity
Cold n Cough Diarrhea Pain
14. With respect to the ailment how many times you take the drug without prescription?
In a Day(1/2/3) In a week(1/2/3) In a Month(1/2/3/4)
15. How many members in the family are taking medicines without prescription?
16. Which all medicines are frequently consumed?
a. Disprin b. Saridon
c. Combiflam d. Crocin
e. Diclowin Plus f. Others(specify)
17. What is the dosage of the drug (above mentioned) is used?
18. Do u know actual dosage of the drug?
Yes/No
19. Are you aware of the side effect of the drug being used?
Yes/ No
20. - Reasons for taking drug without prescription
May not be satisfied with doctor
Lack of expertise of doctor
Laziness to go to doctor
Any other
21. Who suggested you to take that drug without consulting the doctor?
a. Family b. Friends c. Neighbours d. Others
22. For any ailment do you prefer consulting different doctors?
Yes/No
If Yes, Why?
Any other comments:
QUESTIONAIRE FOR CHEMIST
Q1- how many customers on an average came to you asking for drugs without prescription?
ANS- none
- 10
11-30
31-60
61- 90
91- 100
Q2- what are the most frequently purchased drugs taken without prescription?
ANS- Antibiotics
Antihistaminics
Topical steroids
Q3- which are the drugs which you give strictly on prescription only?
ANS- Abortion drugs
Sedative drugs
Steroids
Q4- What are the reasons for people asking the drugs without prescription?
Q5- Are you aware of the DRUGS AND COSMETICS ACT,1940?
QUESTIONAIRE FOR HEALTH CARE PROVIDERS
Q1- How many patients on an average came to you asking for drugs without prescription?
Q2- Which are the drugs which you recommend strictly on prescription only?
Q-3What are the reasons for people asking the drugs without prescription?