Last few months we have seen a spate of cases in India, where patients have repeated self-medicated themselves. The Times of India reported on a cause of a patient called Srikanth who self-medicated himself after testing positive repeated in successive tests. He is not the only isolated case and there have been many cases where either the tests continue to how positive or the patient is on self-medication as a preventive measure. Not only this the sales of over-the-counter supplements like ZInc have gone through the roof.

Earlier this year when I launched my debut book Own Your Health, I had discussed the perils of self-medication in a lot of detail. The issues are chronic ones in India.  In 2015 an online portal had asked more than 20,000 respondents questions around medication. More than 50% of respondents had resorted to self-medication that year. I am not surprised at the number. The most common reasons given by the respondents were the exorbitant fees at private clinics, long lines at government-run hospitals, and the reluctance of the patients to get diagnostic tests done.

I usually take Online surveys with a pinch of salt as most people do tend to lie on such surveys. According to a study conducted among 352 patients in Puducherry across 124 households, the Prevalence of self-medication was found to be 11.9%. Males over 40 years involved in the moderate level activity of occupation, were found to be significantly associated with higher self-medication usage. Fever (31%), headache (19%), and abdominal pain (16.7%) are the most common illnesses where self-medication is being used. Telling the symptoms to pharmacists (38.1%) was the commonest method adopted to procure drugs by the users. The majority of the self-medication users expressed that self-medication is harmless (66.6%) and they are going to use (90%) and advised others also (73.8%) to use self-medication drugs.

I think the numbers are more realistic here, but again regional variation could change all that. I would expect the numbers to be higher in the north and the east of the country and lower in the south and west.

Another exploratory study conducted by Greenhalgh T studied the drugs supplied to 2400 patients by the public and private medical sectors and by private pharmacies. These were supplied based on patient complaints on illness and subsequent prescriptions from the doctors. The study’s most interesting finding was that the private sector was prescribing more drugs than the government-run hospitals. Many of these drugs were combination preparation (Medical Cocktails) and contained some hidden drugs classes.

Prescription medicine was being sold over the counter; some very powerful medicines were being prescribed for simple conditions. Also, many drugs banned in the west were still being prescribed in India. Another interesting finding was that food supplements and tonics of dubious nutritional and pharmacological value make up a high proportion of the total drugs bill. This has gone up since the onset of the COvid19 pandemic, with misinformation and disinformation mixing with genuine efforts to find a management protocol for the pandemic.

The study also concluded that any drug policy from the government might have to involve doctor and pharmacist education to reduce the overprescription of drugs.

There are many dangers of self-medication. Apart from side effects and ill effects, most public health experts feel that it leads to long term challenges like

1. Drug resistance, this is the biggest challenge in our fight against TB for example. Ciprofloxacin prescribed for throat infections is also an anti-TB drug
2. Allergies, as most of these combination medicines with hidden classes of drugs are notorious for causing allergies
3. Late diagnosis – If self- medication is the first line of attack, often by the time the patient reaches the doctor is often late, late diagnosis leads to late treatment, delayed recovery and more medical bills.

So, in my opinion, 3 things you should do immediately

1. Stop self-medication immediately. Period. No need to explain that one.
2. Visit your doctor in case of any symptoms. If you don’t have a family doctor then, identify a good family medicine practitioner in your neighborhood and visit him regularly.
3. Maintain all your medical records, there are apps that can help you with in, otherwise just keep a file if you are not tech savvy. Scanning and uploading records to Google Drive is also a good option. But there are privacy concerns around it so be very careful with your records.

Do let me know your thoughts and ways and means to counter the urge to self-medicate without prescription.