Abstract

Nonprescription medication includes OTC drugs and self-medication drugs. It refers to medicines that can be bought without a prescription from a doctor or other health professionals and are available in pharmacies. Worldwide consumption of non-prescription medication is increasing. The FDA has approved many classes of drugs such as analgesics, cough suppressants, antipyretics etc under non prescription drugs. This study aims to assess the safety and awareness of OTC drugs consumption among the public. An online cross-sectional study was conducted among various individuals to estimate the knowledge, safety, and awareness of non-prescription medications. It was found that more than 75% of individuals bought non-prescribed medicines. The decision to use these drugs was based on the pharmacist's recommendations (57.2%) or based on personal decisions influenced by their basic knowledge on common health problems and their solutions. The most non-prescription drugs purchased were antipyretics (85.2%), antihistamine (73.6%) and antidiarrheal products. Around 58% claimed to read the labels or ask for more information about the drug from the pharmacist. This study discovered a great misconception among consumers toward nonprescription medicines. Therefore, it is suggested that the public be educated through online articles or by conducting webinars about the type of illness to be self-diagnosed, the possible dangers of OTC drugs and prevention of misuse which could avoid unwanted effects that could also have the potential to be fatal.

Keywords

Introduction

The terms "over-the-counter drugs" and "non-prescription drugs" are interchangeable when referring to medications that are available without a prescription [1]. Self-medication is a crucial component of regular self-care practices and a major topic of discussion in healthcare systems [2]. Increased use of over-the-counter (OTC) medications for self-medication has been observed in recent years; these medications are sold at pharmacies and retail establishments. More goods are now available for purchase without a prescription thanks to deregulation at the same time. Health care systems benefit from self-medication because it makes greater use of chemists' clinical abilities, makes medication more accessible, and may lower the costs of prescription drugs linked to government-funded health programs.[3] OTC drugs are freely accessible to consumers, who tend to underestimate their potential risks by thinking they are harmless. They are not fully aware of a number of OTC medicine risk areas, including those pertaining to drug interactions and abuse/misuse. In a recent Swedish study on consumer opinions regarding the safety of over-the-counter (OTC) pharmaceuticals, 7% of participants fully or partially agreed with the claim that OTCs are safe to take regardless of dosage. According to a previous American survey, up to 41% of consumers think over-the-counter drugs are too ineffective to cause any issues. Nevertheless, over-the-counter (OTC) drugs can also be extremely harmful, as evidenced by hospitalisations linked to adverse drug reactions (ADRs).In a German study, hospitalisations linked to adverse drug reactions (ADRs) in internal medicine wards were about 4?used by self-medication; 53.8% of these instances had OTC drugs as the cause of the ADRs.[4]  Although there has been a trend towards increasing deregulation of medicines from prescription to OTC supply and most recently availability from Internet pharmacies, the range of medicines available is often more limited than prescribed medicines, and there are often limitations to indications and doses.[5] Relatively little systematic study has been done on this subject, in part because of the belief that OTC drug abuse and misuse are not as troublesome as other drug kinds. When an over-the-counter medication is used for a valid medical reason, but not for the prescribed length of time or at larger doses than advised, it is referred to as misuse (for example taking more of a painkiller than indicated to relieve a headache). The non-medical use of over-the-counter medications to get "high" or lose weight is called abuse. Even after completing extensive training in medication management, chemists are sometimes viewed more as retail employees than as members of the primary healthcare team. [2]

OBJECTIVES

• The primary aim of this research is to comprehensively evaluate the knowledge, safety practices, and awareness regarding the utilisation of non-prescription drugs.
• This study seeks to identify the extent of understanding that individuals have about over-the-counter medications, assess the measures they take to ensure their safe use, and gauge their overall awareness of the potential risks and benefits associated with these drugs.
• Through a detailed analysis, this research will provide valuable insights into the current state of public knowledge and safety practices concerning non-prescription drug use.

MATERIAL AND METHODS

The cross-sectional study described herein is a comprehensive, questionnaire-based investigation designed and executed by the Department of Pharmaceutics. The primary objective of this study is to gather extensive data on various aspects related to the use of over-the-counter (OTC) medications among a diverse population within a specified geographical area, specifically the city of Bangalore. To achieve this, a meticulously crafted questionnaire was developed, encompassing more than ten questions that aim to probe various dimensions such as the participants' knowledge, safety practices, and general awareness regarding OTC medications. This questionnaire was then disseminated using advanced communication technologies to ensure wide reach and efficient data collection. Questions about what influences people to buy non prescription medications, what people think about it  and how effective they think non prescription medications are were posed to the participants [6].  The terms "misuse" and "abuse" were omitted from the questionnaire in order to minimise the possibility of respondent bias and social desirability as well as potential stigmatisation. Rather, participants were asked to state if they had ever intentionally employed non prescription medications in particular ways.[7] The Google Forms platform was chosen for its user-friendly interface and robust data management capabilities, allowing participants to easily access and complete the questionnaire online. To further enhance the dissemination process, social media platforms such as Twitter, Facebook, WhatsApp, and Instagram were strategically utilised. These platforms provided the means to reach a broad and varied audience, thereby maximising the response rate and ensuring the inclusion of diverse demographic groups. Over the course of the study, a total of 250 participants from Bangalore were successfully surveyed. This sample size is considered substantial enough to provide meaningful insights and statistically significant results. The collected data is expected to shed light on the prevailing trends, behaviours, and perceptions related to the use of OTC medications in the region.

RESULTS

The survey was meticulously conducted, involving a significant sample size of 250 individuals who actively participated by completing and submitting the questionnaire forms. Each participant provided valuable insights by responding to a series of carefully designed questions, thereby contributing to the overall data pool. The process of collecting these responses was facilitated through the efficient use of the Google Forms platform, which allowed participants to easily access, fill out, and submit their answers online.

A significant proportion of the survey participants were female, comprising 54.8% of the total sample size. This was followed by male participants, who accounted for 42% of the respondents. The detailed demographic distribution of the participants is visually represented in Figure 1, which provides a clear depiction of the gender breakdown among the individuals who completed and submitted the questionnaire.

AGE DISTRIBUTION OF STUDY PARTICIPANTS

Most of the participants were between the ages of 18 and 25, making up 59.2% of the total. Those aged 26 to 35 comprised 19.2% of the participants. Only six individuals above the age of 55 responded.

 PURCHASE OF MEDICATION WITHOUT PRESCRIPTION

 REASONS FOR BUYING MEDICATIONS WITHOUT A PRESCRIPTION

Most of the people purchased medications for fever (85.2%), cough and cold (73.6%), nausea and vomiting (40.8%), and diarrhoea (42.8%). The least purchased medications were for menstrual cramps (11.6%), despite most participants being women, as shown in Figure 4.

SOURCE OF INFORMATION ABOUT NON PRESCRIPTION MEDICATIONS

Most of the people received information or suggestions from pharmacists (57.2%) and family or friends (40.4%). It is worrisome that 38.4% of people relied on the internet for information when buying medications, as shown in Figure 5.

READING LABELS AND INSTRUCTIONS BEFORE USING NON-PRESCRIPTION MEDICATIONS

Only 26.8% of participants habitually read labels before using medications. It's really worrisome that 31.6% of people sometimes read labels, 18.8% often read them, and 19.2% rarely read the labels and instructions while using nonprescription medications.

 ADVERSE EFFECTS BY USING NON-PRESCRIPTION MEDICATIONS

More than 50% of people have not experienced any adverse effects from using nonprescription medicines. However, 14.4% of participants reported experiencing some adverse effects while using or after using nonprescription medications.

 SHARING INFORMATION ABOUT NON-PRESCRIPTION MEDICATIONS

33.6% of people shared their medicines or information about nonprescription medications with others, while 50.4% did not share any information with anyone.

 DISPOSING EXPIRED OR UNUSED NON-PRESCRIPTION MEDICATIONS

More than 50% of people commonly throw expired or unused drugs into the dustbin. Very few people i,e. Only 11.2% of the participants had a habit of returning unused drugs back to the pharmacy. The related data has been reported in Figure 8 below.

The fields of interest of the participants were in learning the side effects ( 74.8% ) and correct dosage forms of non-prescription medications, followed by the interactions with other medications, disposal methods and then safety methods ( 41.2% )

DISCUSSION

The results of the current study suggest that the consumption of non prescription medicines (OTC medicines) is high (78.4%), with higher usage in subjects aged 18-25 years (59.2%).  Antipyretics, followed by analgesics, are the most commonly ingested medications, contradicting the results of earlier research that revealed that analgesics were the most commonly utilised self-medication, followed by cough treatments and supplements [8-11].OTC medications are typically safe, but improper usage can lead to difficulties and adverse events that influence public health [12-13]. The majority of individuals reported having moderate to poor understanding of self-medication. Most self-medicators followed suggested dosages and durations. However, almost one-third of them were unsure about the adverse effects . Minor illnesses such as fever, pain, cough, cold were the most common indications for using OTC drugs. For these indications, self-medication was the preferred option among the majority, when compared to consulting a doctor, as this was more convenient, easier to access and timesaving. These medications were most of the time obtained from the pharmacists with a few of the participants purchasing them from retail shops. Other studies have also quoted similar results [14].  The majority of people who have ever become dependent on an NPM did not seek professional help. The reasons behind this are unknown. Previous qualitative research with individuals with non-prescription codeine dependence indicated that attempts at self-treatment were frequently ineffective;9 thus, there is a need for future research to determine the barriers and enablers to seeking treatment for NPM dependence [7,15 This study did not enquire about the frequency or use of various medications because this was not the primary goal of the investigation (i.e., the study wanted to focus on the consumption and kind of OTC pharmaceuticals and the at-risk group using these medicines), however this could be interpreted as a study restriction [13]. Since this study's discussion was based on information acquired from documents, certain topics, such as patient behaviour, were excluded. Thus, further focus groups or public hearings with numerous stakeholders are required prior to any significant implementation [16]. Our study found that young people ask both family and doctors more than middle-aged and older adults, which could be due to their limited experience with OTC use. It is not surprising that they seek information on numerous websites to a higher degree, considering that they have a stronger habit of utilising the internet than older individuals [17]

CONCLUSION:

In comparison to the prevalence of acute or chronic disorders and the use of prescription drugs, the study population has a very high OTC drug consumption rate. OTC drug users are most likely to be members of the non-formal education or university education  demographics [13].  Use of OTC drugs is a generic form of healthcare having potential benefits and health hazards. Awareness should be created among the general population to restrict the use of self-medication and pharmacists toward sale of drugs without prescription The study highlights a significant reliance on non-prescription medications, with over 75% of individuals purchasing them, often based on pharmacist recommendations or personal knowledge. Despite this widespread use, misconceptions about the safety and proper use of these drugs persist.  Educational initiatives, such as online articles and webinars are essential to address these knowledge gaps and prevent potential misuse. Ensuring proper understanding of non-prescription drugs can help mitigate adverse effects and promote safer self-medication practices.

REFERENCE

1. Marathe, P A et al. “Over-the-counter medicines: Global perspective and Indian scenario.” Journal of postgraduate medicine vol. 66,1 (2020): 28-34. doi:10.4103/jpgm.JPGM_381_19
2. Dedy Almasdy & Azmi Sherrif .Self-Medication Practice with Nonprescription Medication among University Students: a review of the literature. Archives of Pharmacy Practice. 2011;
3. Csilla Major, Zoltán Vincze, Consumer habits and interests regarding non-prescription medications in Hungary, Family Practice, Volume 27, Issue 3, June 2010, Pages 333–338, https://doi.org/10.1093/fampra/cmp105
4. Ylä-Rautio, H., Siissalo, S. & Leikola, S. Drug-related problems and pharmacy interventions in non-prescription medication, with a focus on high-risk over-the-counter medications. Int J Clin Pharm 42, 786–795 (2020). https://doi.org/10.1007/s11096-020-00984-8
5. Cooper, R. J. (2011). Over-the-counter medicine abuse – a review of the literature. Journal of Substance Use, 18(2), 82–107. https://doi.org/10.3109/14659891.2011.615002
6. Marc Bevan, Yee Ching Ng, Joyce Cooper, Jane Robertson, Emily Walkom, Simon Chiu, David A Newby, The role of evidence in consumer choice of non-prescription medicines, International Journal of Pharmacy Practice, Volume 27, Issue 6, December 2019, Pages 501–509, https://doi.org/10.1111/ijpp.12546.
7. Niamh A. Fingleton, Margaret C. Watson, Eilidh M. Duncan, Catriona Matheson, Non-prescription medicine misuse, abuse and dependence: a cross-sectional survey of the UK general population, Journal of Public Health, Volume 38, Issue 4, December 2016, Pages 722–730, https://doi.org/10.1093/pubmed/fdv204
8. Cuzzolin L, Benoni G. Safety of non-prescription medicines: knowledge and attitudes of Italian pharmacy customers. Pharm World Sci. Feb 2010;32:97-102.
9. Banerjee I, Bhadury T. Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal. Journal of postgraduate medicine. Apr-Jun 2012;58:127-131.
10. Chua SS, Sabki NH. Use of nonprescription medications by the general public in the Klang Valley. Journal of Applied Pharmaceutical Science. 2011;01:93-98.
11. Glover DD, Rybeck BF, Tracy TS. Medication use in a rural gynecologic population: prescription, over-the-counter, and herbal medicines. American journal of obstetrics and gynaecology. Feb 2004;190:351-357
12. Tesfamariam S., Anand I.S., Kaleab G., Berhane S., Woldai B., Habte E., Russom M. Self-medication with over the counter drugs, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. BMC Public Health. 2019;19:159. doi: 10.1186/s12889-019-6470-5
13. Sánchez-Sánchez E, Fernández-Cerezo FL, Díaz-Jimenez J, Rosety-Rodriguez M, Díaz AJ, Ordonez FJ, Rosety MÁ, Rosety I. Consumption of over-the-Counter Drugs: Prevalence and Type of Drugs. Int J Environ Res Public Health. 2021 May 21;18(11):5530. doi: 10.3390/ijerph18115530. PMID: 34064096; PMCID: PMC8196755
14. Mohamed Irfadh Mohamed Azhar , Kabisha Gunasekaran  Self-medication: Awareness and Attitude among Malaysian Urban Population. International Journal of Collaborative Research on Internal Medicine & Public Health  2013
15. Cooper, Richard J. "‘I can't be an addict. I am.’Over-the-counter medicine abuse: a qualitative study." BMJ open 3.6 (2013): e002913.
16. Leelavanich, D., Adjimatera, N., Broese Van Groenou, L., & Anantachoti, P. (2020). Prescription and Non-Prescription Drug Classification Systems Across Countries: Lessons Learned for Thailand. Risk Management and Healthcare Policy, 13, 2753–2768. https://doi.org/10.2147/RMHP.S281629
17. Tommy Westerlund, Sahra Barzi  , Cecilia Bernsten    Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market  Pharmacy Pract (Granada) vol.15 no.1 Redondela ene./mar. 2017