Intervention in rational use of drugs

By Joe Chisari, BS, DC, DICCP

Most people assume the over-use of drugs is limited to illegal or illegally obtained substances. Significant as these abuses are, more common abuses have developed that are much closer to home. These developments are the over-prescribing, multi-drug prescribing, and misuse of common drugs. In fact, use of unnecessary drugs is the most pressing problem for doctors as well as patients. Drug consumption has increased dramatically worldwide. During 1975-1985 the annual increase was 9% and continued to increase from 1985-1999 at the rate of 8% per year. Becoming more aware and understanding the symptoms and consequences of this irrational use of drugs would have important financial and public health benefits.

Although irrational use of drugs is wide spread, drug use at a community level is often overlooked so that few interventions exist. To better evaluate our society's dependence on drugs we need to know what types of interventions exist and what is known about their impact. These interventions include reviewing an essential drug list and standard treatment guidelines, which have rarely been systematically evaluated. We need to study various health care settings to draw conclusions about the effectiveness of specific intervention strategies. And we need to accomplish these studies soon to prepare for future interventions as a way to developing healthy social habits with regards to drug use.

To further address irrational use of drugs, we first need to identify the main problems in drug use and their financial and public health consequences. Next, different intervention materials and approaches in improving drug prescribing and use are needed. Finally, some recommendations should be made for future research and action.

What are the causes of irrational and inappropriate drug use? What are their main public health and economic consequences? Overuse of drugs and injections occur as a consequence of over-prescribing as well as over-consumption: doctors prescribe more than we need and we use more than we need, especially with regards to antibiotics, pain killers, anti depressants and antacids. According to the International Journal of Health Services as well as Social Science and Medicine, the number of drugs per prescription is often more than needed, with an average of 2.4 to ten drugs—where generally one or two drugs would have sufficed. Incorrect drug use involves the wrong drug for a specific condition, drugs of doubtful efficiency, drugs of uncertain quality, or drugs in the wrong dosage. Incorrect drug use occurs in the sense of incorrect prescribing as well as inappropriate use by the consumers.

In my opinion, problems with drug use would be improved with the creation of a national policy committee on pharmaceutical advertising practices. On a community level self-medication is influenced by many socio-cultural factors, such as people and their own perceptions and preferences for certain pharmaceuticals.

On a national level the weakness or absence of drug advertising policies could be the considerable obstacle for improving drug use. Through the constant advertising of drugs the message we are reinforcing to the very young is, if you have any of these symptoms this pill is the answer. We can address how advertising techniques and the many influencing factors of television advertisements effect patient-demand, partially responsible for physicians' irrational prescribing. Interventions should be targeted at consumers as well as doctors. Face-to-face interventions with adequate training time, quality educational materials, follow ups and supervision are some appropriate methods of intervention.

However, existing interventions aimed at improving drug use from a medical as well as a consumer perspective are very few. The fact that inappropriate drug use is common among consumers is not adequately reflected in the available studies to improve drug use. Interventions targeted at improving consumers' drug use are urgently needed. Interventions should address inappropriate drug use practices, as well as the complexity of factors which may influence drug use among consumers.