Growing Trend of Drug Abuse and Misuse and Its Impact on Society: A Case Study of Hyderabad City

Abstract

Drug abuse is the consumption of drug apart from medical need or use, in unnecessary or in excessive quantities. Drug misuse is the use of drugs for the purpose or conditions for which they are not suitable choice or even if they are suitable choice but used in improper dosage. The menace of drug misuse and abuse is increasing globally day by day and Hyderabad being one of the largest cities of Pakistan is experiencing this practice widely. Psychoactive drugs, sedatives, hypnotics, antibiotics, multivitamins, laxatives, heavy tonics, steroids, antacids, cough syrups and analgesics etc, are commonly misused and abused in our society. Among these psychoactive agents and antibiotics are the most frequently misused and abused drugs. Psychoactive agents have great potential for physiological and psychological addiction; hence the users continuously use them to cope the situation of anxiety, insomnia, depression and pain. It has been observed that repeated use of such agents creates tolerance, which leads to frequent increase in dose of the drug. On other hand, misuse of antibiotics leads to microbial resistance ultimately leading to decreased efficiency of the drug in particular family or community. Self medication and over medication have become the norm. Self medication is risky and highly unsafe and at times dangerous too, it leads to misuse and abuse as well. Non-medically qualified people (Quacks / Store keepers) are not able to judge the correct use of medication or determine the dose, nor are they aware of the risks involved in drug misuse and abuse. It is because all the drugs which are available in market have great potential to be misused and abused. The initially observed causes of drug abuse and misuse are lack of patient’s awareness regarding side effects or complications of drugs, improper patients’ counseling, prescriber’s lust for heavy OPD (because of which incomplete message regarding proper usage of drug is transferred to patients), wrong prescription (generated by unqualified people), prescriptions error, drug advertisement, busy pharmacies, easy availability of controlled drugs, dispensing error, pharmacies or medical stores being run without professional person (without registered Pharmacist), Improper follow-up of patients, lack of concentration of drug regulating agencies and unethical promotions of pharmaceutical companies etc. Lack of patient counseling has a significant role in drug misuse and may result in drug abuse or addiction. ivPrescription error is one the most important factor that leads to drug misuse and abuse. A prescribing error occurs as a result of a prescribing decision or during prescription writing process. Prescription writing skills / instructions should be according to the WHO guidelines which suggest giving the medicine to the patients in the proper manner by Pharmacist / dispenser / storing keeper. Many countries have adopted WHO guideline for the prescription in their health care system. The Pharmacist is the person professionally equipped with knowledge to understand all the drawbacks / complications of drug abuse and misuse and its harmful impacts on health of people. The objectives of this study are to explore the causes of drug misuse, abuse and their contributing factors in Hyderabad city. The survey study was conducted in different main targeted areas of Hyderabad city. A questionnaire and analysis sheets were designed with the study objectives. W.H.O parameters (World Health Organization Guidelines / Standards) for prescriptions writings , Drug information hand book (Lexi-comp) and BNF (British National formulary) were used for evaluation of proper dose of dosage form and drug-drug interaction. Ms-Office 2007 and Statistical tools such as Mean, Standard Deviation, Cumulative Frequencies, Relative Frequencies, Chi square test, Z test, ANOVA, Regression Analysis, and Graphical Representation of data have been applied through the Statistical package SPSS17.0. Trend of sales at medical stores in Hyderabad city shows that sale with prescription is 41.6% and without prescription is 58.4%. It reflects easy availability of drugs on large scale without prescription whereas on other side 49.4% of patients/customers were even not asked about availability of doctors’ prescription by medical store keeper. Among the interviewed customers/patients male (62.4%) and female (37.6%) responded positively. It was observed that 29.1% patients/customers were between 31–45years ages. Maximum patients/customers without prescription (13.7%) were found in Pretabad, Hyderabad, on other hand maximum patients/customers with prescription (8.6%) were found in Saddar, Hyderabad, respectively. The available prescriptions (41.6%) were evaluated and categorized in four types. As Specialist prescriptions (56.4%), General practitioner prescriptions (19.8%), Hospital /Medical center prescriptions (15.7%) and prescriptions without name and vaddress of doctor (8.1%); this includes non qualified persons/quacks as well. As the prescription error factor in drug misuse was considered the error was 30.6% in all prescriptions categories, whereas maximum errors were found in the prescriptions, which were without name and address of prescribers. Collectively 8.3% prescriptions were found very old and 11.8% were without date of generation of prescription. Trend of self medication is another factor of drug misuse identified on large scale in Hyderabad. According to data collected from patients/customers without prescription (58.4%), the decision of self medication, 55.8%, is influenced /suggested by self judgment, chemist, drug advertisement, friends, relatives, neighbors etc. and about 44.2% patients/customers were influenced by doctor. Majority of these customers/patients, 43.6%, were not clear regarding dose, frequency and duration of therapy. In 7.4% cases medicines were sold to < 15 years age children. Major therapeutic classes of drugs which are sold without prescription includes analgesic/painkiller (15.9%), sedative/hypnotics (12.1%), antibiotics (8.6%), antacid (9.2%), cough suppressant (5.3%), sexual vitality inducer (1%), psychoactive (9.2%) and others groups (38.6%). As age of patient is considered, it was observed that > 46 years age customers are involved mostly in drug misuse and abuse. Furthermore, 500 Patients/Respondents were interviewed in Out Patient’s Department (OPD) of a government hospital in Hyderabad to analyze the contribution of improper patient counseling factor in drug misuse and abuse. Out of 500 patients, 159 (31.8%) were not counseled by any health professional, whereas 341 (68.2%) were counseled by the prescriber, store keeper/dispenser or both. Out of 159 un- counseled patients, the highest number of patients 76 (47.7%) were unaware regarding duration of therapy. On the other hand, among 341(68%) counseled patients, 218 (63.92%) were counseled by both prescriber and storekeeper/dispenser, 65(19.06%) by prescriber only and 58(17.0%) by store keeper / dispenser only. The underlying reasons for improper counseling may be lack of pharmacist in hospital settings, heavy OPDs and busy pharmacies. Since the calculated value Z = 9.7061 falls in the critical region, so we reject the null hypothesis, it shows P 1 ≠ P 2, at 0.05 level of significance and concludes on the basis of data, that the proportion of both gender (male and female) are different with respect to the drug misuse and abuse. Additionally a total of 286 antibiotic containing prescriptions were randomly sampled from a government hospital. These prescriptions were categorized according to the antibiotic classes and errors were identified according to various vistandards; W.H.O (World Health Organization) guidelines/standards for prescription writing. The extent of errors were calculated and the highest proportion of the prescriptions (89.86%, n=257) failed to demonstrate the patient’s weight and the least number of prescriptions (2.44%, n=07) contained the dosage form errors. The mean error per prescription was observed as 6.35 with S.D 3.138 and 95% confidence interval for μ is (5.98, 6.71). The major reasons were heavy patients’ influx, insufficient knowledge regarding prescription writing guidelines to prescribers and the lack of pharmacists. Continuous educational training programs regarding prescription writing skills, introduction of computerized prescription order entry system and by recognizing and appreciating the role of pharmacist in evaluating the prescriptions can substantially reduce these widespread errors. On other side 150 related peoples of health care systems (Doctors, Retailers/Store keepers and Pharmaceutical marketing personals) were interviewed to assess the role of these peoples in the eradications of drug abuse and misuse in our society. It was largely observed that there is lack of concentration, especially doctors and store keepers/retailers in the process of counseling with patients/customers regarding harmful effects of drug abuse and misuse on the health of patients/customers. Our results also found that majority of medical stores / pharmacies have no any criteria for dispensing the all types of medicines, which is contributing to easy availability of drugs and lack of concentration of drug regulating agencies at pharmacies/medical stores. This study will recommend the proposals for eradication of this social evil, which has been affecting the health of considerable portion of population in Hyderabad. The findings of this study will help Government to realize the importance of pharmacist in health care system and formulate the long-lasting strategy/policy to deal with problem of drug abuse and misuse and their contributing factors.