Medication misuse - threat to India's public health

The Indian health ministry recently proposed to set up an electronic platform that will track the movement of drugs from the manufacturer to the patient and plug gaps in the sale of medicines. This will help to curb anti-microbial resistance and rampant prescription drug abuse among people India.  

Like narcotics, addiction to prescription drugs is widespread in India; there are many studies which establish clearly that misuse of medications is widespread in India. Misuse of prescription drugs are a common starting points for illicit drug use. Pill popping is an innocent beginning which leads to medication misuse and sometimes drug abuse.

Cough syrups which have opiates, antihistamines as well as alcohol are extremely popular among students in India.

A study by Australian researchers - Nathan Grills and Gillian Porter, University of Melbourne (Medication misuse in India: A major public health issue in India) was conducted in 2015. The study highlights that medication misuse is a public health emergency in India.  The study is one of the most comprehensive assessments of medication misuse in India and highlights the widespread nature of the problem.

The study reveals that “in India, 50% of family spending on healthcare is on unnecessary medications or investigations”.  This is further established by WHO. The WHO highlights that economic impact of pharmaceuticals is extensive – especially in developing countries and in most low income countries pharmaceuticals are the largest public expenditure on health.

A UNDP report in 2011 said “South Asia is facing a serious and growing drug abuse problem, including the abuse of pharmaceutical preparations containing narcotic drugs and psychotropic substances. Prescription drug abuse is growing in India”. The scale of misuse, and in particular overuse, of medications in India is an issue of increasing concern but the last time a drug user survey was conducted in India was in 2001.

The study Medication misuse in India: A major public health issue in India highlights that failures in the pharmaceutical regulatory environment in India have contributed to oversupply and ease of access to various medications including many with little evidence to support their safe use.

The literature accessed during the study demonstrated that the overuse and misuse of medications in India is extensive and antibiotic use was of particular concern. The study provides details about the factors for medication misuse and clearly states that, “medication misuse and overuse can be considered based on the various parties involved in the distribution of pharmaceuticals, namely the healthcare providers, the pharmacists, the consumers and patients. A number of underlying health system factors was also found to be facilitating medication misuse in the community.”

One major reason behind the issue is that pharmacists were found to be dispensing antibiotics without a prescription. The problem is prevalent in rural and remote areas. Lack of education and effective regulations are responsible for prevalence of misuse according to the study.

There are various factors at different levels, ‘on health system level, providers expressed that poor script regulation, the ability for unqualified practitioners to write prescriptions, unregulated dispensing of medications and weak drug policy all serve as primary causes of medication misuse.’ Poor prescribing practices by physicians and lack of training in diagnosis are other common prevalent reasons.

A number of factors related to consumers influence medication misuse in the community. “There were found to be high levels of non-compliance among consumers; factors influencing non-compliance included lack of education about their medication, marital disharmony, superstitious beliefs about the underlying disease and financial constraint.”

The study also found that self-medication, usage of old prescriptions, requesting specific medications directly from pharmacists and using unfinished courses of medicines  are other factors which is making the situation worst.

Above factors are intertwined with poverty and lack of awareness among people in India. Poor knowledge or partial knowledge in the age of internet, lack of money, lack of awareness, unwillingness to return to healthcare providers and inability to afford diagnostics investigations and therefore self-medication are few other causes, highlights study. This gives rise to abuse of pharmaceuticals.