Recently I came across an interesting and well-written article in a local English newspaper about misuse of different medicines. The author raised an important issue but perhaps not having a medical background made it difficult for her to tackle this issue in an appropriate fashion. It is an important issue and deserves some attention. I am not going to discuss what are known as ‘recreational’ drugs but only medicines that are prescribed or bought ‘over the counter’.

Most statistics available about misuse of prescription medications come from western sources. Unfortunately, in a country like Pakistan where there is little oversight and even lesser availability of records of what medicines are dispensed and how many of them are dispensed on doctor’s prescriptions, it is difficult to make any ‘fact based’ statements. That said, medicines that should only be available on a physician prescription are freely available at almost every drug store.

Antibiotics, heart and blood pressure medicines, ‘sugar’ medicines, medicines for children, and other medicines that in most western countries can only be dispensed with a written prescription from a doctor can be bought from any pharmacy without a prescription in Pakistan. Worse, often the person selling these medicines is not a trained pharmacist and has no idea about the danger that these medicines might pose if taken by people with different medical problems or if mixed with other medicines. Sadly, this lack of regulatory oversight is so very typical of what goes on in Pakistan.

Rather than bemoaning the total lack of control of the drug industry, I want to concentrate on something that educated people should do in this context. The most basic advice about ‘over the counter’ medications that we use to treat an occasional fever or a cough and cold is that just read the label on the bottle of cough syrup or the baby’s fever medicine. This will provide a lot of important information. Information like how much and how often as well as a list of all the contents.

A simple medicine like ‘Panadol’ (Acetamenophen) which is probably one of the safest pain and fever medicines around can become dangerous especially for children when the anti-fever or pain pills containing Acetamenophen are combined with cough and cold medicines that also contain Acetamenophen. This combination can inadvertently provide an excessively high dose of this medicine and that can produce severe liver damage. So, even a simple medicine we use almost every day can become a poison if used in higher than acceptable amounts.

Also read: Medicine in the future

Other than medicines that are available ‘over the counter’ almost everywhere in the world, there are three important types of medicines that need to be considered. Here my presumption is that most ‘educated’ people use medicines for chronic diseases like high blood pressure, diabetes, intestinal disorders and other such things only on the advice of a physician and with a prescription from a physician. Here one important caveat, once a person develops high blood pressure or high blood sugar, conditions like these will require lifelong treatment and regular monitoring by a qualified physician.

Of the three types of medicines that I want to discuss a bit more, the first are antibiotics. There is no doubt that antibiotics are one of the greatest medical discoveries of the last century. From simple things like a ‘strep throat’ that in olden days could lead to horrible complications on to serious diseases like typhoid and pulmonary tuberculosis can all now be cured with appropriate antibiotics. That of course makes antibiotics one of the commonest medicines to be used and as such also to be misused.

In a country like the United States, no antibiotic is dispensed without a prescription from a licensed physician. But even in the US, there is some misuse of antibiotics, first of course these might be prescribed more often than necessary, but worse is when patients supposed to take antibiotics for a particular number of days decide to stop taking them when they start feeling better. This is a major problem. Early stopping of antibiotics allows the ‘bacteria’ that are supposed to be killed or controlled to survive, and worse to develop a ‘resistance’ to that particular antibiotic. What this means is that a future infection with that bacteria will no longer be amenable to treatment by that particular antibiotic.

Emergence of bacteria resistant to antibiotics is a major problem. This is especially true in a hospital environment where very sick people often have infections with bacteria that are resistant to most antibiotics. Besides increasing the chance of dying from the infection what such a situation often requires is the use of antibiotics that are capable of producing serious and often fatal side effects. For a country like Pakistan the problem with antibiotic resistant bacteria is that the newer antibiotics needed to treat some common infections are much more expensive and thus make their availability for poor patients a problem.

Related article: The art of being a doctor

So, when it comes to antibiotics a little bit of advice is definitely in order. First, every cold, fever, cough or upset tummy does not need antibiotics. As a matter of fact most of them do not. Second, if antibiotics are indeed ordered by a physician or even if you decide to self medicate, please make sure that you or your ‘patient’ takes the appropriate dose of the antibiotic for an appropriate period of time. Here, for our computer savvy readers and if you are reading this article on-line you are clearly computer savvy, before you self medicate, just do a search for that medicine on the internet and you can find useful information like when to use it, and in what dose and for how long. Also information about side effects as well as interactions with other medicines you might be taking will also be available.

Next in line for discussion are the plethora of sleeping pills and anti-anxiety medications that it seems almost every one of our social elites consumes with ‘gay abandon’. Often at dinnertime, instead of discussion about different wines that might go well with the meal, on realising that a doctor is at the table, the discussion often veers off to the best sleeping pill or anti-anxiety pill and comparisons thereof. And indeed our aforementioned elites will often have a well-stocked ‘poly-pharmacy’ of such medicines that they proudly talk of just as a wine connoisseurs in the US talk of their well-stocked wine cellars.

Unlike the ‘winos’, most of our mem-sahibs carry their ‘poisons of choice’ in their purses. Without being judgmental, all I will say is that most of these ‘drugs’ are habit forming and stopping them suddenly can produce serious ‘withdrawal’ symptoms and problems.

Finally to the matter of ‘herbal’ medicines and ‘dietary supplements’. This does not include vitamins, antioxidants, probiotics and other latest medical fads. What concerns me are ‘alternate’ medical treatments and tonics where the ingredients in the medicine are either not known or not listed on the bottles or pill boxes. Avoid taking these medicines especially if you are also taking ‘regular’ medicines. Basically two different systems of medicine and medical treatment should not be used at the same time.