Misuse of medication
Dirk J Booysen
The extent of the problem of medication misuse can perhaps be realised most fully when considering that it involves not only prescribed drugs and medications, but also polypharmacy (using more than one drug concurrently), self-diagnosis which leads to over the counter (OTC) self-medication or the dispensing of medication by a pharmacist without an accurate diagnosis or recommendations for the correct use of the medication, and the nonmedical use of prescription pain relievers and other medications. All medication and drugs carry risks and, if these risks are not managed by a health care professional such as a doctor or specialist, they can be harmful and even life threatening to a person. The Concise Oxford English dictionary (2006:915) defines misuse as “use wrongly.” When a person takes any legal prescription medication for a reason other than the purpose for which it has been prescribed, is regarded as the misuse of medication. Additionally, if a person takes any medication not specifically prescribed for him or her, or takes medication or drugs not in the manner or dose as prescribed by a health care professional, he or she is misusing the medication because, in fact, he or she is treating him- or herself. This essay highlights some of the complexities of the problem of medication misuse, concluding with the misuse of topical OTC and prescription ophthalmic drugs. Misuse of prescription medication.
The misuse of medication and drugs as prescribed by a health care provider involves three aspects, namely, compliance, adherence, and concordance. Compliance is the degree to which a patient follows the prescribed regimen of medicines; adherence refers to the degree to which a patient follows the rules, guidelines and recommendations from a health care professional; and concordance pertains to the agreed upon opinions, actions and recommendations between the patient and prescriber or practitioner on how the medication must to be used (Aston University, 2009). The effectiveness of prescribed medication depends on the drug efficacy, the appropriate drug choice, and the patient’s adherence to the drug regime. In 1997, the Royal Pharmaceutical Society of Great Britain acknowledged in its report that prescribing is “a technically difficult, and morally complex, problem” and that compliance is an ethically dubious aspiration (Royal Pharmaceutical Society of Great Britain, 1997). The report produced a new term, concordance, which was intended to describe the creation of an agreement between the patient and practitioner that respected the beliefs and wishes of the patient. It was stipulated that, when the views of the patient and practitioner do not agree, the patient’s views take precedence. However, this created challenging questions about choice and responsibility. If, for example, a person is unable to fall asleep after taking a single prescribed sleeping pill, she or he may take another pill an hour later ‒ the motivation being to fall asleep. Or a person may offer her or his prescribed headache medication to a friend with the intent to relieve the latter’s pain. Hence, the patient’s intentions or motivations for using prescribed drugs can influence her or his compliance and/or adherence which can lead to misuse because it is not in accordance with the directions of the health care provider. Concordance can also be perceived as a problematic issue in the geriatric population who generally use multiple drug regimens as well as in patients with chronic diseases requiring long-term therapy. Tarn and Flocke (2011) provide evidence that patients’ successful adherence and compliance to prescribed drugs rely largely on the prescriber or practitioner providing the patient with correct and detailed information. The authors report that, in a cross-sectional study with 117 adult outpatient visits to six family physicians, direct observations of physician-patient...
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