The merits and perils of self-medication need to be properly understood

Do you ever get fed up having to go to your doctor for a prescription for something relatively minor? Let’s say you have been diagnosed with migraine and there is a drug that has been prescribed for you in the past that works and doesn’t cause you side effects. And yet the medication is available on prescription only and at the very least you have to call the surgery to get the prescription left out for you.

The issue of self-care in Ireland has seen a working group beavering away in an effort to find ways to change the culture of self-care here.

Today they will be presenting their findings to a Dublin meeting of European Medicines Agencies and representatives of the self-medication industry in Europe.

One of their conclusions is that there is a need for a culture change in how we assess medication safety and involve patients to a greater degree in the decision-making process.

Paradigm shift

Dr Colin Bradley, professor of general practice at University College Cork, is a member of the working group. He believes there is a need for a paradigm shift for the management of minor illness. As primary care focuses more on chronic illness management, minor illness would ideally move out of general practice and into the realm of self-care.

A big part of such change will be the provision of appropriate and accessible information to the public, Bradley says. “It’s about equipping patients with access to both information and medicines. For some illnesses we need to move away from a doctor-centred model to a system of self-care.

“ While I am broadly in favour of allowing over-the-counter access for appropriate medicines, I feel their safe use can only be assured by adequate and accessible information and that regulation alone does not protect patients from the risks associated with medicines – regardless of whether they are OTC or restricted to prescription only,” he says.

European study

Meanwhile, a study of attitudes to minor ailments in Europe found that Irish people, more than other nationalities, were guided by their confidence in the safety of an OTC product in deciding whether to self-treat.

In the view of the working group this makes consumers here ideal candidates for a different kind of engagement with health services.

I would like to add some constructive scepticism to the mix. Looking to the list of medicines that moved from prescription-only to OTC in the UK in 2007, I would have personal doubts about some of the choices.

For example, the acid suppressant drug omeprazole is available “for the relief of reflux-like symptoms such as heartburn in adults age 18 years and over for a maximum period of four weeks”.

Regulator warnings

On the face of it, the drug sounds safe, and limiting the period of treatment probably covers the concern that someone with these symptoms could continue to harbour a gastrointestinal malignancy.

But the drug and others in its class have attracted a number of warnings from drug regulators in recent years concerning some interactions with other medications.

My understanding, however, is that the UK authorities have not detected any safety issues as a result of their policy change.

A major consideration also must be the quality of the information given to patients who make self-management choices.

Their interaction with pharmacists will clearly be to a high professional standard. But if the person given written information has literacy issues and cannot absorb some of the safety warnings attached to taking a particular medication, how does that impact patient safety?

Paternalistic approach

I am certainly not in favour of a paternalistic approach to healthcare. And I agree that a black-and-white approach which says medicines are either safe or unsafe is overly rigid.

But I do care passionately about patient safety and I remain to be convinced that moving medicines from prescription to OTC availability is an entirely safe thing to do.

mhouston@irishtimes.com

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