Over the counter drugs among health care professionals

1. Over the counter drugs and drug abuse among the healthcare professionals:
Prevalence, etiology, prevention and intervention. What would you advice the Ministry of
Health in your Country to put in place as a mitigation measure.
Group 5
 Philip Ejiro Tialobi

2. Janet
• This presentation will discuss over the counter drugs and drug abuse among healthcare
professionals.
• It will look at the prevalence of substance use, prevention and intervention measures and
recommendations to the ministry of health on how the intervene.
What are over the counter drugs?
• These are non-prescription medication sold directly to the consumer
• Some commonly abused OTC drugs include;
– sedatives such as barbiturates and benzodiazepines
– sleep medication such as Ambien, sonata and Lunesta
– pain killers such as codeine, morphine, oxycodone, Percocet
– stimulants such as amphetamines, methylphenidate
– cold medication such as pseudoephedrine and dextromethorphan.
Introduction

3. Lucy

4. PREVALENCE
• What is prevalence?: case numbers, present in a particular
population at a certain time.
• The major problem we are facing is abuse of over the
counter drugs without prescriptions.
• According to a study done in 2016 by National medicines
and food administration of Eretria, healthcare professionals
of were asked if they have ever used over the counter drugs
and it concluded to 65.1% males and 34.9% of females have
abused the over the counter drugs.
• Thus, the study revealed 81.8% of healthcare professionals
who are at risk with the abuse of over the counter drugs.
• Sharma, et.al 2017, 34.8% of healthcare professionals
reported to seek information from pharmacists while 27.1%
got information from medical doctors for self-medicating for
the first time.
• Thus, the drugs were not prescribed but their usage was
provided on request.
• Other healthcare professionals reported to get advice from
friends and relatives, while others used the internet as a
source of information.
Viola

5. PREVALENCE
• Vidyvati, et.al. 2016 found the common reasons for self-
medicating with over the counter drugs which were; ease of
accessibility, saving time, perception of being safe and
tolerable, saving money, treating minor ailments and getting
quick relief.
• Hence, the frequently used over the counter drugs were
analgesics and antipyretics.
• A research done by Patel, et.al recorded seventy nine out of
550 healthcare professionals who had practiced self-
medication admitted that they had taken more than the
recommended dose at least once.
• Some of them took more than the recommended dose to
maximize the effectiveness of the medicine, while the rest
said that they took more than the recommended dose by
mistake.
• Of those who had self-medicated, 6.9% had experienced
drug related problems following the consumption of OTC
drugs.
Viola

6. Cont.
• A study by Onchonga 2020 done in Kenya during the Covid-
19 pandemic, noted 60.4% used over the counter drugs. It
revealed an increase of 24.3% of healthcare professionals
after the Covid-19 outbreak.
• Healthcare professionals were questioned about the
increase of over the counter drugs hence, 42% mentioned
headache and migraine, 15% indicated joint and muscle
pains, and 13% mentioned running nose.
• The table below illustrates the number of healthcare
professionals and their reasons for using over the counter
drugs.

7. Reasons for taking Over the Counter Drugs
Viola

8. Etiology
The study of the origin or cause (in drug abuse of Health Care Professionals -HCP)
Sigmund Freud – the father of modern psychology was a documented user of cocaine
and smoked cigars to his death
Sylvia

9. Etiology
The study of the origin or cause (drug addiction)
• Florence Nightingale – the mother of modern nursing. Took
to her bed after Crimea war there is speculation where she
died from neurosis (PTSD) or syphilis
Sylvia

10. Etiology
• Jane Gibson, an intern under Florence Nightingale, is amongst the earliest
documented case of substance use disorders where she became an alcoholic and
lost her job in a hospital soon after the war. (Monahan, 2003)
• Genetic predisposition. A study has been done where significant minority(over 30%)
may have substance use disorder and/or mental health concerns before entering
medical school. (Merlo, 2008)
• ¾ of physicians with substance use disorder (SUD) have a family history of addiction.
(Merlo, 2008)
• Dysfunctional family setting where there was drug use and emotional abuse. The
Health Care professionals from this background
– Are attracted to the profession because high social status and they can continue
in the co-dependant role of selfless care giving.
– Nurses from this background have a greater tolerance for abusive behaviour
from doctors, patients and even colleagues (Coombs, 2000)may turn to
maladaptive coping mechanism of drug abuse.
Sylvia

11. Etiology
• Lifetime use – started with youth experimentation either before or during medical
school and overtime higher drug tolerance. A sample study done in Kenya show that
lifetime use of both OTC and prescriptive drug is higher than current users in health
care professionals. (Mokaya, 2016)
• Easy Access at workplace to both prescriptive and OTC drugs. The health care
professionals prescribe and administer drugs from the pharmacist, nurse or doctor
thus have a ready supply of drugs. There have been studies on this aspect where its
dependent of workplace control of drugs, frequency of administration and perceived
availability determines drug misuse. (Cares, 2015)
• Health Care Professionals are revered as ‘pedestal professionals’ who have
respect and authority. Losing this status to drug abuse means destroying a career
and very negative social stigma. Therefore those with problems do not seek help.
Sylvia

12. Etiology
• We never expect our doctor to be sick and always available on call day and night.
Often, they are stressed, overworked and sleep deprived and take a little
something (stimulant) to stay awake and keep going and keep the image.
(Coombs, 2000)
• The Covid 19 pandemic has seen horror stories of medics having to decide who gets
the ventilator or treatment and who doesn’t. Daily their own families and their own
lives are put at risk. Faced with such decisions without proper therapy and release,
they may turn to the embrace of the chemical substance in the cabinet at workplace
for relief.
• Limited training and knowledge on drug use, dosages and regular self evaluation in
many of the categories of Healthcare professionals. Healthcare professionals have
the greatest belief of immunity to what they might be doing to themselves.

13. Etiology
• Workplace hazards & toxic environments. Recent
neuroscience studies to support the above theories have shown
that surgeons, nurses and the anesthologists in a surgery room
are second- hand inhalers of anesthesia and analgesics
(Merlo,2008)

14. Intervention.
• It is important to identify and treat healthcare providers who are
suffering from substance use disorders in order to avoid
negative consequences like criminal convictions, loss of
licenses to practice and safeguard patient safety Monahan
(2003).
Janet

15. Intervention.
Janet
1) An anonymous physician health program- This is a program that
evaluates and treats impaired physicians while maintaining
confidentiality Cares et.al (2015) These programs are required to
ensure that a physician remains anonymous and have provision
for treatment through self-referral or be enrolled through a referral
system for comprehensive care. This should also include facilities
like an anonymous hotline for counselling and support.

16. Intervention.
2) Medical interventions. These are the actual steps taken and
procedures followed to enable a health care practitioner overcome
substance abuse. According to Merlo and Gold (2008) it is
recommended that physicians undergo a more aggressive
treatment and longer duration of treatment for substance abuse as
compared to the general population, because of the public health
ramifications of practicing while under the influence of a drug.
Such interventions include spending approximately six months in
a structured rehabilitation program, followed by outpatient
treatment with close follow-up. This also includes treatment of
other underlying physical and psychological conditions that could
be fueling substance abuse.

17. Intervention.
3) Behavioral interventions. These include aspects
such as nutritional education and regular, scheduled
physical activity. These have been shown by Merlo
and Gold (2008) to help the physicians abstain from
drug use, manage stress better and contribute to the
overall health and wellbeing even after discharge
from a treatment facility.
Janet

18. Intervention.
4) Psychosocial treatment. Physician’s treatment
programs include a strong emphasis on psychosocial
modes of intervention. Merlo and Gold (2008), found that
interventions like education on sleep hygiene for
physicians suffering from sleep disturbance or
participating in CBT sessions to determine if there are
negative core beliefs, environmental triggers or lack of
self-efficacy that reinforce substance abuse.
Janet

19. Intervention.
5) Conditions for licensure and preventing a relapse. This was found to
be effective by Merlo and Gold (2008), and it implies that health care
practitioner licenses and contracts should be tied to certain conditions to
help motivate them stay on the recovery path. Such conditions include a
commitment to stay sober for a certain number of years, periodically
submit to testing and follow up visits as an outpatient. A study by
Brewster et.al. (2008) found that structured treatment and monitoring
program is essential to high recovery rates, as much as 85% with a low
relapse rate of 14%.
Janet

20. Prevention
• Since this substance use behaviours start as early as high school, education on the
effects of substance use, addiction and dependency should begin as early as high
school and be revisited during their university and training years.
• Because of stress, anxiety and depression caused by these highly demanding jobs.
this it is important to offer therapeutic care to help them cope with their stressors in
order to avoid initial substance use.
• It is important for institutions not to be too strict by having a zero tolerance approach
when a substance abuse problem is discovered or reported because it prevents a
person from coming forward to seek help because it might lead to them losing their
jobs or a place in an institution.
Lucy

21. Prevention
• There needs to be measures to protect health care professionals who because of the nature of
their work spend a lot of time in the operating rooms
Some of these measures can include
– having better ventilated filtration and ventilation systems,
– education on the possibilities and signs of second hand exposure
– changing surgical clothing such as masks regularly.
• To prevent relapses once a health care provider seeks therapeutic care or starts participating in
programs within the organization
– some work-related changes can be put in place, these include; minimizing the
employees work hours and shifts to reduce work related stress
– restricting drug prescription privileges or if not possible monitoring their
prescriptions.
Lucy

22. Recommendation to the Ministry of Health in own
Country to put in place as a mitigation measure.
1) A regulatory body is needed to ensure
drug approval and over-the-counter drug
monograph.
2) The Agency/MOH should come up with
regulation and policy issues.
3) Dispensing practice guidelines & and drug
control should be reintroduced.
4) The MOH should regulate the distribution
and sale of OTC drugs.
Philip

23. Cont.
4) Expanded Warnings (written) on OTC drugs
especially on the labelling of the product.
5) Taking an official stance by addressing the issue
of OTC drugs as a controlled drugs and placed under
directive issues.
6) Providing clear guidelines to clinicians on good
practices for prescribing the use of strong
psychoactive medication, including both initiation and
the time limits.
Philip

24. Cont.
• 7) Using systems of supervised daily dosing for
strong psychoactive medication when appropriate
• 8) Legal actions should be taken over unapproved
OTC drugs and unapproved OTC drugs should be
removed from the markets because of the
potential risks.
• 9) All OTC drugs should be approved to ensure, it
is safe and effective.

25. Cont…
10) Provide counselling services in medical units and create
psycho-education for clinicians to discourage the risk of self-
medication and create a network of psychosocial support to
clinicians.
11) Provide an integrated OTC drugs prevention program through:
prevention education, school policies & attachment, drug abuse
policies, workplace prevention, media and prescription of drugs.
12) Background check and conduct of good behaviour is
important to run that check before employment.

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