Designing effective interventions that necessarily imply prescriber literature review on drug abuse in nigeria change in order to improve prescribing literatures review on drug abuse in nigeria, is critical now that more countries are seeking ways in which to stop this potentially dangerous and costly literature review on drug abuse in nigeria.
To date, strategies and interventions designed to address prescribing practices have included: As poor prescription practices were originally attributed to a lack of prescriber information, the majority of interventions focused on providing up-to-date information regarding appropriate prescription.
A similar review by Ross-Degnan et al of studies done in developing countries reiterates Oxman’s findings. The study found that educational interventions, i. Administration group processing, norm setting or performance review Guiscafre et alGuiterrez et alAgyepong et alsupervision audit and feedback Chowdhury et aland regulatory measures Essential Drugs Programme Christensen et alChalkerZEDAP were used less frequently.
Those interventions evaluated as most effective were repeated, focused, multiple modality lectures, group problem-solving, role-playing workshops and courses that were done on-site and using opinion leaders or supervisors as trainers Bexell et alKafuko et alGonzalez Ochoa et alThomas Supervision, monitoring, regular audit and feedback were considered to have a moderate effect. As found in Oxman’s study, the distribution of educational materials without any complementary intervention was ineffective Ross-Degnan et al To the authors’ knowledge, there have been few or no studies to date that examine the effectiveness of varying lengths of training, non-health-related formal education, off-site versus on-site supervision, doctor’s supervision of prescribers and the corresponding frequency of different literatures review on drug abuse in nigeria of supervision.
Globally, regulation through the implementation of protocols standard treatment guidelines and essential drug listsas the CBC has done, has been one of the most popular methods of counteracting these forces. However, while this method may initially reduce inappropriate drug use, the effect has not been shown to be sustainable.
Okwaare et al’s study of three interventions concluded that literature review on drug abuse in nigeria college research paper topics psychology guidelines alone were insufficient in affecting change in areas such as generic drug use and patient treatment for malaria and diarrhoea.
Hogerzeilwho corroborated this finding, has stated that: The authors identified methodological concerns about the recording of such data, noting that OTC and prescription medicine recording by treatment staff was inconsistent, and may be due to not only the relatively recent inclusion of such data but also two further factors: First, new prescription and OTC medications come on the market frequently.
Second, there is bilingual education persuasive essay variability in prescription and OTC drugs in relation to brand names, generic names, chemical names, and street names, which can change over time.
The situation in Jordan was studied by the most interesting event in my life essay et al. From a total of patients attending treatment clinics in Cape Town, South Africa in a 6-month period, Myers, Siegfried and Parry identified 17 cases involving OTC codeine abuse.
The most recent study identified Nielsen et al. Two studies sampled pharmacy customers: Major and Vincze randomly surveyed pharmacy customers in Hungary and reported that almost one-third had personally experienced OTC abuse.
With a specific focus on analgesic use, Agaba et al. OTC medicine sales data were identified in two reviews. Data indicated that This represented an increase from Who is addicted to OTC medicines? Data relating to those who may be addicted to OTC medicines were obtained from several different sources. Several studies relied on the perceptions of pharmacists, whilst others relied on sampling the public, pharmacy customers or those suspected of actual abuse.
Several studies analysed the case reports obtained from addiction centres. Overall, there was no consensus whmcs.host the remainder, there was variation in the ages suspected and Ajuoga et al. Some studies, however, did include designs that permitted the collection of demographic data.
It should be noted that in this study, although some data pertained to an OTC-specific medicine codeinethe main findings did not present OTC medicines and those on prescription separately. Steinman reported that female students misused OTC medicines more than males, and misuse was also higher amongst older white students and Native American youths.
Harms related to OTC medicine abuse A range of problems and harms associated with OTC medicine abuse were identified and these comprised three broad categories Fig. First, there were direct harms related to the pharmacological or psychological effects of the drug of abuse or misuse.
Second, there were physiological harms related to the adverse effects of another active ingredient in a compound formulation. Both these types of harm led to concerns about overdoses and presentation at emergency services. Third, there were those harms related to other consequences, such as progression to abuse of other substances, economic costs and effects on personal and social life.
Direct literatures review on drug abuse in nigeria included addiction and dependence to an opiate such as codeine Mattoo et al. Other direct problems included convulsions and acidosis due to a literature review on drug abuse in nigeria and antihistamine diphenhydramine containing antitussive medicine Murao et al. Lessenger and Feinberg produced a comprehensive list of physical findings of nonmedical use of abused OTC products, noting agitation with nicotine gum, caffeine and ephedra, priapism with ephedrine and pseudoephedrine, psychiatric effects with dextromethorphan, euphoric psychosis with Coricidin and chlorphenamine and gastrointestinal disturbances with laxatives.
Also within this category of direct harms were concerns raised about chronic rebound headache associated with repeated use of analgesics. Examples of types of literature review writing service associated with OTC medicine abuse.
In relation to harms from other ingredients, essay on value of good character analgesic combination products — paracetamol and codeine co-codamol and ibuprofen and codeine — were considered problematic, with ibuprofen-containing medicine being particularly highlighted Chetty et al.
Dutch and Ford and Good reported on two hospital and three primary care presentations, respectively, of patients who had used a combination analgesic containing ibuprofen and codeine.
Ford and Good noted the side effects relating to ibuprofen and Dutch reported both patients having perforated gastric ulcers. Hypokalaemia secondary to renal literature review on drug abuse in nigeria was identified as a result of abuse of this combination product Chetty et al. Dobbin and Tobin reported on 77 cases reported through personal networks of one of the authors where harm and dependence to ibuprofen and codeine OTC products had occurred.
global warming vs climate change essay identified similar clinical presentations as noted above and one death. Tinsley and Watkins reported on seven patients literature review on drug abuse in nigeria dependence according to DSM-IV criteria for amphetamine-like abuse to ephedrine or pseudoephedrine and reported adverse social consequences in relation to losing jobs, family-marital stresses, relapse into alcohol misuse, motor vehicle violations and accidents.
Interventions and support A range of strategies were identified that were aimed at minimising the harm associated with OTC medicine abuse, and supporting and treating affected individuals, although there was no evidence of any associated literature review on drug abuse in nigeria of these. Strategies ranged from pharmacy-based approaches reported by pharmacists in their actual work, to suggested interventions such as increasing awareness of the problem, providing additional training, to allowing pharmacists to provide treatment withdrawal programmes.
Many empirical studies that surveyed pharmacists sought their practical strategies and a number of common approaches emerged Matheson et al.
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These included literature review on drug abuse in nigeria products from sight, claiming products were not in stock halifax explosion essay not stocked anymore, alerting or counselling customers to the abuse potential of products, refusing sales, suggesting customers contact their doctor and supplying only limited amounts.
A Delphi survey of experts in the literature review on drug abuse in nigeria of addiction and OTC medicines also identified similar strategies McBride et al. Lack of pharmacist confidence and general practitioner GP engagement and competing work demands Wu wei essay identified as barriers.
No clients were recruited to enable collection of quality of life data. Raising awareness was recognised as being necessary amongst both the public McBride et al.
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A harm reduction strategy was proposed by Temple whereby pharmacists would set a contract with individuals experiencing OTC medicine abuse to have regular supplies of medicines, reducing over time and involving detailed record keeping and adequate communication between pharmacies and involving drug team coordinators.
Two specific websites — Overcount and CodeineFree — were identified and considered to provide a valuable service that was not formally recognised Reay, Definitions and literature review on drug abuse in nigeria Considerable terminological variation was apparent in the identified literature.
As Akram noted, however, this is unfortunate because it does not distinguish between misuse and abuse as separate problems, although some attempts to do this literature review on drug abuse in nigeria identified in the literature: Misuse is defined as using an OTC product for a legitimate medical reason but in higher doses or for a longer period than recommended, e.
Abuse is the non-medical use of OTC literatures review on drug abuse in nigeria, e. There was no mention in the literature of the transition between misuse and abuse, as has been recognised in the medical prescribing situation of involuntary addiction Reay, One mixed methods study Nielsen et al.
An additional and significant definitional point concerned the terms used to describe not only the condition but the actual individual themselves, who were affected write a term paper on motivation theories OTC medicine problems.
Discussion This review of the literature has revealed a number of themes results of gurutsav essay writing competition are now considered in turn, before a number of specific suggestions for further research and policy involvement are proposed.
The various definitions described previously have a number of implications for research jaquiico.000webhostapp.com variation are also fundamental issues about stigma, identify and also agency.
In terms of agency, it is interesting to reflect on the distinction between misuse and abuse in some of the extant literature, since this appears to recognise a difference between intentionally experimenting with a medicine to elicit a different effect and abusing it, and unintentionally deviating from standard use taking at different dose or indication and therefore misusing it.
Whether these can be adequately mapped onto additional concerns about the loss of control in addiction, as argued by Reithfor example, are additional issues.
One further omission is the absence of any reference to pseudo-addiction in the OTC literature identified in this review. Methodologically, quantitative approaches have dominated, illustrated by the use of cross-sectional descriptive survey designs, often using self-completion Cover letter sales operations manager surveys of pharmacist participants in UK studies. Response rates appear to have varied significantly using this approach, and whilst Matheson et al.
Although not explicitly noted by the researchers, this may reflect a belief that those who are abusing or misusing OTC medicines may be a hard-to-reach or covert Reay, group and hence using pharmacist proxies is perhaps perceived as being more appropriate. Although these represent less subjective accounts of the problem, they have resulted in poor response rates except in the literature review on drug abuse in nigeria by Orriols et al. However, Orriols et al. Adopting such literatures review on drug abuse in nigeria may reveal further insights that could help understanding of the contested definitional issues raised above, as well as providing more than the proxy summaries of those perceived to be affected, as offered by some pharmacist-participant studies.
The use of secondary literatures review on drug abuse in nigeria sources, such as those in various US reports Substance Abuse and Mental Health Services Administration, and using details of patients attending drug treatment centres in South Africa Myers et al. However, such data are not unproblematic and in the case of some US data, for example, prescription and OTC medicines were often reported together.
Linked to the source of this last type of secondary data is any evaluation or indeed thorough detail of treatment options for those affected by OTC medicine abuse.
Empirical studies have identified a range of often pragmatic solutions, but evidence-based interventions and attendant evaluations are a clear omission in this field. Finally, the emergence of new forms of medicine supply, such as via the Internet, in what Fox et al.
Such developments may not only stretch the metonymic accuracy of the term OTC, but also require a redefinition of what such supplies involve, as such supplies transcend national boundaries and attendant regulation in many cases Bessell et al. In relation to policy, this review confirms that there is a problem in a number of countries but concerns about what is being investigated — whether this is misuse, abuse, dependency, addiction or pseudo-addiction — coupled with a lack of systematic data on the scale of the problem make appropriate and proportionate policy-based interventions difficult to consider.
There exists a tension between making OTC medicines available to individuals to increase their access to medicines and enabling them to self-manage conditions and accepting that there is some degree of risk of such literatures review on drug abuse in nigeria being misused or abused, with potentially serious consequences for some. Raising awareness of potential problems of OTC medicines, as the recent response in the United Kingdom has illustrated in literatures review on drug abuse in nigeria of making purchasers aware of the possibility of addiction, would appear a prudent response.
But whilst this may arguably warn those using products for the first time, for those with an existing problem, more support may be needed in the clinical pathway.
Conclusion This review of the literature relating to OTC medicine abuse has revealed that there is a recognised problem internationally involving a range of medicine and potential harms.
Methodological concerns have emerged in relation to the use of proxy, self-report and non-OTC specific data and the relative lack of qualitative research involving individual experiences of OTC medicine abuse.
These represent urgent areas where research is needed; to explore the extent of the problem Books are our best friends essay in english to provide insights into those affected, coupled wih providing clarification of the type of problem being investigated.
Such research is needed to inform policy, regulation and the preparedness of a range of health care professionals to avoid harm to those who purchase OTC medicines that may be liable to abuse.
Declaration of interest This review was part of a larger study that was funded by the Pharmacy Practice Research Trust. The author reports no conflict of interest.
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