The potential role of OTC medications on health care has attracted the attention of policy makers and health care professionals in recent years.
It has been argued that the benefits of OTC medications can only be achieved if patients use them safely and effectively (Pharmacy Today, 2010). Research indicates that, roughly 82 percent of Americans have not experienced any form of adverse effects from taking non- prescription drugs, whilst only 17 percent reported to have negative reactions (NCPIE, 2002). Generally, customers perceive OTC remedies to be effective and safe compared to prescription drugs. For example, a survey conducted by Ajuoga, Sansgiry, Ngo, and Yeh (2008) suggested that 71.6 percent regarded OTC medications as safe, while 73.3 percent perceived them as effective for managing HIV/Aids. Moreover, research revealed that about 53 percent of American adults who consumed OTC herbal remedies thought that they were effective, whilst 65 percent perceived them to be safe (Johnston, 1997).
Though, OTC drugs are well-recognised to have a positive safety profile, the public anxiety relating to the potential risks remains a matter of concern because of the unrestricted use of these medicines (Calamusa, Marzio, Cristofani, Arrighetti, Santaniello, Alfani, & Carducci, 2012). It is also argued that the increasing availability of OTC medicines in the pharmaceutical retail outlets in some countries might have led to abuse, delays in diagnosis and a waste of resources (WHO, 1988). People who resort to OTC medications sometimes refuse to seek for professional advice for conditions which are critical and desist from self-medication for alternative therapies (Shaw, 1998; Mathialagan & Kaur, 2012).
It has however been argued that intentional or unintentional failure to follow the usage instructions of medicines is applicable to all categories of medicines whether prescription or non-prescription drugs (Pharmacy Today, 2010). Additionally, it has been estimated that, globally, over 50 percent of all drugs have been sold, dispensed or prescribed wrongly, while 50 percent of patients failed to take them correctly (WHO, 2002c).
However, many developing countries are faced with an acute shortage of pharmacists and qualified dispensing staff to run chemist stores, coupled with poor regulatory mechanisms at the grass-root level as well as inefficient storage facilities. The potential effect of this situation is poor dispensing and irrational use of medicines in the community that can ultimately result
in increased drug resistance (Harper & Gyansa-Lutterodt, 2007). Previous research indicates that, out of a sampled population of 215, 37.2% (80) of the respondents had misused OTC medications in one way or the other while, out of a total of 380 medicines consumed, 31.9% had been misused (Ajuoba et al., 2008).
Moreover, there is misconception among customers that if a medicinal herbal product is described as a “natural” and increasing the dosage can boost its effectiveness. This can rather cause persistent overdose of the product. For example, a past customer survey indicates that about 33 percent of Americans took more than the recommended dosage of OTC medication for the simple reason that they thought that the efficacy of the products would increase (NCPIE, 2002). In addition, overdose could also arise when two or more OTC drugs are taken which are used for the same treatment of an ailment (Shaw, 1998). An empirical research revealed that almost 36 percent of Americans were more likely to use multiple OTC medicines when they have more than one symptoms, such as, headache and sore throat (NCPIE, 2002).
Furthermore, non-prescription medications usually interact with many prescription-only pharmaceuticals and other products, such as, food and alcohol. Unfortunately, before a prescription is made, the physician may not investigate whether the patient is using any OTC drugs (WHO, 2000b). Similarly, several patients fail to inform doctors about non-prescription drugs they are using for fear of unfavourable reaction by the health care practitioner. In extreme cases, it is only until adverse drug event occurs that the use of these medicines is disclosed (Shaw, 1998).
However, a survey in 2002 indicated that nearly 75 percent of medical professionals in America frequently inquire directly from the patients about the use of OTC drugs (NCPIE, 2002). It has also been highlighted that self-treatment with OTC medicines depends on the patient`s judgement, in addition to, the label information to permit correct diagnosis of the condition. This requires the patient`s ability to read and interpret the information on the package or the leaflet (Brass, 2011).
World Health Organization (2000c), however, pointed out that the ordinary end-user of OTC medications usually does not understand the principles of pharmacology or therapy and/or particular features of the medicinal product used. Brieger et al. (2005) also stated that most patients, specifically, in Africa have low literacy rates and may find it difficult to interpret a
picture on the packet insert of a pharmaceutical product. Past research also indicates that only 38.1 percent completely understand the contents, due to significant differences in educational levels (Calamusa et al., 2012). As a result, a wrong diagnosis can result in treatment failures of the actual cause of the present condition (Brass, 2011).
Additionally, promotional messages via the media and internet about non-prescription medications seem to portray the absence of the risks of the products. This often creates the impression that OTC drugs are just like another customer health product which can be taken excessively and this can result in the non-medical use of the product (WHO, 2000b).