Pills, Potions and Prescriptions

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An Update on Over-The -Counter Medications

By Hilary Diack

It seems so easy, just pop into your local pharmacy and head off a few minutes later with a panacea for all your ills. A situation that very people even bother to question, after all, it has been like that for years. But why is this the case, and what are the implications? Cairo West  Magazine sat down with Dr. Ahmed El-Dosoky, Consultant Psychiatrist  and Managing Director of Behman Hospital,  to learn more about the pros and cons of OTC medications.

CWM: Why is it so easy to obtain medications here by simply walking into a pharmacy when many Egyptians can attest to the fact that they have problems trying to get the same medication from a pharmacy while travelling abroad?

AD: Very few people seem to be aware of the fact that there is legislation in place covering the distribution and sale of medications. In reality, this is mainly applied in the case of medications like morphia and benzodiazepines like diazepam. These are considered as 1st category drugs and require specific paperwork to be filled in order to dispense them. Of course, a prescription is essential. Basically we can put the ease of availability of lower category medications down to a win-win situation, where neither the pharmacist or customer wants to change the status quo.

What are the most common medications requested over the counter?

Usually anti-depressants and  sleeping medications like Valium, Xanax, Prozac, Calmepan, Cipralex and their local generics.  Of course, there is also a lot of demand for appetite suppressants, antibiotics and antihistamines.  Mosegor seems to be the medication most widely requested for appetite stimulation.

What sectors of our society tend to be the main users of this system?

It really varies, in many cases the lower income groups avoid the cost of seeing a doctor, and do not feel comfortable going to a government hospital, so they solicit advice from their local pharmacist. Medications are often given based on a pharmacist’s previous experience with a person displaying similar symptoms. In other cases people are simply too busy to seek professional advice so they get information from family, friends and the internet, then purchase what they think is the correct medication.

So, aren’t there dangers associated with incorrect dosages and side-effects or adverse interaction with other medications?

Actually, it has been noted that when people take medications without a consultation or prescription they tend to take less than the recommended dosage to be on the safe side. So, when this doesn’t appear to be working they end up having to refer to a medical professional to address the problem correctly.

What controls are in place to deter misuse and abuse of medications?

A pharmacist has the right to ask for formal identification and proof of age when dispensing any medication.  They also have the right to refuse a request for an OTC medication without a prescription, although less scrupulous pharmacists may provide it at inflated pricing without question. Some pharmacists may only accept to deliver an order so they have a definite address to use as a back-up reference. Again, procedures are widely left to the discretion of the pharmacist.

What other factors come into play?

There is still a social stigma attached to consulting a psychiatrist, so even when a person is suffering from anxiety, depression or a related condition they tend to go to their GP for treatment. Although GPs receive a certain level of training in psychiatric issues they still lack the level of specialized knowledge of dosages of medications and duration required to effectively address a lot of the conditions that people resort to OTC medications for.

Eventually most people do need to consult a specialized psychiatrist to receive the expert advice and support which  is just as important as medications, many of which only serve to block out the symptoms and de-sensitive the patient on a short term basis. This can lead to a person gradually resorting to more powerful medication as their system responds less to a drug over time. It must be noted that generally the more educated a person the easier it is for them to find a solution to a problem without having to actually take medication, the less educated sector of the community seems to feel that an improvement comes only with pills, something that is tangible.

There is also a lot of self-administering of antibiotics. Again, overuse of these without a doctor’s supervision can have long term negative effects on a person’s natural immune system.

Why do we hear so much about misuse of anti-depressants these days?

They are often nick-named ‘the marital happiness pill’. Use is more prevalent in women who for one reason or another wish to avoid confrontation or feel trapped in an unhappy marriage. Rather than rock the boat by trying to address the situation they medicate to keep themselves in a semi-permanent zombie-like state.

Which drugs hold the highest risk of becoming addictive?

Unfortunately the groups that are commonly abused, the benzodiazepines ( anti-depressants and tranquillizers) and opioids ( painkillers). A person can quickly develop a tolerance to them and need to increase the dosage to receive the same effect after a relatively short period of use.

Are people becoming more willing to take a holistic approach to both mental and physical health these days?

Very much so with the better educated part of society. There is a definite trend towards using natural methods to maintain a positive state of both physical  and psychological health. They are  more aware of warning signals that they need to make lifestyle or relationship adjustments, and more proactive in taking the right steps by natural means. Paradoxically, the older generation in the countryside still hold a fount of knowledge when it comes to natural remedies and the benefit of herbs as well.

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