As prescription drug use continues to rise in Africa, there is a sense of satisfaction that we are making some headway in solving the problem of lack of access. However, behind this success story is a growing epidemic of drug misuse that has claimed millions of innocent lives. The reverse in fortunes calls for refocusing on the ethical standard of medical practice primum non nocere, Latin for “first, do no harm” in order to protect the lives that we are attempting to save.
Ms. Betty a 40 year old woman was rushed to a hospital in Kampala following complications from her diabetes. She was admitted immediately and prescribed insulin to stabilize her blood sugar levels. Ms. Betty was discharged after a week in good health and returned home with instructions to continue her insulin injections three times a day. Two weeks following her discharge, she exhibited signs of confusion, shakiness, dizziness and was readmitted after spells of loss of consciousness. She slipped into a coma and was pronounced dead a week after re-admission.
The rate at which our healthcare providers put patients at risk is alarming– making it difficult to discern medical malpractice or negligence from limited resources in society to guide patients through the complex healthcare maze. Vulnerable patients are left behind the wheel and asked to drive without adequate instruction on how to operate the vehicle or how to read and interpret road signs. Inevitably some will drive on the wrong side of the road, run red lights among other violations that often lead to disaster. Ms. Betty was sent home with insulin yet she had no blood sugar monitor and didn’t understand how dangerous insulin can be when administered without eating. In addition to that she could not read English or understand any of the provided medication package inserts.
Loss of a family member, friend or loved one is always a challenging and painful event in our lives. Failure to know the cause of death often adds to our sorrow and leaves many without a sense of closure. This is a common occurrence in Africa because we often lack the means or resources to conduct an autopsy and obtain an accurate cause of death. The locals are left to speculate on the cause of death—some whispering at the funeral if the deceased had AIDS, was invaded by spirits from enemies among other farfetched theories.
Healthcare providers likewise learn from mistakes but the systemic lack of checks and balances is allowing avoidable practices and weaknesses within our healthcare system to continue unabated. This is not an attempt to endorse a movement towards medical malpractice lawsuits though such safeguards play a limited role in protecting the rights of patients. A more productive approach would involve widespread trouble shooting to identify cracks in the systems that require immediate action to protect prescription drug consumers.
A push for quality assurance is urgently needed to combat the culture of throwing pills at patients without proper counseling, follow up evaluation and providing community resources to counsel and support patients and caretakers. Our policy makers have mostly focused on enacting policies to combat the trafficking and abuse of illicit drugs such as marijuana, ecstasy, crack, heroin, methamphetamine and cocaine. The mentality that prescription drugs are safe is misguided and the primary reason prescription drugs are becoming a disease under the radar. Non-medical use of prescription drugs is also on a rise particularly narcotics and puzzling ones such as Efavirenz an HIV drug which is crashed and smoked for hallucinogenic effect.
Improper use of prescription drugs has numerous repercussions that include addiction, overdose, under-treatment, adverse reactions, drug resistant strains and ultimately higher healthcare cost. Widespread use of drugs to treat chronic conditions mostly among the elderly accounts for the occurrence of polypharmacy. The combination of multiple prescription drugs and herbal supplements often result into catastrophic adverse reactions and drug interactions. Healthcare providers particularly pharmacists who are the trained custodians have to be vigilant and available to guide patients towards safe use of drugs by identifying red flags and minimizing their impact before it’s too late.
Additional steps that should be taken to stem the tide include sensitizing the masses about the dangers of prescription drugs; providing leaflets and instructions translated in local languages; monitoring prescribing practices of physicians; effective post marketing surveillance of prescription drugs; conducting research and data collection on prescription drug abuse; requiring trained pharmacists to operate retail pharmacies rather than cashiers who lack the skills and knowledge to counsel patients on safe use of dispensed drugs; healthcare providers should spend time with patients to educate them on the indication, safety, efficacy and monitoring parameters of all prescribed drugs along with the pertinent monitoring and testing devices.
It’s imperative that we minimize the number of patients who endure the fate of Ms. Betty. Though we continue to live under the guise that prescription drugs are safe, the difference between a safe and toxic dose is often marginal. As a result, we have to make sure that patients are provided with a road map and trained to read it before they set off on the journey towards recovery. This is not exclusively the responsibility of the healthcare providers but also the patients and care takers. If we fail to act, the cure will continue to cause as much harm as the disease.