Almost half of all medicines globally are used irrationally. This, say medicines experts at the World Health Organization (WHO), can have severe consequences: adverse drug reactions, drug resistance, protracted illness and even death. In addition, the financial cost incurred by individuals and governments due to irrational use is unnecessary and often extremely high, particularly in developing countries where patients often pay for medicines out of pocket.
At a global meeting opening in Thailand on 30 March, WHO and partners (comprising donor governments, foundations and non-governmental organizations) will spend four days looking at ways to improve use of medicines in developing countries.
"Most people see a lack of access to medicines as the main problem," says Hans Hogerzeil, Director ad interim of Essential Drugs and Medicines Policy at WHO. "Unfortunately, the irrational use of available medicines is also a major threat to health and leads to considerable waste."
Irrational use of medicines includes: over-treatment of a mild illness; inadequate treatment of a serious illness; misuse of anti-infective drugs; over-use of injections; self-medication of prescription drugs; premature interruption of treatment. Several country figures show that such practices are frequent, and not exclusively in developing countries.
According to figures gathered by surveys presented to WHO, in 2000, about 60% of antibiotics in Nigeria were prescribed unnecessarily. In Nepal, over 50% of antibiotics prescribed in 1996 were not needed and 40% of medicines expenditure in the same year was wasted due to inappropriate prescriptions. Globally, the figure for unwarranted antibiotics prescriptions stands at roughly 50%.
Overuse of most medicines contributes to drug resistance. For example, overuse of chloroquine, the traditional remedy for malaria, has led to resistance which has been recorded in over 80 countries. Resistance to penicillin, used to treat gonorrhoea, is present in as many as 98% of patients in certain regions.
Irrational use of drugs due to inappropriate prescription can also lead to adverse drug events which cause illness or death. In the United Sates, adverse drug events represent one of the six leading causes of death.
The bottom line to increasing rational use of medicines is the improvement of health systems, which can only be achieved through multilateral partnerships concretely promoting development. WHO and other agencies have worked to promote rational use of medicines through advocacy and education programmes for health providers, prescribers and consumers. Further steps to be promoted in the future are: advice to policy makers on market and price controls and limiting the medicines options for a country to those that are strictly necessary for the public health priority concerns.
“Misuse of antibiotics, overuse of injections, and under-use of life-extending drugs for illnesses such as HIV/AIDS, heart disease, and other chronic illnesses together constitute a global epidemic of irrational use of medicines,” explains Jonathan Quick, incoming president and CEO of Management Sciences for Health. "This epidemic results in untold needless suffering and costs millions of lives each year.”
Currently, about 20 000 medicines are sold on the global market. WHO's List of Essential Medicines, which includes examples of medicines addressing all the major diseases of public health importance, contains 316 products. The wide range of very similar medicines that exist for the same condition can lead to irrational use and all the negative consequences this brings with it.
The International Conference on Improving Use of Medicines is the second of its kind and will take place in Chiang Mai, Thailand, from 30 March to 2 April. The Conference is sponsored by WHO, the Thai Network for Rational Use of Drugs (ThaiNRUD), Management Sciences for Health, the Centre for International Health, Boston University School of Public Health; Harvard Medical School and the International Network for the Rational Use of Drugs.