RSU studies why people take medication without doctor's recommendation

Writer: Zane Zemīte, RSU master's student in the programme Public Health

Almost everyone has experienced having a headache, catching a cold, or developing some other health issue. In the case of minor health complaints, people often choose to treat themselves rather than see a doctor straight away. This is known as self-medication – a person identifies the symptoms and chooses to take medicines without a doctor’s advice.^1,2 In Europe, one-third (34%) but in Latvia, half (50%) of the population have used medicines, vitamins or herbal remedies not prescribed by a doctor over the past two weeks.³ 

In this article, I will present the findings of my master’s thesis study developed at Rīga Stradiņš University (RSU) Public Health study programme, in which I examined the factors associated with the use of non-prescription medicines in Latvia. The study’s results point to marked differences between women and men. Is the decision to self-medicate driven by difficulties to see a doctor in time? What other factors influence this behaviour? 

In the study, I used data from the 2019 European Health Interview Survey (EHIS) – the latest fully available internationally comparable data characterising the Latvian population. In the study, the use of non-prescription medicines was assessed based on the EHIS survey question about medicines, vitamins or herbal remedies used over the past two weeks that had not been prescribed or recommended by a doctor. 

Women are more likely to self-medicate 

Self-medication most commonly is associated with the use of non-prescription medicines,² but in practice, people may also use prescription medicines left over in the home medicine cabinet from previous treatment or obtained from family members.^4,5 

Although self-medication can help address minor health problems and reduce the burden on the healthcare system,⁶ it also carries risks. Incorrectly chosen medicines, inappropriate dosages, prolonged use or combining different medicines can cause adverse side effects and other health risks.^2,7 Furthermore, misinterpretation of symptoms can delay timely diagnosis and treatment.⁸ 

Self-medication is common worldwide, and studies indicate that its prevalence continues to increase each year.⁹ Several factors contribute to this, including an aging population, the increase in chronic diseases, access to healthcare services and changes in medicine marketing policies.^{2, 10} 

The results of my study revealed marked differences between women and men. In Latvia, 59% of women and 35% of men have taken medicines not prescribed by a doctor. A similar trend can be observed across Europe, where women use such medicines more frequently than men.³ This may be explained by the fact that women are more likely to seek health information, share with one another, and have more experience in visiting pharmacies – both when purchasing contraceptives and when caring for their family members.^{11, 12} 

The use of non-prescription medicines was more common among working-age population and older people. In these groups, the prevalence of using non-prescription medicines was approximately 51-53%. Among older people, this may be associated with the higher prevalence of chronic diseases and pain,^13,14 but older people also face a significant risk of adverse drug interactions and side effects when taking several medicines at the same time.¹⁵ 

Among the working-age population, however, non-prescription medicines may be a way of dealing with minor health problems more quickly, helping avoid absences from work due to doctor’s appointments or taking sick leave, which may result in financial implications.¹² The findings suggest that the single concept of self-medication can include a wide variety of situations. For one person, it can be a short-term action, such as taking a headache remedy. For another, it may be a regular attempt to cope with chronic pain or a long-term health problem.  

Those who visit a doctor are more likely to self-medicate  

People who have visited their family doctor in the past year are more likely to use medicines not prescribed by a doctor than those who have not consulted their family doctor. The use of non-prescription medicines is not necessarily an alternative to using healthcare services but may be a form of preventative health behaviour alongside to visiting a doctor. A similar trend was also observed among people who had visited a specialist in the past year – they were more likely to use non-prescription medicines, which may be associated with more complex health problems, as well as with a desire to relieve symptoms between appointments or to seek cheaper and more readily available alternatives.¹⁶ 

People who have visited a functional specialist within the last year are also more inclined to use medicines not prescribed by a doctor. In cases of chronic pain and long-term health problems, people also engage in self-care of their symptoms by taking painkillers and other medicines alongside the treatment provided by a specialist.¹⁷ 

A similar situation can also be observed among people who have undergone laboratory tests or diagnostic examinations over the past year. In Latvia, a doctor’s referral is required to receive laboratory or diagnostic services funded from the state budget.¹⁸ Given that the procedure prior to accessing such examinations requires contacting a primary or secondary healthcare specialist, a visit to a laboratory or diagnostic centre could be an indirect indicator of an acute health problem or the monitoring of chronic health conditions. At the same time, tests are not always carried out solely for treatment purposes – they are often used preventatively to monitor health or detect health problems at an early stage.¹⁹ Therefore, receiving laboratory or diagnostic services can be a sign of both health problems and health monitoring, and in both cases, people tend to take medicines in parallel that have not been prescribed or recommended by a doctor. 

In addition, a pattern emerged whereby men who had used healthcare services in the past year were more likely to take medicines not prescribed by a doctor than women, suggesting differing self-care habits between the sexes. 

Long waiting lists for appointments  

The study also assessed whether the use of medicines not been prescribed by a doctor is associated with situations where people have not received healthcare services on time or have not received them at all. Latvia has one of the highest rates of unmet medical needs in the European Union - 8.4%.²⁰ 

One of the key factors associated with the use of medicines not prescribed by a doctor is long waiting lists for healthcare services. When people are unable to see a doctor because of long waiting lists, they are much more likely to self-medicate than those for whom long waiting time have not been an obstacle for accessing healthcare services. Sometimes such behaviour is also influenced by cultural factors – in some countries, people tend to avoid taking risks and therefore are less likely to use non-prescription medicines, while in others, people view non-prescription medicines as a quick solution, focusing less on long-term risks.¹² The trend observed in Latvia indicates to risk taking in situations where the healthcare system is unable to ensure access because of long waiting lists. 

However, the data do not show that people are taking medicines that have not been prescribed by a doctor because the specialist is too far away or they do not have a means of transport to get to them. Still, Latvia’s geographical situation is a significant factor, as access to healthcare varies considerably between urban and rural areas. In rural areas, a family doctor is more readily available; however, specialist healthcare services are often only accessible in the larger cities. This requires additional time and resources for people living in rural areas.²¹ At the same time, it should be noted that limited access to pharmacies in rural areas can also be an obstacle for purchasing medicines. 

Furthermore, difficulties in paying for medical and dental services, as well as for medicines prescribed by a doctor, were not associated with the use of medicines not prescribed by a doctor. This does not mean that the cost of healthcare services has no impact upon people’s health behaviour, but rather that the reasons for self-medication can be multi-layered. The findings suggest that the reasons for self-medication may be more complex than merely the cost of healthcare services – they may also be associated with access to healthcare, health behaviours, the health status of the population and other factors. 

Overall, the study shows that the use of medicines not prescribed by a doctor is common in Latvia and determined by various reasons. In some cases, self-medication goes hand in hand with more active use of healthcare services, while in others, it may be a response to long waiting lists or the need to relieve symptoms quickly. Therefore, it would be too simplistic to assess self-medication merely as either appropriate or inappropriate health behaviour. It is far more important to understand the circumstances under which a person decides to take a medicine without a doctor’s advice and whether they have sufficient information to make this decision safely. 

The World Health Organization emphasises that self-care can help reduce the challenges faced by healthcare systems when people have access to safe, clear and reliable information.²² The discussion is therefore not only about whether people should be allowed to take care of their own health, but rather how to ensure that such behaviour is as safe and well-informed as possible and does not become a substitute for a doctor’s assistance. In practical terms, this means that the public needs simple and reliable information on the most commonly used non-prescription medicines, their dosages, duration of use and the situations in which self-medication should not be continued. 

It is equally important to make it clear that a medicine not prescribed by a doctor is not automatically harmless merely because it can be purchased without a prescription. 

This article was originally published on the LSM news portal.

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