Surely everyone knows how to use their medicines exactly as advised, and complies with all the instructions?! I clearly remember thinking this during my pharmacy undergraduate studies when the lecturers talked about people misusing their medicines. Why would anyone not comply? But as soon as I was ‘in the real world’, working in community pharmacies, I realised that no – people DON’T always use their medications safely, or as intended.
My entry to the University of Otago’s recent ‘Bake Your Thesis’ competition shows the ‘wave of pills’ out there that is causing harm to people in the community. My research examines this ‘wave’ in detail, to try and identify the particular medications most responsible for causing the damage. The pills on the cake form a symbol for emergency medical help.
One cause for concern and source of ill health is poisonings. The majority of poisonings or overdoses with medicines occur as a result of a simple mistake or an unintentional error in judgment (“Oh, I thought it would be fine to just take two extra pills!”). But about two-thirds of poisonings that lead to a presentation at an Emergency Department (ED) are caused by intentional decisions to take too much. There are many reasons why someone may overdose on purpose.
This behaviour is often quite impulsive; people grab the nearest item or whatever is in the medicine cabinet. Many take their own prescription medicines, because they’re there, easily accessible. If prescribers know what to look for they can, for example, plan weekly dispensing for someone who may be at risk of an overdose, ensuring access to only small amounts at any one time. On the other hand, if we know that a particular medicine sold without a script appears often in overdose presentations, we can perhaps plan to place limitations on its sales.
To plan appropriate interventions, we need accurate data. Currently, however, hospital presentation data don’t tell us which specific medicines are most frequently seen in intentional overdoses, and so we don’t know exactly which medications need to be targeted.
Most people who have taken too much medication present to ED, making the emergency department the most useful place to collect details about what was taken. In my PhD project, I collected this information from a few EDs in New Zealand. This was done to show that it’s doable, and to highlight how specific information can help make a difference in policy planning by enabling more informed decisions.
For many of those who have overdosed intentionally, ED may be their only contact with health care. That is where we need to reach them before they disappear from the radar of services. As well as organising follow-up care in the community, we need to collect this specific information about what has been taken, so that we can see what is causing harm in our communities.
On my cake, the specific information is represented by the clearly separated pills that can be counted. And yes, the blue diamond-shaped pills are indeed Viagra. They’re there for ‘shock value’, to make people look twice. We need to actively engage people in discussions about preventing intentional overdoses. People need to be aware that help is out there, and that it’s okay to seek it. This cake won’t be able to resolve the problem, but I hope the research behind it may push our efforts just a little bit further.
Eeva Kumpula is a postgraduate student at the School of Pharmacy. Her research interests include large national datasets and how they could be used to inform policy planning and to prevent intentional self-poisonings.
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Eeva Kumpula baked her cake, ‘A Wave of Pills’, for the University of Otago’s inaugural Bake Your Thesis competition. Read how some of the other entrants cooked up their research ideas:
Photo credit: Sharron Bennett.