Drug Over-Prescription

Understanding Drug Over-Prescription in Nigeria

Drug over-prescription refers to the practice where healthcare providers inappropriately write prescriptions for medications that a patient does not clinically need, or prescribe them in excessive doses, durations, or frequencies. Within the Nigerian healthcare landscape, this practice strains scarce family resources and severely compromises public health. The National Drug Policy (NDP) provides the regulatory framework aimed at promoting the rational use of drugs, ensuring that patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period, and at the lowest cost to them and their community. Despite these guidelines, over-prescription remains prevalent across primary, secondary, and tertiary health facilities, driven by a complex interplay of clinical uncertainties, commercial pressures, and deeply ingrained patient expectations.

Drivers and Manifestations of Inappropriate Prescribing

Inappropriate prescribing manifests in several distinct ways that put patients at risk. Clinicians frequently encounter scenarios involving polypharmacy, therapeutic duplication, and incorrect duration.

• Polypharmacy: The concurrent use of multiple medications, often exceeding what is clinically justifiable for the patient's diagnosed conditions.
• Therapeutic Duplication: Prescribing two or more drugs from the exact same pharmacological class, such as giving ibuprofen alongside diclofenac, which drastically increases toxicity risks without added benefit.
• Incorrect Duration: Extending a medication course far beyond the clinical indication, which commonly occurs with proton pump inhibitors and antibiotics.
• Misaligned Dosage: Administering doses that are either too high for organ function or too low to achieve therapeutic effect.

Systemic and Behavioral Causes in Healthcare Facilities

The persistence of over-prescription is rarely just about individual error; it stems from deep-seated systemic and behavioral pressures within the healthcare environment.

1. Patient Demand and Beliefs: Many patients equate a visit to the doctor or nurse with receiving physical items, creating intense pressure to leave with a prescription slip.
2. Commercial Incentives: In settings where drug sales fund operational costs or staff bonuses, providers face financial motives to dispense more medications.
3. Diagnostic Uncertainty: Fear of missing an infection or failing to satisfy an anxious patient often leads to defensive prescribing, particularly with broad-spectrum antimicrobials.
4. Inadequate Continuing Education: Outdated clinical knowledge leaves practitioners relying on habits rather than current evidence-based guidelines.

Clinical Consequences on Patient Safety and Public Health

Unchecked drug over-prescription inflicts heavy tolls on individual bodies and public health infrastructure. At the individual level, taking surplus medications skyrockets the incidence of adverse drug reactions, drug-drug interactions, and organ toxicity, particularly affecting the liver and kidneys. Elderly patients are especially vulnerable due to age-related changes in pharmacokinetics and pharmacodynamics. On a broader public health scale, the indiscriminate over-prescription of antimicrobials accelerates global antimicrobial resistance, rendering standard treatments useless against common infections. Furthermore, out-of-pocket spending on useless medications drains household finances, frequently leading patients to abandon essential nutritional or housing needs to pay for hospital bills.

Nursing Identification and Medication Review Strategies

Nurses occupy a frontline position to identify over-prescribed regimens before they harm the patient. Conducting a thorough medication reconciliation upon admission and during clinic visits allows nurses to compare what the patient is actually taking against prescribed charts and clinical diagnoses.

• Look out for red flags such as duplicate therapies, long-term sedative use without re-evaluation, or broad-spectrum antibiotics continued past fever resolution.
• Perform systematic medication reviews by engaging patients with open-ended questions about their drug history, traditional remedies, and side effects.
• Collaborate actively with pharmacists and attending physicians to question discordant prescriptions and advocate for dose reductions or drug cessation (deprescribing) when indications have lapsed.

Regulatory Approaches and Policy Enforcement in Nigeria

Combating over-prescription requires robust structural interventions and strict regulatory enforcement. Agencies such as the National Agency for Food and Drug Administration and Control (NAFDAC) and the Pharmacists Council of Nigeria (PCN) hold the mandate to regulate drug distribution, prescription practices, and retail dispensing. Policy enforcement involves cracking down on patent medicine vendors who sell prescription-only medicines over the counter without proper authorization. Additionally, health institutions must implement hospital-based antimicrobial stewardship programs and therapeutic committees to audit prescribing patterns regularly. Training healthcare providers on standard treatment guidelines ensures accountability and helps curb the financial and clinical damages caused by rampant over-prescription.