INTRODUCTION: Misuse of prescription medicines and the harms associated with such use are growing threats across the world. There is currently, however, limited data on the extent of prescription medicine misuse in Singapore and whether this is a current threat in the country. METHODS: An online survey, limited to 1,000 individuals (aged 21 years and over) who were residents in Singapore, was administered through a survey panel company in September 2015. The survey collected information on participant demographics, and their awareness, self-reported lifetime and past-year misuse of commonly available prescription medicines in Singapore as well as the use of a range of recreational drugs and novel psychoactive substances (NPS). RESULTS: Lifetime (6.7%) and past-year (4.8%) misuse of any prescription medicine was comparable to lifetime (6.0%) and past-year (3.0%) use of any recreational drugs/NPS. The top five prescription medicines for lifetime misuse were: diazepam (2.7%); codeine (2.3%); dhasedyl (promethazine, codeine and ephedrine; 1.6%); panadeine (paracetamol and codeine; 1.5%); and methylphenidate (1.2%). The top five drugs for past-year misuse were: diazepam (1.6%); codeine (0.9%); panadeine (0.7%); alprazolam (0.6%); baclofen (0.6%); and gabapentin (0.6%). CONCLUSION Misuse of prescription medicine in Singapore was common, with prevalence comparable to the use of recreational drugs/NPS. A common source for misused drugs was physicians. Further studies are required to determine whether this is more widespread in Singapore and establish the different forms of drug diversion, so that appropriate prevention strategies can be implemented.
Humans ; Illicit Drugs/adverse effects* ; Public Health ; Singapore/epidemiology* ; Substance-Related Disorders/drug therapy* ; Prescription Drugs/adverse effects* ; Codeine ; Diazepam ; Prescriptions

BACKGROUND: The abuse, misuse, and resultant adverse reactions of various drugs have been widespread due to lack of division of work of medicine and pharmacy in Korea. OBJECTIVE: This study was conducted to bring people to an awareness of the seriousness of drug abuse and misuse. METHODS: A multicenter, prospective, clinico-epidemiologic evaluation was made from patients with adverse drug reactions who visited 126 dermatologic departments in university hospitals(21) or private clinics(105) nationwide from July 1st to July 31st, 1999. RESULTS: The prevalence of adverse drug reaction was 10.4%, among them 47.9% of the patients had adverse cutaneous effects from external use of topical steroids and 24.1% of the patients had contact dermatitis from external use of various topical agents. The rate(66.3%) of misuse of topical steroids was higher than that(33.7%) of abuse of the drugs. 79.8% of patients had obtained drugs without an accurate diagnosis and prescription from their doctors. Regarding the potency of topical steroids, it was revealed that the lowest potency drugs also caused adverse effects. CONCLUSION: The strict grouping of drugs as prescription drugs or over-the-counter drugs based on drug safety is the key factor to avoid the abuse and misuse of drugs, and to protect the public health from harmful drug effects.
Dermatitis, Contact ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Korea ; Nonprescription Drugs ; Pharmacy ; Prescription Drugs ; Prescriptions ; Prevalence ; Prospective Studies* ; Public Health ; Steroids ; Substance-Related Disorders

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Dietary Supplements/adverse effects ; Drug-Induced Liver Injury/enzymology/*etiology/pathology ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy/adverse effects ; Plant Preparations/adverse effects ; Prescription Drugs/adverse effects ; Republic of Korea ; Retrospective Studies

Three hundred sixty-two(male 131, female 231) elderly aged over 65 in Chungbuk area were interviewed to determine the disease states and drug usage patterns. The prebalence of disease was 78% and women reported more chronic diseases(83%) than men(71%). Elderly who live with spouse and have an occupation have a lower rate of disease. Average number of diseases of the elderly was 1.8+/-1.1, and women(2.1+/-1.3) have significantly higher average number of diseases than that of men(1.4+/-0.7). Also the elderly in urban areas(2.1+/-1.4) have significantly higher number of diseases than that of the elderly in rural areas(1.6+/-0.9). Arthritis, hypertension, cardiovascular and gastric diseases were the most frequently listed chronic diseases in order for both men and women. Anemia and fracture of bone were relatively higher in women than in men. Particularly, the arthritis of the urban elderly have a rate of 1.5 times higher than that of the rural elderly. Fifty-two percent of the elderly were currently using drugs ; among drug users 71.2% used prescription drugs and 20.5% used nonprescription drugs. The average number taken per person was 2.1+/-1.4 and there was no sex or age difference. However, the elderly in rural areas (2.7+/-1.7) consumed a significantly higher number of drugs than those in urban areas(1.7+/-0.7). The average number of prescription drugs taken was 2.0+/-1.4 while the average of nonprescription drugs taken was 1.3+/-0.6. Analgesics and antihypertensive drugs were most commonly used. Vitamin and analgesics were the most frequently used self-prescribed drugs. It was noted that potential adverse drug interaction by concominant drug consumption for arthritis and antihypensive drug, abuse of digestants and antiacid without treatment of the underlying disease, and misuse of quick-acting bowel medications were problematic for the elderly. In addition drugs used for the elderly have some adverse effect on the digestive system. The types and composition of drugs used by the elderly were identified and presented. Medication compliance was poor and 13.5% reported adverse reactions such as edema, heartburn, nausea, and difficulty with eating. Seventeen percent of the elderly obtained drugs arranged by those other than medical staff. Also, even among those elderly who obtained drugs prescribed by a doctor, 69.1% of subjects had not receive instruction about potential adverse reactions. These results suggest that nutritional problems related to drug usage might exist and so dietitians, either individually or as members of health teams, need to have a better understanding of drug-nutrient interaction and closer supervision, and drug information/education service should therefore be provided to prevent or minimize adverse drug reaction in elderly users of medication.
Aged* ; Analgesics ; Anemia ; Antihypertensive Agents ; Arthritis ; Chronic Disease ; Chungcheongbuk-do ; Digestive System ; Drug Interactions ; Drug Users ; Drug-Related Side Effects and Adverse Reactions ; Eating ; Edema ; Female ; Gastrointestinal Agents ; Heartburn ; Humans ; Hypertension ; Male ; Medical Staff ; Medication Adherence ; Nausea ; Nonprescription Drugs ; Nutritional Status* ; Nutritionists ; Occupations ; Organization and Administration ; Prescription Drugs ; Spouses ; Stomach Diseases ; Vitamins