High Prevalence of Analgesic Misuse and Abuse and Associated Factors Among Pharmacy Students in Public and Private Universities in Zambia
This study reveals a high prevalence of analgesic misuse and abuse among pharmacy students in public and private Zambian universities, with nearly 70% engaging in off-label use and 39% reporting recreational abuse, factors significantly associated with female sex and marital status.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Pain is a universal human experience, and the medicines we use to quiet it are among the most common tools in modern healthcare. These drugs, known as analgesics, range from simple pills taken for a headache to powerful substances reserved for severe suffering. In the world of medicine, there is a clear line between using a drug correctly, using it incorrectly for a medical reason, and using it for a non-medical purpose like seeking a feeling of euphoria. Using a medicine for a legitimate reason but in the wrong way, such as taking too much or using it for a condition it was not meant to treat, is called misuse. Using a medicine purely to get high or feel good is called abuse. While these behaviors are studied in the general population, they take on a different weight when they occur among future healthcare professionals. Pharmacy students are trained to be the guardians of medicine, the experts who guide how drugs are used and distributed. If the people who will soon be dispensing and advising on these drugs are themselves struggling with how to use them, it raises a serious question about the safety of the entire system.
A recent study conducted in Zambia sought to understand exactly how widespread these behaviors are among pharmacy students. Researchers gathered a group of 224 students from two universities in the capital city, Lusaka: one public institution and one private. They asked these students to fill out a questionnaire about their habits over the previous year, specifically looking for three types of behavior: taking a painkiller for a reason it was not prescribed for, taking more than the recommended amount, or taking it to feel a sense of pleasure or a "high." The goal was not just to count how many students had used painkillers, but to see how many were using them in ways that could be dangerous or illegal.
The results revealed a startling picture of near-universal use mixed with significant risk. Almost every student in the study, about 93 percent, had taken an analgesic in the last year. However, the way they used these drugs was often far from the careful, rational approach they are taught in class. When the researchers broke down the answers, they found that 70 percent of the students had used a painkiller for a reason it was not intended to treat. More than half, 58 percent, admitted to taking higher doses than recommended. Perhaps most concerning was the finding that nearly 40 percent of the students reported using these drugs for recreation or to experience a euphoric feeling. This group included students who had used opioids, a class of powerful painkillers that includes drugs like tramadol and codeine, which carry a high risk of dependence.
The study also looked at what the students knew and believed about these medicines. Despite their advanced training, a large portion of the group did not know the correct dose for common painkillers. More than half believed that all painkillers could be bought without a prescription, and a majority felt it was acceptable to purchase them from supermarkets. This gap between knowledge and behavior suggests that simply teaching students the facts about drugs is not enough to stop them from using them poorly. The researchers found that knowing the right dose did not protect a student from misuse. Instead, other factors played a bigger role. Female students were significantly more likely to engage in these risky behaviors than their male counterparts, and students who were unmarried were more likely to misuse or abuse the drugs than those who were married.
The location of the university also mattered. Students at the private university reported higher rates of taking painkillers for the wrong reasons and taking too much compared to students at the public university. However, students at the public university were slightly more likely to report using the drugs for recreation. The researchers noted that the reasons for these differences were not entirely clear, but they could be linked to different pressures, living situations, or even the specific way each school teaches its curriculum. One thing was certain: the students were not just using these drugs; they were using them in ways that put their health at risk and undermined the very principles of their future profession.
The study concludes that the problem is not just a lack of information. The students know the theory, but they are not applying it. The researchers suggest that the solution requires two different approaches. For the behaviors related to taking the wrong amount or using the drug for the wrong condition, the answer lies in better education that focuses on the practical realities of safe use. For the recreational use of powerful drugs, especially opioids, education alone is not enough. The study points out that stricter rules and enforcement are needed to control access to these substances. The findings serve as a wake-up call for the institutions training these future pharmacists. If the people who will one day be responsible for handing out these medicines cannot manage their own use, the entire system of pain management in the country is at risk. The path forward requires acknowledging that knowledge does not automatically lead to safe behavior, and that protecting public health means addressing the habits of the healers themselves.
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