Corticosteroid Nonprescription Use: A Cross-Sectional Hospital-Based Study in Basrah

Abstract

Objective: To study the prevalence and attitude of using nonprescription corticosteroids (oral or parenteral formulation of glucocorticosteroids) in Basrah, Iraq. Methods: A face-to-face model structured interview was used to collect information from 682 patients between January 2006 and December 2008. The following information was obtained: age, gender, marital status, smoking, drinking of alcohol, occupation, educational level, social class and place of residence. Results: Of the 682 (2.6%) subjects using nonprescription corticosteroids most were females: 471 (69%); married: 567 (83%); of low social class: 430 (63.1%); lived in the city center: 475 (69.6%). The majority (569, 83.5%) thought that corticosteroid use was safe and 463 (68.0%) did not feel guilty for using such medications. About half of them (377, 55.3%) were still using drugs at the time of presentation. Three hundred and fifty-seven (52.4%) reported that physicians advised them for the first time to use corticosteroids and the remaining 325 (42.2%) used it to become beautiful or marry. Three hundred and sixty-four (53.4%) patients obtained the drug from the pharmacy and 252 (36.9%) from street vendors. Weight gain was the main indication for use in 342 (50.1%) patients. Almost all had some features of corticosteroid side effects. Conclusion: This study showed high use of nonprescription corticosteroid in Basrah, Iraqi. We therefore recommend educational programs to alert the population of the untoward side effects of corticosteroids.

Self-reported substance use in Iraq: findings from the Iraqi National Household Survey of Alcohol and Drug Use, 2014

“…Self‐reported use of all drugs (prescription and illicit) was generally low and almost non‐existent among females. Consistent with a previous Iraqi study , the most commonly reported drug by men was steroids. Due to the cultural sensitivity of the survey topic, we suspect under‐reporting of substance use in this survey.…”

“…Our estimate of life‐time alcohol use in Iraq is approximately twice what is reported in the Iraqi Mental Health Survey in 2007 . There is poor coverage of alcohol use in Arab‐world studies, and most reports only involve life‐time use . Despite the low prevalence of alcohol use found in our study, the average number of drinks consumed among those who reported drinking was quite high (seven drinks per day).…”

The performance of serum cortisol, plasma corticotropin and serum dehydroepiandrosterone sulfate levels in the diagnosis of hypothalamic pituitary adrenal dysfunction

“…[15][16] A majority of HPAD seen in our Center is due to use of exogenous corticosteroids for various reasons, but most of them are due to nonprescription use. [13] This is established fact, all over the world. [16] Adrenal insufficiency after discontinuation of glucocorticoid occurs frequently; there is no administration form, dosing, treatment duration, or underlying disease for which adrenal insufficiency it can be excluded with certainty.…”

“…Similar finding seen from the same Center before, where women constituted 69% of those self-prescribed corticosteroids. [13] In a study by Hahner et al, women to men ratio for secondary AI were 113:77 with median age of 59 years. [18] The female predominance for HPAD is due to more use of corticosteroids in our patients that difficult to explain.…”

“…This makes the risk of HPAD prevalence very high, especially with denial of use. [13] The availability of short cosyntropin test can not guarantee always, and the insulin stress test is dangerous in our locality. [14] For that reason, we tried to have a panel of simple tests which are feasible and available to assess the risk of HPAD, which can be fatal if missed.…”