Medication Safety Feature Article

We’re medicine experts, why don’t we refer to them as just that?

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Wendy Ewing1,2 (on behalf of the Medication Safety Leadership Committee)

BPharm, MSHP

  1. Medication Safety Leadership Committee, The Society of Hospital Pharmacists of Australia, Collingwood, Australia
  2. Deputy Director of Pharmacy — Quality, Monash Health, Clayton, Australia

[Published on 7 March 2023 in Pharmacy GRIT. Article No: 2023002] 

It is time to discard a word from our collective written and verbal vocabularies.

It is time to avoid a term associated with negative connotations and no longer reflected in the language used by our patients.

The word is drug, and it is time for clinicians to use the term medicines or medications, consistently and comprehensively, reserving the term drug for illicit or recreational drugs.

Pharmacists are medicine experts. We are essential members in the health care team, specifically because of our medicines knowledge. Most health care organisations now use the terms medicine or medication exclusively. The World Health Organization’s Global Health Challenge is ‘Medication without Harm’. The International Pharmaceutical Federation (FIP) vision includes “access to safe, effective, quality and affordable medicines”.1 Australia’s largest scientific pharmacy conference — held by the Society of Hospital Pharmacists of Australia (SHPA) — is Medicines Management. The Pharmaceutical Society of Australia considers its members as the “custodians for safe and effective medicine use”.2 An entire standard of the National Safety and Quality Health Service Standards is dedicated to medication safety.3 At a legislative level, the Standard for Uniform Scheduling of Medicines and Poisons has referred to medicines rather than drugs for over a decade.4 The first edition of the National Medicines Policy was published over 20 years ago,5 and medicines safety was named the 10th National Health Priority Area in 2019 by the Council of Australian Governments (COAG) Health Council.6

Recall your last encounter with a patient, did you enquire as to the medicines they regularly take, counsel them on a new medicine, provide them with Consumer Medicines Information (CMI), or perhaps provide them with a medication list? I would propose the conversation with an 80-year-old patient may have a different tilt if the first question was to enquire about their regular drug use. It is undeniable that the terms medicine and medication are embedded in both clinicians’ and patients’ health care language.

So why do organisations persist with Drugs and Therapeutics Committees (DTCs), policy and procedure documents littered with the term drug, health care professionals discuss drug trials, drug budgets, and request drug information? There is no other reason besides being a historical artefact.

Along with thousands of fellow Victorian College of Pharmacy students, I studied the weekly ‘Drugs in Profile’, conducted Drug Use Evaluations (DUEs), and would search for the DD (drugs of dependence) keys in the dispensary. These terms are now largely redundant. We are well overdue for significant changes to ensure consistency in medicine-related language.  

One of the resources most commonly used by Australian pharmacy, nursing. and midwifery staff contains the word drug in the title. This is the SHPA’s publication, Australian Injectable Drugs Handbook (AIDH), despite its own promotion of “vital information on more than 500 injectable medicines (emphasis added)”.7 While this is very well-known by its four-letter acronym and distinctive yellow cover, it’s clear I have had an uphill battle replacing the word drug from all medication related documents at my organisation!

It must be acknowledged the most common inclusion of the term drug in medication safety is ‘adverse drug reaction’ a term defined by the World Health Organization before many current practising pharmacists were born.8 Information gathered from patients and carers regarding adverse reactions frequently includes much more than just medicine-related reactions they have experienced, such as food and environmental allergens, and other products such as latex and chlorhexidine. Although perhaps not always relevant, (bees are fortunately a rare sight in most healthcare settings), egg allergy can change therapeutic options. Fortunately, Australia’s Therapeutic Goods Administration utilises the inclusive term “adverse events” to encompass medicines, vaccines, and medical devices.9

Certainly, there is a place for the term drug, in the context of describing illicit substances, tobacco, and even alcohol. But let’s embrace the terms medicines and medications when referring to the substances at the core of our profession.

It is time to change our language, to politely and respectfully correct each other’s language, and to advocate for consistent and comprehensive language whenever referring to the therapeutic agents in which we proudly declare to be experts. As medicines experts, who is better than us to lead this change?

References

1. International Pharmaceutical Federation (FIP). Strategic Plan 2019 to 2024. The Hauge, The Netherlands: FIP; 2019.

2. Pharmaceutical Society of Australia (PSA). 2022 World Patient Safety Day — Pharmacists key to reducing medicine harm. 16 September 2022. ­­PSA; 2022. Available from <https://www.psa.org.au/2022-world-patient-safety-day-pharmacists-key-to-reducing-medicine-harm/>. Accessed 12 December 2022.

3. Australian Commission of Safety and Quality in Health Care (ACSQHC). Medication Safety Standard. National Safety and Quality Health Service Standards. 2nd Edition. Sydney: ACSQHC; 2017 [updated 2021].

4. Poisons Standard 2010 (Cth).

5. Department of Health and Ageing. National Medicines Policy. Canberra: Commonwealth of Australia; 2000.

6. Paola S. ‘Medicine safety is a priority for us all.’ AJP.com.au. 10 December 2019. Available from <https://ajp.com.au/news/medicine-safety-is-a-priority-for-us-all/>. Accessed 12 December 2022.

7. Ermer J, Symons K, eds. Australian Injectable Drug Handbook. 8th edition. Collingwood, Vic: Society of Hospital Pharmacists of Australia; 2020.

8. World Health Organization (WHO). International drug monitoring: the role of national centres. Technical Report Series. No. 498. Geneva: WHO; 1972.

9. Therapeutic Goods Administration. Reporting adverse events. Canberra: Department of Health and Aged Care; 2021. Available from <https://www.tga.gov.au/resources/resource/guidance/reporting-adverse-events>. Accessed 12 December 2022.