The highly competitive nature of modern-day sports and the economic impact of athletic performance at elite levels have driven athletes to play with injury and sickness , which has led to the widespread use of a variety medicines including analgesic agents in developed countries. Most studies in the developed world on intake of non-performance enhancing medicines have focussed on NSAIDs [3,4,5,6,7, 9, 11, 12]. This study, one of the few that has examined the use of self-medication in the South Asian region, looked at the use of NSAIDs, herbal/traditional medications and some selected medicines, and reports that self-medication is a frequent practice among local elite athletes. A direct comparison of self-medication prevalence rates in elite athletes in the developed world is not possible, since self-medication rates have not been included in most published reports . In our study, self-medication was seen for both symptomatic pain relief and pain prophylaxis. Both allopathic and herbal/traditional medications were used by many athletes without a prescription or medical advice. Though a number of athletes used oral NSAIDs, the prevalence of use is much less than that is reported from studies in developed countries . In a study that compared self-medication practices of world athletes in different continents, African and Asian track and field athletes reported using significantly fewer medications . Cultural and economic factors may play a role here, and the reasons for the low prevalence would be worth investigating.
The marked differences in self-medication practices among different teams with kabadi and badminton having the highest prevalence and wrestling the lowest, may be possibly due to the differences in injuries and symptoms encountered in the different sports, views of the players, instructors and physiotherapists, even though these variables were not assessed.
Musculoskeletal pain followed by respiratory symptoms, fever and dysmenorrhea were common indications for self-medication, which corresponds with previous data from studies in the developed countries [6, 21]. Allopathic drug usage was most frequent for pain relief whereas herbal/traditional medications were used for respiratory symptoms which is a unique finding in this study. Pain prophylaxis was mainly practiced with non-prescription topical medicines which included topical NSAIDs and analgesic balms containing salicylates. The commonest medicine used for pain relief was paracetamol (acetaminophen) which is a non-prescription medicine in Sri Lanka, whereas among elite athletes in other studies, it was other NSAIDs, which falls into non-prescription category in the West [4,5,6, 12, 13]. Opioid analgesic use among the players was not reported in our study, whereas it has raised concerns in other parts of the world . In Sri Lanka, all oral and topical NSAIDs are prescription medicines, except Aspirin. Though it has a relatively safer adverse effects profile than other NSAIDs, acetaminophen overuse may be associated with hepatic and renal dysfunction.
Despite regular use, close to 50% of athletes were unaware of possible adverse effects of self-medication.
Only 42.8% gave reasons for self-medication. More than 50% of participants not disclosing the reason and hence the unavailability of data on that aspect is a limitation of this study. The reasons for self-medication given are similar to those in a study among medical students in Nepal where mild illness, previous experience of treating a similar illness, and non-availability of health personnel were the most frequently cited reasons .
Athletes purchased medication by direct request, indicating the role of the pharmacist in facilitating undue self-medication practices. In Sri Lanka, the number of non- prescription drugs is very limited, but the general public frequently has access to prescription drugs without an authorized prescription due to violations of regulations by the National Medicinal Regulatory Authority . Athletes appear to have rather unrestricted access to both non-prescription and prescription drugs, as well as herbal preparations, which are widely available in the market. This phenomenon is possibly compounded by the facts that the athletes themselves and their trainers not being fully aware about the potential harm caused by inappropriate practices of self-medication and the deficiencies of a proper documenting system to record the medication use by athletes at national level.
A significant finding is that family members rather than trainers or peers influenced practicing of self-medication, emphasizing the need to increase awareness of the dangers of self-medication through allopathic or herbal/traditional medications throughout the general population.
Reporting of adverse effects following NSAIDs in our study was lower than in the developed world , possibly due to lower frequency of use of oral NSAIDs. Use of antibiotics, particularly for respiratory tract problems and fever, was also noted, raising the possibility of unsupervised use of antibiotics causing microbial resistance.
Herbal/traditional medicines used by this population were mainly commercially prepared mixtures. Use of herbal/traditional medicine in Asian countries where such practices are prevalent among patients , has not been adequately studied so far among athletes. Herbals/traditional medicines also contain many substances/ingredients which have not been evaluated in the context of doping as well as their potential adverse effects and reactions with other concomitant medicines.
The response rates in most squads were excellent except for 4 squads, in which the response rates were approximately 40%. Cricket, rugby, swimming and basketball squads were unable to participate because of on-going tournaments, hence the actual figures on prevalence of self-medication in Sri Lankan athletes could be higher than those reported in this study.
Our study did not compare intake of medicines between athletes and non-athletes. There are reports of higher medicinal intake among athletes than non-athletes .