Why Knowing the Facts Fails to Stop Risky Painkiller Habits in Thai Universities

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The finding that nearly four in five participants engaged in at least one risky analgesic behavior places the Thai university population studied here at the higher end of the international spectrum. Surveys of university populations in other regions have reported self-medication rates ranging from roughly one quarter to more than three quarters of respondents, with substantial variation depending on how self-medication and inappropriate use are defined. The Thai figure of 79.7 percent for inappropriate use is particularly notable because it counts specific risk behaviors rather than the mere act of taking a medicine without a prescription, meaning that even participants who obtained analgesics through legitimate channels were frequently using them in ways that carry documented harm potential. This distinction matters for interpreting the results, since a person can purchase paracetamol over the counter appropriately yet still fall into the inappropriate category by lending tablets to a housemate or doubling up on products containing the same active ingredient.

Medication sharing, which dominated the behavioral profile at 71.2 percent, deserves particular scrutiny because it is often socially normalized and rarely perceived as risky. When analgesics are shared, the recipient receives no assessment of contraindications, no verification that the dose is appropriate for their body weight or age, and no counseling about maximum daily limits or interactions with other medicines they may be taking. The person sharing the medication may also inadvertently communicate unsafe practices, for example by describing a dose that works for them without mentioning that it exceeds package labeling. Prior research on medication sharing in community settings has identified convenience, cost savings, and the perception that over-the-counter products are inherently benign as the principal drivers of the behavior, and the present findings suggest these dynamics operate even in a highly educated population where nearly four in ten staff members held doctoral degrees.

The disconnect between knowledge and behavior observed in this study aligns with a well-documented pattern in health psychology. Factual knowledge about medicines, such as awareness that paracetamol overdose causes liver damage, does not reliably translate into safer practice because behavior in real-world situations is governed by a different set of cognitive and social processes. A person may know the maximum daily dose of paracetamol yet still take an extra tablet when pain persists, reasoning that a small excess is harmless, or may share medication because refusing a friend’s request feels socially awkward. This gap between knowing and doing, sometimes described as the knowledge-behavior gap, has been demonstrated across domains ranging from antibiotic stewardship to sun protection, and the present study provides quantitative support for it in the analgesic context through the absence of any association between knowledge scores and inappropriate-use classification.

By contrast, the significant association between attitudes and behavior, with each point improvement in attitude score corresponding to roughly an eight percent reduction in the odds of inappropriate use, is consistent with theoretical models that position attitudes as more proximal determinants of action than factual knowledge. In frameworks such as the theory of planned behavior, attitudes toward a behavior, together with perceived social norms and perceived control, shape intentions, which in turn predict actual conduct. The practical implication is that interventions designed to change how people feel and think about safe medication practices, for example by emphasizing the social acceptability of declining to share medicine or by building confidence in reading and following package labels, may achieve more than campaigns that simply transmit pharmacological facts. The Ecuadorian study cited in the original article reached a similar conclusion, finding that attitude carried the greatest relative importance for self-medication decisions even among health sciences students who possessed superior pharmacological knowledge.

The finding that recent analgesic use nearly tripled the odds of inappropriate behavior, with an adjusted odds ratio of 2.889, can be interpreted in several ways. One possibility is that frequent exposure to analgesics simply creates more opportunities for risky behaviors to occur, since a person who takes analgesics weekly has many more occasions to share, escalate, or combine products than someone who takes them twice a year. Another possibility is that heavier analgesic use reflects underlying chronic pain conditions that themselves push users toward dose escalation and prolonged courses. A third interpretation involves reverse causation in the attitudinal pathway: people who use analgesics frequently may develop habits and rationalizations that erode cautious attitudes over time. The cross-sectional design of the study cannot disentangle these explanations, and the authors appropriately note this limitation, but the association itself is robust to adjustment for knowledge, attitudes, sex, participant status, and proximity to healthcare professionals.

The composition of the sample warrants consideration when generalizing the results. Women constituted about three quarters of respondents, which is common in voluntary survey research but may mean that behaviors more typical of male participants are underrepresented. Similarly, the overwhelming majority of participants were non-healthcare professionals, which strengthens the relevance of the findings for the general university population but limits what can be said about clinicians and pharmacists themselves. The recruitment method, which relied on institutional email with follow-up reminders, may have favored respondents with higher engagement in university communications, and the possibility that individuals with particularly poor medication practices were less likely to respond cannot be excluded. These are standard limitations of cross-sectional survey research, and the authors’ use of a calculated minimum sample size, piloted instruments with acceptable reliability coefficients, and expert content validation strengthens confidence in the internal validity of the measurements.

The Thai context adds a dimension that distinguishes this study from comparable work in other countries. The availability of non-prescribed combination packs known locally as Yaa-Chud, which contain analgesics alongside steroids and other agents, creates a pathway to harm that has no direct equivalent in many other health systems. Consumers who purchase such packs may be exposed to corticosteroids without any awareness of it, and the analgesic component may be taken at doses or frequencies that would be unsafe in combination with the other constituents. The historical persistence of these products in informal markets means that educational interventions in Thailand must contend not only with individual behavior but also with a supply-side environment in which potentially hazardous combinations are readily accessible. The study’s finding that concurrent multi-analgesic use was reported by nearly a quarter of participants may partly reflect this environment, since consumers who are unaware of active ingredients may unknowingly combine products containing the same compound.

The clinical stakes of these behaviors are well established in the toxicology and pharmacovigilance literature. Paracetamol overdose, whether intentional or unintentional, remains a leading cause of acute liver failure in many countries, and a substantial proportion of unintentional cases involve what toxicologists call staggered overdose, in which a person takes repeated doses exceeding recommended limits over hours or days without recognizing the cumulative danger. Staggered overdose is particularly relevant to the dose escalation and prolonged use behaviors measured in this study, because these are precisely the patterns that produce staggered exposure. Non-steroidal anti-inflammatory drugs carry their own burden of harm, including gastrointestinal bleeding, renal impairment, and cardiovascular events, with risk rising steeply in older adults and in people with pre-existing conditions. Because university staff in the sample ranged widely in age, some of the behaviors reported may carry greater immediate risk for older respondents than for students.

The WHO Medication Without Harm initiative, launched in 2017, identified medication errors and unsafe practices as a priority area for global action, with a target of reducing severe avoidable medication-related harm. The present study contributes to that agenda by providing item-level behavioral data from a population that is often assumed to be well equipped to use medicines safely. The demonstration that even highly educated individuals frequently share medication, combine products, or exceed doses challenges the assumption that formal education confers protection against medication misuse, and it supports the growing consensus that medication-safety interventions should target attitudes, norms, and practical decision-making rather than knowledge transmission alone.

Future research building on these findings could take several directions. Longitudinal designs would help clarify whether attitudes precede behavior change or vice versa, and whether recent analgesic use is a cause or consequence of inappropriate practices. Intervention studies testing attitude-focused educational approaches, such as normative feedback or motivational interviewing techniques adapted to medication safety, would provide direct evidence on whether the attitudinal association observed here can be exploited to reduce harm. Studies in other Thai provinces and in rural populations would establish whether the patterns observed at a single northeastern university generalize across the country. Finally, research examining the role of digital information sources, including social media and online pharmacies, in shaping analgesic-use attitudes would address the evolving landscape through which consumers now encounter medication information.

For universities themselves, the findings suggest concrete opportunities. Campus health services could incorporate brief medication-safety screening into routine consultations, asking specifically about sharing, combining, and dose escalation rather than simply recording whether analgesics are used. Orientation programs for new students could include practical guidance on reading analgesic labels, recognizing duplicate active ingredients across products, and understanding maximum daily limits. Because staff members were included in the sample and exhibited the same behavioral patterns, such initiatives should extend beyond the student body to the workforce. The high proportion of participants with healthcare professional relatives or close contacts, more than half of the sample, also suggests that informal advice networks within families may be a fruitful channel for safety messaging, since these trusted relationships already function as a source of medication guidance for many consumers.

In sum, this study provides a detailed behavioral portrait of analgesic self-medication in a Thai university population and offers evidence that attitudes, not knowledge, are the modifiable factor most closely tied to safer practice. The dominance of medication sharing as the most common inappropriate behavior points to a specific, socially embedded practice that interventions can target directly. As analgesics remain the most consumed drug class worldwide and their non-prescription availability continues to expand, understanding the psychological and social drivers of unsafe use in educated populations is an essential step toward reducing the preventable burden of medication-related harm.

Subject of Research: …

Article Title: Analgesic self-medication among university students and staff in Thailand: Prevalence and factors associated with inappropriate use

Article References: Orosram, J., Netthong, R., Sakulrak, M., Pakprom, A., & Saengkaeo, S. (2026). Analgesic self-medication among university students and staff in Thailand: Prevalence and factors associated with inappropriate use. Pharmacia, 73, Article e202864. https://doi.org/10.3897/pharmacia.73.e202864

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e202864

Keywords: Analgesic, self-medication, university, students, staff, Thailand, Prevalence, factors, associated, inappropriate, scientific research