About Those Pills . . . 

As exchange students arrive in the U.S. for the coming year, so, it seems, do their “travel pharmacies.” We’re not talking about specific medications for known conditions; we’re referring to items that have no link to any medical conditions listed in the student’s application. It’s as if students’ families back home don’t believe that their children will be able to buy aspirin or antibiotics in the U.S.

Students arrive with an astounding variety of pills, powders, and herbal concoctions. Often the collection comes with no prescriptions or documentation, with ingredients listed only in the student’s native language. Antibiotics, anti-diarrheal capsules, anti-inflammatories, and pain-killers all may be in individually wrapped packets with no dosage directions. Many times items are not in their original packaging. Some students are able to tell you what each medication and treatment is for; most, however, cannot tell you more than “my mother told me to take these pills if I have a sore throat” (when asked about antibiotics) or “I’m supposed to take these if I have a headache” (when asked about pain killers). They usually cannot tell you what the correct dosage is for each item.

Many host families never find out about these stashes. Others don’t give them much thought. A common point of view is that “if the student’s natural parents trust them with all these pills, I should, too.” We’ve heard host parents say that their student is intelligent and knows when to take medicines, so who are we to take control? Others have said that their student assured them that they did not have prescription level medicines or anything dangerous — and the student must know, right?

Simply put, that is a terrible line of reasoning. How many parents let their own teens have pharmacies in their bedrooms, self-medicating at will? I doubt very many. So why would it be ok for exchange students to self-diagnose and self-medicate?

Several issues should be considered as part of this discussion:

1. Antibiotics are grossly overused, a trend that is contributing to the spread of drug-resistant microbes around the world. Many in the medical community consider this to be a top global health risk; the U.S. Centers for Disease Control has called it one of the “world’s most pressing public health problems.” When antibiotics are used, it is critical that they be used correctly and for the full time period. How often do self-medicating teens follow through for the full 10-day cycle when they’re feeling better after a couple of days? Moreover, if someone is deciding on their own based on a self-diagnosis whether to take antibiotics, most of the time it probably isn’t anything antibiotics could help with anyway; taking antibiotics for the common cold is useless.

2. It is very easy to over-consume drugs like aspirin or acetaminophen without even knowing you’re doing so. We have had exchange students take Tylenol® for a headache under our direction, only to find out later they had already taken something else from back home just an hour before – which, when we investigated, turns out to have been the same thing (acetaminophen). Over-consumption of acetaminophen can lead to liver damage, as stated by the U.S. Food and Drug Administration (FDA) on its website:

“This drug is generally considered safe when used according to the directions on its labeling. But taking more than the recommended amount can cause liver damage, ranging from abnormalities in liver function blood tests, to acute liver failure, and even death.”

Remember, too, that teenage brains are not fully developed; decision-making is still a “work in progress.” We had a student taking prescribed acne medicine one year. He said he brought enough for the year. About halfway through the year, he said he needed a new prescription. Why? Well, you see, it wasn’t working, so he took more — twice the recommended dosage for one of the strongest acne medicines available on the market, a medicine that can cause serious side effects.

3. There is the issue of communication. It’s critical for exchange students to establish good lines of communication with their host parents.  Whether a student is feeling ill is certainly an important aspect of such communication. Yet we’ve had situations where a student we are hosting is sitting quietly in the kitchen or living room, not saying anything while he or she is on the Internet. Not a problem, of course – until we discover that the student is texting with parents back home, complaining of a sore throat, and getting instructions from 5,000 miles away on what drugs to take from their “travel pharmacy.” This is not the way to develop lasting bonds with host families. Students need to know that it’s better to tell their host parents they are not feeling well and let their host families help them deal with it, rather than trying to get a diagnosis from parents who are not present.  (Even beyond the issue of forming relationships, it’s just logical to get medical advice from someone who is with you, rather than someone who is not!)

4. Finally, there is the question of responsibility. Who’s responsible for bad outcomes if students self-medicate while living in a host family’s home? What if they simultaneously are taking something prescribed by a local doctor (e.g. a genuine antibiotic prescription, or if they are taking over-the-counter medications from the host family’s own medicine cabinet? Acetaminophen is a great example because it’s so common. Should we be giving Tylenol® to 15 and 16 year olds if they may also be self-medicating from their own private stashes? By one estimate, dosage errors involving acetaminophen accounts for more than 100,000 calls to poison centers, roughly 60,000 emergency-room visits, and hundreds of deaths each year in the United States alone.

I don’t really understand why students arrive with all of these pills, but that’s largely outside of my control as a host parent. What is within my control is to find out after they have arrived what they have brought with them, and deal with it. That may mean disposing of it if I can’t figure out what it is and what it’s for, or if it’s considered a prescription drug here in the U.S. (even if not in the student’s country of origin) and the student comes with no prescription. It may simply mean taking possession of the “travel pharmacy,” and giving the student access to it as needed upon request and if we agree that treatment from the “pharmacy” is appropriate for the particular ailment. Sometimes, it means finding out about a medical condition that the student and his or her family did not previously disclose (something host parents clearly need to know).

At the end of the day, I hope that at least in my family we have substantially reduced this one source of risk for our exchange students during the coming year; the same goes for the host families we work with, since we recommend that they, too, do not hesitate to take the above actions. There will of course be other risks during the year that aren’t as easy to manage, but why not start with the easy ones?