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The abuse of prescribed drugs due to the belief that they are less dangerous has been a matter of concern in the United States and should be an issue exercising the whole world, as this general belief has led to about 30% of all drug-related deaths. Most people who misuse prescribed drugs believe that such medication is less harmful as compared to non-prescribed drugs. The perception of dangerousness is often based on hearsay and the degree of attention that certain drugs receive.

This study is aimed to explore the public's perception of the dangerousness of prescription drugs.  The objective of the study is to review literature as a way of establishing the public's perception of prescribed and non-prescribed drugs. The study also analyzes the public's perception when it comes to matters concerning the dangerousness of prescription drugs. It analyzes if the general society assumes that prescription drugs are less harmful than non-prescribed.

To meet the objectives, specifically in what concerns analysis of how society defines prescription drugs to be less harmful, social demographics as a sample population was taken and it contained people from different groups, ages, genders and educational qualification. The survey utilized a sample size of 77 male and 68 female participants randomly selected from the Lord Street and Church Street in the Central Retail Area of Liverpool City Center. The collection of data was done by the use of paper and pencil version questionnaire in a multiple choice format. Respondents had to choose from options by ticking their preferred answer. The questions referred to participants' familiarity with the listed dugs and their perception of these drugs' dangerousness. The questionnaire was presented in English to ensure the participants understand and spent little time for answering questions. Results were filled in the table (See Appendix B).

From the study, it is apparent that most members of the public considered non-prescribed to be dangerous than prescribed drugs. It was also found out that the public (represented by the sample of 138) think prescription drugs as ‘safe' and non-prescription drugs as ‘unsafe'. The conclusion of this is that members of the public perceive non-prescription drugs to be more lethal than prescription drugs. The analysis of the perceived dangerousness of the ten drugs showed that the way people view the dangerousness of prescribed drugs is significantly different supported by the fact that many of the participants had seen or heard of non-prescription drugs as compared to prescription drugs. The general public is more conversant or aware of non-prescription drugs than prescription drugs.

The study concluds that the prescription status of a drug affects how the general public perceives the drug. In other words, the study does show that the public tend to perceive prescription drugs to be less dangerous and non-prescription drugs as more dangerous.

Table of Contents

Acknowledgement ………………………………………………………………………… 2

Abstract ……………………………………………………………………………………. 3

Chapter 1. Introduction …………………………………………………………………..... 7

1.1. Introduction ……………………………………………………….……….. 7

1.2. The problem of drug misuse ……………………………………….……… 8

1.3. Significance of the study ……………………………………………...….. 9

1.4. Statement of the problem ……………………………………………….... 10

1.5. Purpose of the study ………………………………………………………. 13

Chapter 2. Literature review ……………………………………………………………… 14

2.1. Literature review ………………………………………………………….. 14

2.2. Perceived dangerousness and the use of prescription drugs ……………… 14

2.3. Perception of risk …………………………………………………………. 18

2.4. Summary ………………………………………………………………….. 21   

Chapter 3. Methods and procedures………………………………………………………. 22

3.1. Population ………………………………………………………………… 22

3.2. Design ……………………………………………………………………. 23

3.3. Sample selection …………………………………………………………..24

3.4. Strengths and limitations …………………………………………………. 25

3.5. Data collection/materials ………………………………………………… 26

3.6. Analysis ………………………………………………………………….  28

3.7. Ethics …………………………………………………………………… 28

3.8. Summary …………………………………………………………………. 29

Chapter 4. Results ………………………………………………………………..…………. 31

4.1. Results ……………………………………………………………..……….. 31

4.2.  Drugs and their popularity ………………………………………..…............ 31

Chapter 5. Discussion and conclusion ………………………………………….…………... 35

5.1. Discussion and conclusion ………………………………………………….. 35

5.2. Summary of inferential statistics (prescribed vs non-prescribed) …………... 35

5.3. The public's familiarity with drugs and their perception of dangerousness …36

5.3. Perception of harm and drug use …………………………………………… 37

5.4. Recommendations for policy ……………………………………………… 39

5.5. Study limitations and future research ……………………………………… 42

References …………………………………………………………………………………. 44

Appendices ………………………………………………………………………………… 51

Chapter 1. Introduction

1.1. Introduction

Liverpool is known as a drug abuse capital of England with hundreds of people to be admitted to hospital for drug-related health and behavioral problems in the recent years (Taylor, 2016). According to Liverpoolecho publication, there were 228 people admitted to hospitals including 80 women and 198 men. In the country, the use of drugs in overall is in decline due to heightened awareness; a smaller, naive group might be using more illegal substances at a higher rate than ever before. This paper considers the problem of drug misuse dwelling on the level at which the general public view both non-prescription and prescription drugs dangerousness. It views the problem from both the side with one in three adults to use the illegal drugs and the sector of the population that has never indulged in the use of drugs is slowly decreasing (Statistics on Drugs Misuse: England, 2016, 2018). At the same time, despite the fast and steady spread of prescription drug usage, the society at large believes that this issue is not a problem and the majority of those who have used prescription drugs do not seem to have an issue with them, and those who are addicted to such drugs still consume it anyway (Buckley, 2018).

This particular chapter represents the purpose, significance, limitations, and delimitations of the study. It shows that in many instances, a good number of people who partake in in the usage of prescribed drugs are affected by conditions and other people around. The study addresses how the public's perception of prescription drugs dangerousness has to be altered especially to decrease its detriments to society resulting from the maladaptive pattern of use.

   

1.2. The problem of drug misuse

With the turn of the 20th century, the society has been inundated with the development and constant supply of prescription drugs, many of which have psychoactive effects contributing to misuse, abuse, and dependence on these drugs (SAMHSA, 2005; CBHSQ, 2015). Guelmann and Perrone (2011), also posit that most of the prescribed drugs, such as opioids analgesics, sold over the counter are the main cause of numerous deaths, especially among the youth, resulting from drug overdose. In the year 2000, approximately 30% of the deaths reported were caused by overdose and drug abuse. Unfortunately, this figure has increased by almost 60% in recent times (US Department of Health and Human Services, 2013, p. 3). Realistically, the majority of proprietary drugs such as antacids, pain relievers such as tramadol, laxatives, cough medicines and anti-allergens, are sold over-the-counter (OTC), thus easing public access. The ease of access to some of these prescription drugs tends to lead to a maladaptive pattern of use furthered by the notion that over the counter drugs are legal and therefore not as detrimental as illegal drugs. This misconception is rapidly growing especially among the youths as evident in reports (SAMHSA, 2005; CBHSQ, 2015).

Prescribed drugs, as postulated by Breggin (2009), are frequently misused and abused in the society, especially among the youths, either by self-medication or in an attempt to get high. The maladaptive use of these drugs, often times, alter or impair the behavior of the person who consumes them (AMA, (2015). Different drugs affect different people differently. In essence, some prescription drugs, which in this case may or may not be over the counter drugs, are known to sedative the body and as a result might be potentially disastrous in some cases leading to death (Weaver, 2015). According to American Market Association (AMA) (2015), prescribed drugs, such as OxyContin, can be dangerous, and have caused the deaths of a significant percentage of the users than heroin and cocaine, especially among teens and young adults. The desire to gain popularity and acceptance among their peers, and the general rise in level of anxiety has contributed to the increased use of prescribed drugs amongst the youth making them vulnerability and open to alcohol and other psychoactive substances (Arria, Caldeira, Vincent, O'Grady, & Wish, 2008). The dependency to drugs illustrates that the use of prescribed drugs may be a gateway to abuse of illegal drugs.

In recent years, emergency department visits, the rising number of treatment admissions, and the economic costs that are associated with the use of prescribed drugs is alarming (Ruschmann, & Marzilli, 2007). At home, parents, on the other hand, have underestimated the influence of these prescribed and OTC drugs since some of these drugs can be found at home in the medicine cabinet where the teenagers have easy access to them. Many parents do not keep track of their dosages and do not know if their children are consuming them (Ruschmann, 2007). According to a British Drug Survey (2014) teens are easily influenced into becoming addicts of prescription, OTC and illegal drugs. This matter requires immediate intervention and can be achieved through raising addiction awareness anti-drug campaigns.

1.3. Significance of the study

The importance of this study is to investigate and display the public perception of the dangerousness of prescription drugs taking into account the overall perception of people toward drugs, both prescribed and non-prescribed. Compton and Volkown (2006) state that public perception is a social phenomenon described as the difference between absolute truth based on media coverage, reputation, and facts versus virtual truth shaped by political views, popular opinion, corporations, and celebrities. The general public perception about drug users is mainly negative, while it is known that prescribed drug abuse also leads to drug-related crimes and other negative aspects such as unemployment (Bradley, 2010). Unfortunately, prescribed and non-prescribed addiction are displayed as more social moral vulnerability rather than a medical condition or perhaps as a disease, which should be treated (Center for Improvement in Healthcare Quality (CIHQ). 2016).  

1.4. Statement of the problem

Major pharmaceutical companies make ridiculously high profits at the expense of a large number of people who continue to die due to dangerous prescribed drugs (Cornwell & Cornwell, n.d.). A factor that is contributing to this issue is the production of flawed reports, advanced by dishonest agents, taken from results of unreliable critical trials such as studying small group of people and presenting such reports to the FDA (Faerber, & Kreling, 2014; Fanelli, 2018).

In some cases, these drugs are continuously abused due to the public perception that they are not as detrimental as other illicit drugs (Olsen, & Whalen, 2012). This view, according to Manchikanti (2006), has perverted the recommended usage of the drugs, and in some occasions, drug addictions have developed specifically among the young who had the intention of self-medication despite the dangers associated with the use. This perspective has largely pitched into what the public has termed as “right and acceptable” within the society allowing other non-drug users in the society to be induced into drug dependency and addictions.

  These large pharmaceuticals apply the “direct-to-consumer” mode of advertising which seems to be growing rapidly over the past decades and is now the most prominent type of health communication that the public encounter. This mode of advertising comes in forms of efforts by these companies to promote their prescription products directly to patients (Bond & Lean, 1997; Holmer, 2002; Donohue & Berndt, 2004; Kornfield, Donohue, Berndt, & Alexander, 2013). They communicate in the form of “help-seeking ad,” which provides only information about a medical condition and encourages patients to contact their physician but do not mention a product. The adverts subtly encourage the general public to diagnose themselves and buy over the counter medicine without full disclosure of the detrimental health effects the drug might have on one's body, nor do they provide the right information about the dosage required for the medication to work properly.

The second mode of advertising is the “reminder ad,” which includes the product name; this type may provide information about strength, dosage form, or price, but it does not mention the indication or make any claims. They intentionally leave out the risks involved with the consumption of the drugs one is purchasing. The third and most common type is the “product claim ad” which mentions the product and its indication and includes efficacy or safety claims (Bond & Lean, 1997; Holmer, 2002; Donohue & Berndt, 2004). The above forms of advertising are to a large degree responsible for the public perception of dangerousness of prescription drugs.

A study published in Sep. 2013 issue of Journal of General Internal Medicine A physicians' survey showed that numerous prescription drug ads misinformed patients and believed the ads paid more attention to the advantages of the drugs, resulting in miscommunication (Faerber, & Kreling, 2014). The study states that 60% of claims made in DTC prescription drug ads aired from 2008 to 2010 ‘omitted vital information, exaggerated information, presented opinions, or made insignificant associations with lifestyles' (Faerber, 2014). It found 43% of the claims in DTC drug ads were ‘partially true' while 55% were ‘somehow misleading' and 2% were ‘wrong' (Faerber, 2014). DTC prescription drug ads are normally easy to read and comprehend to enable them to be mass-distributed. This means a large number of the targeted population cannot understand the information presented. Majority of the DTC prescription drug ads emphasize on benefits more than negative side effects.  84% of regulatory letters sent by the FDA from 1997 to 2006 brought up the fact that the ads were minimizing risks and exaggerating the effectiveness of drugs (Faerber, & Kreling, 2014)

  Secondly, prescription drug ads promote drugs prior the knowledge of long-term safety effects. Majority of doctors agree with this opinion mainly because of the fact that there is no single evidence about whether the ads bring positive or negative impact on the consumers and patients (Fain & Alexander, 2015). Despite the fact the FDA does not play a role in the approval of ads before they air on radio or TV, 50% of consumers surveyed thought DTC prescription drug ads are approved by the government. 43% of consumers surveyed assumed that the drug had to be 100% safe before being advertised, but unfortunately, many of these drugs have not undergone the long-term safety trials before advertising commences.

Thirdly, they instigate the habit of over-medication. 81% of doctors surveyed in the 2013 study, state that DTC prescription drug advertising encourages drug overutilization. These ads tend to emphasize that drugs (vs. diet or exercise) will improve one's health. Attention Deficit Hyperactivity Disorder (ADHD) medication is recommended about 25 times more in the United States than in the United Kingdom where prescription drug ads are not allowed. Between 1996 to 2005, the pharmaceutical industry's expenditure on marketing tripled for psychotropic drugs (Huskamp, 2006). This led to a 500% increase in prescription drugs ads. The general public's consumption of psychotropic drugs, such as Lunesta and Prozac increased 22% from 2001 to 2010. Increase in consumption resulted in one in five adults taking at least one psychotropic drug.

1.5. Purpose of the study

This study aims to find out the publics' view of dangerousness of prescription drugs and the factors that informs this. People buy prescription drugs to alleviate common symptoms such as indigestion, cough and headaches. These drugs can give the consumer immediate relief, but they can also be lethal if not used properly or if combined with other drugs (Warner, Chen, Makuc, Anderson, & Miniño, 2011).

The general assumption is that because the drug is purchased over the counter, it is therefore safe to consume; whereas, even little doses of these drugs can have negative effects of dire health consequences if the recommended directions, doses, and warnings are not adhered to. The public need to be educated to pay attention to readily available information which translates into knowledge that would assist them to make better decisions (Handel, & Schwartz, 2018).

On the other hand, the awareness of the dangerousness of prescription drugs has grown in recent years worldwide (Best, Gross, Vingoe, Witton, & Strang, 2003). In places like the United Kingdom, there are affordable treatment centers for prescription drug addicts. The society, in general, is sensitized to the dangers of non- prescription drugs excluding prescription drugs despite the fact that they both have adverse negative effects on those who misuse or abuse them.

Chapter 2. Literature review

2.1. Literature review

This chapter looks at the findings of research from the past literature with regards to the public perception of the dangerousness of prescription and non-prescription drugs. Some of these studies will be critically examined and combined to shape their findings, their reliability, and applicability of the findings. It will begin by investigating literature on the perceived dangerousness, and the use of prescription drugs and non-prescription drugs, consumers' perceptions, consumers' attitudes and perceived dangerousness. It will then proceed to explore the perception of risk, and finally end the chapter by showing the existent research gaps and how this study will remedy gap.  

2.2. Perceived dangerousness and the use of prescription drugs

 One of the reasons for prescription drug abuse could be that society does not perceive them to be as dangerous as non-prescription drugs. This view has allowed the public to deem it as “safe” since they can get them over the counter from reliable and trustworthy chemists. This perception may lead an individual to down play the negative effects of prescription drugs. Findings from a surveys conducted showed that a large section of society often presume that the prescription substances are safer to take and less addictive than illegal drugs such as cocaine or heroin (McCabe, Boyd, Cranford, & Teter, 2009; Lord, Brevard, & Budman, 2011). The issue of perceived dangerousness for both types of drugs is categorized as ‘Low perceived dangerousness,' which means the drug has little or no risk, and ‘high perceived dangerousness' which connotes great or moderate risk ((Arria, Caldeira, Vincent, O'Grady & Wish, 2008; Bachman, Johnston, O'Malley, & Humphrey, 1989).

Several studies have found that those who use prescription drugs for non-medical recreational purposes also perceive as them as less dangerous. A survey conducted among college students showed that 25% of students who used non-description drugs for various reasons perceived them as harmfulness. Majority of them had low perceived harmfulness due to the increased need to seek a high sensation (Arria, Caldeira, Vincent, O'Grady, & Wish, 2008; McCabe, Boyd, Cranford, & Teter, 2009).

This also seems to be the case with the general public (non-student). The general public believes that prescribed drugs are safer than and non-prescribed drugs (Slavik et al, 2007). This perception is caused by a lack of sensitization in matters related to health knowledge, self –care and risk assessment. (Bachman, Johnston, O'Malley, & Humphrey, 1989; Fielding, 2018). From literature (SAMHSA, 2005; Ruschmann, & Marzilli, 2007; CBHSQ, 2015), it appears that a good majority of the public are not aware of the health-risks, such as addiction associated with consuming various medications. Given the increasing emphasis on self-care and empowering the public to manage their health with prescription drugs, there is an urgent need for an improved pharmacosvigilance of these drugs to maximize benefits with minimal risks. National sensitization should be conducted to contain the epidemic of addiction to prescription and non-prescription drugs alike. The general public needs to be educated properly about the effects of consuming these drugs (SAMHSA, 2005; Ruschmann, & Marzilli, 2007; CBHSQ, 2015).

    Efforts to mitigate the negative effects of drugs to the public are futile because of their distorted judgment. According to Droege, Maniscalco, Daniel, and Baldwin (2007), the positive risk perceptions by people who use these drugs would results to higher acceptance, higher adherence rates, and better patient outcomes. Nonetheless, when the public think these drugs to be harmful, or having greater risks in comparison to the benefits, they tend to avoid the drug. Perception of dangerousness of drugs was also decided by what the individual was using it for (Bachman, Johnston, O'Malley & Humphrey, 1998). From literature (Bachman, Johnston, O'Malley & Humphrey, 1998; Arria, Caldeira, Vincent, O'Grady & Wish, 2008), many college students think stimulants to be of ‘low perceived dangerousness' in comparison to a few who thought the same for analgesics. Researchers show that low perceived dangerousness and the non-medical use of prescription drugs were positively correlated (Bachman, Johnston, O'Malley & Humphrey, 1998; Arria, Caldeira, Vincent, O'Grady & Wish, 2008).  According to Bachman, Johnston, O'Malley and Humphrey (1998), the students in the 12th grade in the early 1980s were less likely to use marijuana because of their perception about cannabis to cause risk for their health (Bachman, Johnston, O'Malley & Humphrey, 1998 as cited by Arria, Caldeira, Vincent, O'Grady & Wish, 2008). This study, however, is not reliable because the participants of the test sample were college students only and may not represent the population as a whole.

These results are backed up by Cheadle and Gallagher (2006) who show that prescription drugs are abused at a higher rate than non-prescribed drugs. However, an important factor of the study by Arria, Caldeira, Vincent, O'Grady, and Wish (2008) is that the sample used is large (1,253 students) increasing the reliability of the results and conclusions. So far, this report has stated the perception of dangerousness towards prescription drug and not non-prescribed drugs. For the public in general, apart for marijuana, the perceived dangerousness for non-prescription drugs is slightly high. The use of cannabis is becoming ‘normalized' among the youth. It has become the same as smoking a cigarette or excessive drinking of alcohol; the youth who do not engage in such behaviors are also at risk of such exposures. Two-thirds of 18-34 years old have a comrade or family member who uses illegal drugs, half of that statistics have used cannabis themselves, and only a third think that cannabis should not be legalized. Fifty-five percent concur that ‘using illegal drugs is a normal part of life. Finally, the people who have never indulged in the use of cannabis have become lax about its legalization. This can be attributed to the age differences that spark different attitudes towards cannabis, for example, and explain the movement towards more liberal attitudes. The more restrictive and older generations are being replaced with a more liberal and younger generation thus the attitudes of the society as a whole has shifted. An example being that in 1983, 7% of people between the age of 45-53 were pro legalizing cannabis, but by 2001, 25% of this same generation (now aged 63-71) supported this (Arria, 2008). The alteration in attitudes towards cannabis across all generations is associated with altering perceptions of the drug's harmfulness. Almost half of the public currently agree that cannabis is not as bad as some people think, this compared to a third in 1993. Fewer people now are of the opinion that cannabis is addictive or that it causes violence and crime. When questioned about which drugs are the most dangerous to regular users, cocaine, heroin, alcohol, and tobacco are at the top of the list; cannabis is almost never mentioned and only a little percentage of public consider ecstasy as dangerous. The perspective that ecstasy is a ‘soft' drug like cannabis has dismal public support. To put the findings into context, the researcher considered the knowledge about the effects of drugs, to find out to what level knowledge drives attitudes. Keeping in mind that any such measure will be arguable, the researcher came up with a methodology to complete this task by asking people to choose from a list of drugs from a card that they thought could have a particular effect on people. An example being, people say that cannabis can make one feel relaxed, ecstasy makes people feel energetic and that LSD makes someone to hallucinate. The answers to each question were then combined into an overall ‘drug knowledge score.'

Most of the people were aware of the principal characteristics of every drug and could differentiate between the effects of the different drugs. The symptoms of heroin and cocaine are, however, less known than those of cannabis, ecstasy, amphetamines, and LSD.

2.3. Perception of Risk

According to Wolfe (2011), understanding the health risks involved when an individual is exposed to drugs shows a significant number of people could avoid drugs. Findings released in 2011 by the National Institute on Drug Abuse (NIDA) showed that a majority of teenagers between the 8th and 12th grades used marijuana due to the perception that it is not dangerous and, hence, not harmful to their health. Studies conducted by Wolfe (2011), Bryan, Moran, Farrell, and O'Brien (2000), Leaner, Shetland, and Wiles (1993), and Compton and Volker (2006) indicate that people are most likely to use drugs when they think that the drugs are not dangerous. Reason for this is because the public does not pay attention to information. Larson, Paterson, and Erondu (2012) disagree with such findings though and state that the idea of ignorance of the function and composition of prescription and non-prescription drugs is the main factor that makes people oblivious of the dangerousness of the drugs. They state further that this factor may be responsible for society ranking some drugs as dangerous when in truth they are not, a statement that agrees with the findings of a 1989 study by Horisberger, Dinkel, and Ciba-Geigy.

Apparently, Horisberger, Dinkel, and Ciba-Geigy (1989), Sarkar, Balachander, and Basu (2014), and Larson, Paterson, and Erondu (2012) are of the opinion that some people erroneously believe some drugs to be dangerous since they do not know what the chemical make up the drugs are. These studies blame medical practitioners for failing to show patients the exact composition of drugs and the effects or functioning of each component in the drugs. This is because of the poor patient-physician relationship caused by the negative attitude that physicians often have towards their patients (Sarvet et al. 2017). Poly-pharmacy is another factor that has made it difficult for patients to comprehend the composition since the use of multiple prescription drugs at the same time causes division of the patient's attention or concentration (Horisberger, Dinkel & Ciba-Geigy, 1989; Larson, Paterson & Erondu, 2012).

 Some patients choose to ignore any perceived risks and consume the drugs trusting that their medical practitioners are trustworthy and may not prescribe dangerous drugs. (Larson, Paterson & Erondu, 2012; Anderson & Oppermann, 2015). This trend is changing among the youth who want to understand the true components of drugs (Bryan, Moran, Farrell & O'Brien, 2000, p. 36). The youth, however, even after comprehending the dangers of using a particular prescription drug, may still use the drug due to the need to gain acceptance or popularity (White, & Rabiner, 2012).

The way people think about drugs is shaped to a large extent by mass media (Bryan, Moran, Farrell, and O'Brien, 2000). A study by Leitner, Shapland, and Wiles (1993) was conducted in Britain to investigate the public's drug-associated views and habits, as cited in Bryan, Moran, Farrell, and O'Brien (2000). The conclusion was that “The substances cited by respondents as being most lethal were the ones that had a great focus on political and media attention, namely heroin, cocaine, crack and solvents.” These results are reliable and relevant as they will assist in evaluating the answers that are acquired in the current study. Specifically, it will assist in assessing if the society's familiarity (or lack of) with a certain drug affects their perception of dangerousness of the drug.

Apparently, the general public perceives drugs to be less dangerous when the ruling political class and media do not focus attention on the drugs (Bryan, Moran, Farrell & O'Brien, 2000). When the political class and media do not pay any attention to the negative effectives of prescription drugs, this could potentially mislead the public into thinking that such drugs as less dangerous; and regrettably, may lead to a misuse or abuse. In the KAB report by Bryan et al (2005), it is stated that general public has a good general understanding of common illegal drugs but not of prescribed drugs. Approximately 97% of the participants in the survey were stated to have heard of non-prescribed drugs such as cocaine (96.4%), heroin and ecstasy, and heroine both at 94.3%. Few participants knew about prescription drugs (Bryan, Moran, Farrell & O'Brien, 2000). 80% of the respondents thought that all illegal drugs to be and harmful to an individual's health. Most respondents, however, had minimal knowledge of the pharmacological effects of non-prescription or prescription drugs. They thought that the dangerousness of the drugs is based on unproven apprehensions as indicated by Bryan, Moran, Farrell, and O'Brien (2000). Many of them perceived some drugs to be dangerous based on what doctors told them or label instructions as shown in the study by Anderson and Oppermann (2015). While this study is fairly reliable, its weakness is in the fact that it is based on a limited analysis of how the attitudes grow and the way perceived dangerousness of drugs change with varying attitude levels.

Following the various findings mentioned above (Sarkar, Balachander & Basu, 2014; Anderson & Oppermann, 2015; Bryan, Moran, Farrell, and O'Brien, 2015) , it is possible to conclude that public perception of prescribed drugs depends on the level of their knowledge of the difference between when, what measuring and what is the purpose of taking prescribed drugs. Thus, educated people are more likely to judge substances they are prescribed; they are more knowledgeable with the risks involved with the use of medication and do not rely much on mass media and how it perceives and displays use of prescribed drugs.

2.4. Summary

Previous researchers have explored this topic and conclude that the public considers drugs to be dangerous based on what the media portrays and the overall attention that the drugs receive. They have also agreed that the public considers prescribed drugs to be less dangerous as compared to non-prescribed drugs because they believe that such drugs are less harmful. As a way to remedy the research gap, this chapter indicates that researchers have not fully investigated if prescription drugs are perceived, by the society to be lethal as compared to non-prescribed drugs. Instead, they have shown why prescription drugs are at a slow rate turning out to be the drug of choice for the youth since it has a greater prevalence rate than illegal drugs use. Adolescents' perception may cause the continuous misuse of prescription drugs among adolescents that this type of drug use is safer than illegal drugs, how easy it is to access these drugs, and lower societal stigma about abuse compared to illegal drugs use. This is mainly due to peer influence. The youth are shaping their behaviors and attitudes based on their peer's behaviors, and social reinforcement involves adolescents taking in and displaying behaviors approved by others. Both theories apply to adolescents' perception of prescription drug use being safer than illicit drugs and lower stigma about misuse since these perceptions are based on attitudes displayed by others in conjunction with adolescents' own beliefs.

Chapter 3. Methods and procedures

1.1. Population

The people who participated in the study were not compensated but rather volunteered after the researcher politely introduced himself and the purpose of research. The sample was made up of general public, both male and female. Anything less than that 18 years old age bracket was considered ineligible and was not included in the study. The participants who had not attained 18 years were politely requested not to participate in the study.

The information collected and analyzed in this survey was obtained from 138 (n = 138) completed questionnaires. Out of 138 participants, 61, representing 44.2% of the sample, were females while 77, denoting 55.8% were male. The public venue had a large crowd setting. The participants were picked through a random sampling method whereby each person was approached entirely by chance. The researchers had no way to identify who among the general population would willingly participate in the survey, for reliable and valid inferences from a sample to obtain unbiased results. There was a large difference between the number of males and females who participated in the study. The researcher did not prefer either gender since the sample was randomly selected.

130 respondents (94.2%) indicated that they live in Liverpool city and its environs. The eight respondents (5.8%) who do not live in Liverpool, often go in Lord Street and Church Street in the Central Retail Area for shopping, meeting friends, among other activities.

The age range of participants is between 18 and 65. However, the greatest number of respondents is for the people between 31 and 35.

Table 1

 Age Classification of Participants

Age (years) 18-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65

No. of respondents 3 11 23 29 24 21 12 9 4 2

Percentage (%) 2.2 7.9 16.7 21.0 17.9 15.2 8.6 6.5 2.8 1.4

The fact that the majority of the respondents are within that age bracket 31-35 is an indication that the demographics of our participants matched with the proportion of those who were estimated to be users of drugs. These participants were picked from the streets of Central Retail Area in the Liverpool City Centre.

The choice of this locale was apt due to the sense that there existed many shops and restaurants implying that there is diversity regarding age, religion, race, and gender. This location also has a level of pedestrian traffic making it ideal to approach participants. To gain their interest, the researcher had to selected adjacent strategic locations such as pubs, coffee shops, and entertainment spots. These places had a large crowd setting, and people who were willing to spare time and participate in the survey. The topic of the survey also resonated with a high number of the population.

1.2. Design

The study was conducted using a  survey methodology and within the subjects' design. The participants were asked to substantiate how dangerous they perceived drugs to be, which served as the dependent variable (DV), through conducting a tally, how they viewed the prescription status of the drug served as the independent variable (IV) (Ruschmann & Marzilli, 2007).

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