A study on current status of herbal utilization in Bulgaria. Part 2: Safety concerns

Ethnopharmacological relevance: Herbs play an important role for Bulgarian people since centuries. Nowadays an increasing number of people are using over-the-counter natural health products. It is widely accepted that herbs are harmless and herbal remedies are often used without safety precaution. There is strong evidence that herbal chemical constituents could exert toxic effects, similarly to conventional drugs. Moreover, adverse reactions due to incorrect herbal utilization are often reported. Aim of the study: The aim of this survey was to establish the knowledge of a representative random sample of Bulgarian people about herbal safety in order to find out: 1) the attitudes towards side effects of medicinal plants; 2) the knowledge on safety of the doses recommended in folk medicine; 3) the statement whether the herbs can replace conventional drugs; 4) the opinion about the necessity of control of herbal preparations; 5) the source of information of herbal utilization; 6) how specific demographic features of the participants related to their attitude towards safe herbal utilization. Materials and methods: The present study is focused on safety of herbal utilization as a second part of a larger survey (Dragoeva et al., 2015). In order to determine the correlation between items questioned and demographic variables standardized Pearson correlation coefficient was calculated. Results: The larger proportion of the respondents are not informed about the possible side effects of the herbs: 18.11% have given answer "I don't know" and 39.16% declare that herbs cannot cause side effects. About 86% of the informants declared that they trust in traditional knowledge of herbal application or that they have no information. A greatest proportion of the informants (about 67%) were of the opinion that herbs can replace conventional drugs. The positive answer was given mainly by young respondents - pupils and students. Informants belonging to age groups 41-50 and 51-60 years declared necessity of equal regulation of herbal products and conventional drugs. Some impact of the employment status on the answers was also established. This correlation is due partly to negative answer given by pupils. Another group of informants giving negative answer or answer "I can't decide" was unemployed. A large proportion obtains information from friends (41.11%) and 36.91% of respondents acquire information from specialized books. Interestingly, only 21.98% have used mass media as a source of information. Conclusions: This survey presents for the first time information regarding people knowledge about the safety of herbs in Bulgaria. The results reveal a necessary to ensure clear and comprehensible information about herbal safety for Bulgarian population. The public health role of mass media should be improved. The information should be especially adapted to pupils and unemployed. (C) 2016 Elsevier Ireland Ltd. All rights reserved.