It turns out that, in the Middle East, getting access to prescription medications for serious ailments, in the absence of supervision, can sometimes be as easy as picking up an over-the-counter medicine for a headache or the common cold, or so claims a new review published in Pharmacology Research & Perspectives.

In theory, the regulations separating access to either brand of medication is there. In practice, the review cites a “massive problem” of self-medication misuse in the region, particularly with prescription medication, one that eventually leads to greater health risks among patients, including drug dependency and addiction.

Drugs that are used recklessly or sometimes abused by Middle Eastern patients include codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. According to the review, which looked at 72 papers published on the subject between 1990 and 2015, self-medication medicine misuse cannot always be exactly quantified in the region but it seems widespread.

Some of the statistics that the review highlights are quite jarring.

For instance, 73.9% of the Sudanese population have reportedly used antibiotics or antimalarials without a prescription. Equally alarming trends have been observed in Syria, Yemen, Jordan, Tunisia, Egypt and the UAE, with drugs such as amoxicillin or ampicillin being dispensed freely. According to the review, most patients self-medicating on antibioitcs did not even follow through the full course of the medications and took them for less than three days.

Many of the patients follow the advice of relatives, or have a drug prescribed to them by a doctor over the phone. As well, some pharmacists play a role. “People tended to select medication based mainly on advice received from community pharmacists,” says one of the studies cited.

One study said that the majority of the 200 pharmacies under scrutiny in Syria had sold antibiotics without prescription, and in Saudi Arabia, only a single pharmacy had refused to release the medication without a doctor’s prescription.

As well as stacking prescription medications for future use, Middle Eastern patients often used them inappropriately; it’s not uncommon for many to pop antibiotics to treat illnesses unrelated to bacterial infections, for instance, or with incorrect dosages for inappropriate period of time, according to the review.