Background Over-the-counter (OTC) medicines are typically safe. However, there is evidence that OTC medicines can sometimes cause harm as a result of their misuse, abuse and dependence. Aim of the review To review the literature on OTC medicines misuse, abuse and dependence in adults and identify the implicated medicines, contributing factors, associated harms and risk-mitigating interventions. Methods Following PRISMA guidelines, electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO Web of Science and Google Scholar were searched for peer-reviewed journal articles published in English between January 2011 and March 2019. Quantitative, qualitative and mixed-methods studies assessing aspects of misuse, abuse and dependence of OTC medicines in individuals aged 18 years or more were included. Studies that solely focused on adolescents only, doping in sports or abuse of OTC medicines in people who are substance abusers were excluded. The random effect meta-analysis model was used to pool the prevalence among the population-based studies. Results Of 2355 peer-reviewed studies initially identified, 53 were included in this review. According to the study design, the prevalence varied, but the overall pooled prevalence in the population-based studies was: 16.2% for misuse, 2.0% for abuse, and 7.2% for dependence. The common OTC medicines groups involved in the problematic use were analgesics (with or without codeine), sedative antihistamines, cough mixtures containing dextromethorphan. Physical, psychological, social and financial harms were associated with problematic use of OTC medicines in addition to hospitalisation and death. Interventions for the affected individuals were provided mainly through the community pharmacies, general practices and specialised addiction centres. Conclusion The problematic use of OTC medicines is quite prevalent in adults, necessitating raising public awareness about their safe use. In addition, innovative harm minimisation models need to be developed, evaluated and implemented across health care settings.
Background: Community pharmacists are uniquely positioned to identify and address the issue of misuse and abuse of over-the-counter (OTC) medicines. To date, no study has explored the Saudi community pharmacists’ views and experiences regarding aspects of OTC medicines’ misuse and abuse.Objective: To explore the views and experiences of the Saudi community pharmacists towards OTC medicines misuse and abuse. Furthermore, we aimed to identify frequently misused and abused medicines, the reasons and contributing factors, the role of pharmacists, and potential risk-mitigating strategies.Methods: Semi-structured interviews were conducted with a convenient sample of sixteen community pharmacists recruited from community pharmacies across the AL-Baha region, Saudi Arabia. Interviews were conducted using a pilot-tested interview guide in the Arabic language. All interviews were audio-recorded, transcribed verbatim, translated from Arabic into English, and then thematically analysed.Results: Analysis of interviews generated five main themes, including the commonly misused and abused OTC medicines, reasons and factors contributing to misuse and abuse of OTC medicines, pharmacists’ interventions to manage misuse and abuse, challenges and barriers to pharmacists’ interventions in misuse and abuse issues; and potential strategies to reduce the risk of OTC medicines misuse and abuse and improve pharmacists’ practice. Sedative antihistamines, cough products containing dextromethorphan, codeine-based analgesics, and non-codeine-based analgesics were commonly misused and abused OTC medicines. Managing ongoing medical conditions was the main reason for misusing OTC analgesics while recreational use and inducing sleep were the common reasons for abuse. Several factors contributing to misuse and abuse were reported, including unprofessional advice sought from other people, lack of awareness about medicines, and commercial advertisement of OTC products. Community pharmacists identified misuse and abuse among customers by judging their behaviours and attitudes and using structured questioning techniques. Counselling customers on the appropriate use of medicines, providing safe alternatives, and refusing to sell products were among the commonly used actions of pharmacists to address misuse/abuse. Pharmacists proposed several strategies to reduce the risk of OTC medicines misuse/abuse but believed that rescheduling OTC medicines with abuse potential to prescription-only medicine was the best option.Conclusion: Community pharmacists believed that the misuse and abuse of OTC medicines amongst pharmacy customers was common. A multidimensional strategy consisting of upskilling community pharmacists, a comprehensive review of OTC medicines sale regulations, and patient education to limit the risks of OTC medicines misuse/abuse is required.
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