A mixed-methods systematic review of the prevalence, reasons, associated harms and risk-reduction interventions of over-the-counter (OTC) medicines misuse, abuse and dependence in adults

Abstract

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.

Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users

“…For instance, in these countries, OTC analgesics can be purchased in local supermarkets or at gas stations which might create the impression to the public that these drugs are safer than prescription-only drugs, potentially resulting in higher rates of frequent and problematic use ( 49 ). Finally, the use of inconsistent definitions of abuse and misuse leads to different results in the estimation of NOA abuse between studies ( 19 , 50 ). The development of standardized substance abuse terminology is urgently needed to compare prevalence estimates between countries ( 19 ).…”

“…Finally, the use of inconsistent definitions of abuse and misuse leads to different results in the estimation of NOA abuse between studies ( 19 , 50 ). The development of standardized substance abuse terminology is urgently needed to compare prevalence estimates between countries ( 19 ).…”

“…In previous literature the terms more often found, and frequently used interchangeably, are abuse and misuse with several definitions existing for each. In international epidemiological studies, abuse is generally defined as the use of NOA for non-medical recreational purposes such as to achieve mind-altering effects ( 13 , 15 – 19 ), while misuse is largely defined as the use of NOA for a legitimate medical reason but taken in a higher dose or for a period of time longer than recommended ( 10 , 13 , 15 , 16 , 20 , 21 ). In other studies, abuse has been defined as taking a drug together with another substance, like alcohol ( 22 ), or substituting the drug with another one because the drug the individual is dependent on is not available ( 23 ).…”

Development of a Propensity to Self-Medicate with Over-the-Counter Medicines Scale (PSM-OTC)

“…10,11 However, there are also many reports that outline the problems patients experience during the use of OTC medicines. [12][13][14][15][16] Two recent systematic reviews noted a worrisome impact of OTC misuse. 12,15 One reported the overall prevalence as 16.2 percent for misuse, 2.0 percent were classified as abuse, and 7.2 percent classified as dependence.…”

“…[12][13][14][15][16] Two recent systematic reviews noted a worrisome impact of OTC misuse. 12,15 One reported the overall prevalence as 16.2 percent for misuse, 2.0 percent were classified as abuse, and 7.2 percent classified as dependence. 12 Problematic use was associated with analgesics (with or without codeine), sedative antihistamines, and cough mixtures containing dextromethorphan.…”