Outcomes associated with scheduling or up-scheduling controlled substances

Caulkins, Jonathan P.; Goyeneche, Laura A.; Guo, Lingrong; Lenart, Kathryn; Rath, Michael

doi:10.1016/j.drugpo.2021.103110

Cited by 6 publications

(5 citation statements)

References 45 publications

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“…The legalization of a previously controlled substance (e.g., marijuana) or the conversion of a prescription drug to an OTC drug (e.g., steroids) is called down-scheduling, whereas the placement of an OTC drug under prescription or full regulation is called up-scheduling [ 17 ]. In some countries and regions, OTC drugs that have become a public health problem are up-scheduled into drugs that require a physician’s prescription.…”

Section: Case Study Resultsmentioning

confidence: 99%

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Ino

Nakazawa

2022

Pharmacy

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Over-the-counter (OTC) drugs, such as codeine, are available as an OTC drug at common drugstores and major e-commerce platforms, despite their known propensity for causing psychological dependence and harm from overuse. Misuse of and dependence on over-the-counter drugs are serious public health issues. Possible measures include stricter regulation and control, as well as regulation of access to information and awareness activities, but their effectiveness is limited. Up-scheduling, in which OTC drugs are placed under prescription or full regulation, is expected to have a definite effect. However, up-scheduling poses public health ethical challenges. Up-scheduling restricts the freedom of consumers to purchase OTC drugs, and the economic right of manufacturers and sellers. Up-scheduling may also interfere with people’s right to seek self-care through the proper use of OTC drugs. Limited up-scheduling with respect to age may be an effective way to implement up-scheduling while avoiding ethical issues. However, from a public health perspective, it is necessary to improve the information infrastructure so that prescription drug information can be shared electronically, and to strengthen measures to prevent mental health problems among young people that lead to OTC drug misuse, even after up-scheduling.

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Section: Case Study Resultsmentioning

confidence: 99%

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Ino

Nakazawa

2022

Pharmacy

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“…The variety of sources used to obtain OTC/POMs highlights that making changes to supplies from pharmacies or prescribing changes in isolation (eg, in the case of codeine) 83 would be unlikely to completely ameliorate availability, especially where online sales and street dealing remains ongoing: indeed such approaches may result in unintended consequences such as people seeking unregulated alternatives. 84 …”

Section: Discussionmentioning

confidence: 99%

“…82 The variety of sources used to obtain OTC/POMs highlights that making changes to supplies from pharmacies or prescribing changes in isolation (eg, in the case of codeine) 83 would be unlikely to completely ameliorate availability, especially where online sales and street dealing remains ongoing: indeed such approaches may result in unintended consequences such as people seeking unregulated alternatives. 84 The frequency that the need for improvement in raising awareness of OTC/POM misuse and other changes to healthcare provision was commented upon was notable. Despite the age of some of the publications, it was observed how much of an issue this remains to be, especially given the recent national review by Marsden et al 39 This highlights the need for continued developments and a greater understanding of how best to undertake these required improvements.…”

Section: Implications For Clinicians Policymakers and Researchersmentioning

confidence: 99%

Misuse of Over the Counter and Prescription Only Medication by Adults Accessing Specialist Treatment Services in the UK: A Narrative Synthesis

2022

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Background: Concerns about the misuse of over the counter (OTC) and prescription only medication (POM) are due to their impact upon physical/mental wellbeing, drug interactions and drug-related deaths. Improving an understanding of the pattern of use by people accessing specialist substance misuse services (SMSs) should enable improvements to treatment provision. Aim: To review the literature on the misuse of OTC/POM among adults accessing SMS, including the pattern of use, types of medication and associated characteristics. Methods: This review is reported in line with PRISMA. The protocol has been registered on PROSPERO (CRD42020135216) and separately published. A search of Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases and grey literature was undertaken. Only English language publications outlining OTC/POM misuse by adults in receipt of psychological/pharmacological interventions for substance misuse were included. Two reviewers conducted the title, abstract and full-text reviews using predetermined selection criteria and a piloted data extraction form to ensure a consistent approach. A third reviewer resolved disagreements and the Mixed Methods Appraisal Tool assessed for bias. Ethical approval was not required. Results: Thirteen studies with notable heterogeneity were included in the narrative synthesis after non-UK-based and ineligible publications were excluded, from the 143 potentially relevant papers. To reduce bias all studies were included in the analysis and GRADE-CERQual was applied. ‘High confidence’ was identified for all review findings, despite moderate methodological limitations. Antihistamine, benzodiazepine and opioid misuse was mentioned most frequently. Usage patterns and supply sources varied. Adverse consequences and polypharmacy are concerning. Withdrawal symptoms perpetuated misuse, often alongside illicit substance use, comorbid psychiatric/pain disorders and street drug shortages. Conclusion: OTC/POM misuse is common amongst adults accessing SMS. A renewed approach to withdrawal management is required. The limited number of studies may impact on generalisability but allowed for a more detailed review. Restricting to UK studies improved relevance due to drug market variations and availability of medicines in different countries. Further UK-based research on OTC/POM misuse in SMS is needed to build upon the current paucity in the published literature.

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Section: Discussionmentioning

confidence: 99%

“…Additionally, if steps are taken to limit access, for example by rescheduling/ceasing prescribing of opioid products, these should be implemented with care to avoid unintended consequences such as people seeking unregulated alternatives. 65,66 Since data saturation was not felt to have been achieved, additional research, such as qualitative interviews should allow for more detailed exploration and enable triangulation to assess the validity of the findings. This could support a greater understanding of the reasons for OTC/POM misuse, impact upon other substances used, physical/mental wellbeing, harm reduction provision (such as take home naloxone supplies) and views about SMS developments identified from the questionnaire.…”

Section: Implications For Clinicians Policymakers and Researchersmentioning

confidence: 99%

Surveying Over the Counter and Prescription Only Medication Misuse in Treatment Services During COVID-19

Gittins

Vaziri²,

Maidment

2022

Subst�Abuse

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Background: A greater understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse amongst adults accessing substance misuse services (SMS) during COVID-19 is required to identify how SMS can better meet the needs of the people who require treatment. Aim: To use a questionnaire to explore OTC/POM misuse during COVID-19 in adults accessing community SMS in England. Methods: In 2020 to 2021 anonymous self-administered online/paper questionnaires which collated quantitative and qualitative data were completed. They were piloted for suitability and ethical approval was obtained. Thematic analysis was conducted for qualitative data and chi-square tests used to assess the relationship between quantitative variables. Results: Participants were Caucasian (94.6% British), majority male (58.9%), aged 18 to 61 years. Most were prescribed medication for problematic substance use, with a 92.5% self-reported adherence rate. The misuse of benzodiazepines (22.2%) codeine products (30.8%) and pregabalin (14.5%) predominated and 37.5% misused 2 or more medicines. Administration was usually oral and concomitant use of other substances was common: alcohol 44.6% (52% daily), tobacco/vaping 73.2% and illicit substances 58.9%. There were statistically significant associations identified, including between changes during COVID-19 to OTC/POM misuse and illicit use. Only 56 questionnaires were included in the analysis: we believe this low number was because of infection control measures, limited footfall in services, pressures on staff limiting their capacity to distribute the paper questionnaires and reliance upon telephone consultations limiting online distribution. Increasing OTC/POM misuse and obtaining illicit supplies were reported when access to usual supplies were restricted; however, changes to doses/dispensing arrangement liberalisation in response to COVID-19 were positively viewed. Conclusion: OTC/POM misuse, including polypharmacy and concomitant use of other substances occurred during COVID-19: SMS need to be vigilant for these issues and mitigate the associated risks for example with harm reduction interventions. Further qualitative research is required to explore the issues identified.

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Outcomes associated with scheduling or up-scheduling controlled substances

Cited by 6 publications

References 45 publications

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Misuse of Over the Counter and Prescription Only Medication by Adults Accessing Specialist Treatment Services in the UK: A Narrative Synthesis

Surveying Over the Counter and Prescription Only Medication Misuse in Treatment Services During COVID-19

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