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

Abstract

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.

The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review

“…2020 No Yes S11 Garg et al, 2022 [ 79 ] Canada To investigate the impact of COVID-19, [including the] subsequent change in OAT guidance, on OAT discontinuation" (p. 2) Time series study Apr. 2019 Nov. 2020 Yes No S12 Gittins et al, 2022 [ 80 ] United Kingdom (England) To explore over-the-counter and prescription drug misuse among SMS [substance misuse services] clients during COVID-19 Mixed methods (qualitative/cross-sectional) Aug. 2020 Aug. 2021 No Yes S13 Gomes et al, 2022 [ 81 ] Canada "to evaluate whether increased access to take-home doses of OAT related to pandemic specific guidance was associated with changes in treatment retention and opioid-related harms" (p. 847) Cohort study Feb. 2020 NR Yes No S14 Harris et al, 2022 [ 82 ] United States "to explore how the COVID-19 pandemic impacted MOUD and addiction service experiences." (p. 2) Qualitative study Aug. 2020 Oct. 2020 No Yes S15 Hoffman et al, 2022 [ 83 ] United States "to assess patients' responses to the enhanced access to take-home methadone" (p.2) Mixed methods (qualitative/before-and-after) Sept. 2019 Dec. 2020 Yes Yes S16 Javakhishv...…”

“… Is there coherence between qualitative data sources, collection, analysis and interpretation? S1 Abidogun et al, 2023 [ 69 ] Yes Yes Yes Yes Yes S5 Conway et al, 2023 [ 73 ] Yes Yes Yes Yes Yes S10 Gage et al, 2022 [ 78 ] Yes Yes Yes Yes Yes S12 Gittins et al, 2022 [ 80 ] Yes No Can't tell Yes Yes S14 Harris et al, 2022 [ 82 ] Yes Yes Yes Yes Yes S15 Hoffman et al, 2022 [ 83 ] Yes Yes Yes Yes Yes S16 Javakhishvili et al, 2021 [ 84 ] Yes Yes Can't tell Yes Yes S19 Krawczyk et al, 2021 [ 87 ] Yes Yes ...…”

‘It's a horrible situation for everyone’: The impact of over the counter and prescription medication misuse on friends and family

“…Although only eight interviews were conducted, a rich data set was still obtained and themes were identified; indeed Guest et al, (2006) have indicated that the ‘ basic elements for metathemes’ may occur with just six interviews. Additionally such approaches with limited sample sizes have been successful in sensitive subject matters such as this (Gittins et al, 2018) and the challenges in recruitment during the pandemic have been similarly reported (Gittins et al, 2022b). Greater assurance in the findings may have been achieved if repeat interviews and member-checking were implemented, and this could be considered as a future development to strengthen data reliability and validity.…”

“…Thematic analysis was used for the associated qualitative data. All researchers were suitably experienced in qualitative analyses and have a particular interest in this area of research and have previously published on the topic of OTC/POM misuse (Gittins and Cole, 2021; Gittins et al, 2022a; Gittins et al, 2022b; Gittins et al ., 2022c). The lead researcher (RG) who is a female pharmacist and was previously unknown to the participants conducted the interviews and checked the transcripts to ensure completeness and anonymity; any contradictions to the key conclusions; any observations such as changes in intonation; and coded the data.…”

“…Additionally such approaches with limited sample sizes have been successful in sensitive subject matters such as this (Gittins et al, 2018) and the challenges in recruitment during the pandemic have been similarly reported (Gittins et al, 2022b). Greater assurance in the findings may have been achieved if repeat interviews and member-checking were implemented, and this could be considered as a future development to strengthen data reliability and validity.…”