Community pharmacists' experience of over-the-counter medicine misuse in Scotland

Abstract

Over the last decade Britain has observed a trend towards the re-regulation of 'prescription only medicines' in favour of pharmacy status drugs. This move towards self-treatment to reduce pressures on general practitioner drug budgets and workloads has focused attention on the need for community pharmacists to extend their patient education and screening roles. In response to these changes, this study was conducted to explore: the type of over-the-counter (OTC) medicine being misused in Scotland; pharmacists' professional attitudes and management of OTC misuse; and the training and support needs of pharmacists. A postal questionnaire was designed. This was informed by an earlier stage of qualitative research and the available literature. It was then piloted and administered to all 110 pharmacies in the study area. A 79% response rate was achieved. The research found that OTC misuse, particularly of certain analgesics, sleeping prescriptions, products containing codeine or pseudoephedrine, caffeine, cough mixtures, and laxatives was common. The estimated mean number of patients suspected of misusing medicines in a typical week was 5.63. Pharmacies in urban areas were more likely than those in rural areas to report suspected misuse. The research identified a number of intervention strategies relating to: patient/pharmacist interaction; information provision; removal of products from the point of sale; sharing of information with other local pharmacists; and referral to other members of the primary care team. Pharmacists expressed a need for support in managing OTC misuse and in organising 'early warning systems' to share information locally.

Misuse of Medicines in the European Union: A Systematic Review of the Literature

“…For each of these medicine types, the most relevant publications on patterns of misuse, factors related to misuse, and high-risk groups will be presented below. Other medicines, such as antidepressants [29], antiparkinson drugs [30,31], cough and cold medicines [32,33], and stimulants, such as methylphenidate [34,35], have also been found to be misused. However, the literature on these drug types is limited in comparison to the main groups of misused medicines listed above.…”

“…Twenty-four percent of over-the-counter medicine sales in the UK in 2001 were traced back to analgesics, making them the most commonly used nonprescription medicines [36]. In the UK, a number of prescription medicines, among them analgesics, have been re-classified as nonprescription to increase their accessibility and encourage self-care of minor illnesses [33]. Even though availability alone does not lead to increased misuse, it does contribute to the proliferation and consumption of the drug, which, in combination with other factors, such as diversion potential and the development of tolerance can contribute to the likelihood of misuse and dependence.…”

“…For example, while over-the-counter drugs in France are only allowed to be sold in pharmacies, in Germany some of them may be sold in pharmacies or drugstores, in the UK additionally in general stores, reflecting the UK’s trend towards self-treatment [33,76]. Prices also fluctuate between countries: in Germany over-the-counter drugs are less expensive than prescribed drugs to encourage patients to self-medicate.…”

A Comparative Exploration of Community Pharmacists’ Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom

“…Pharmacists' concerns regarding the misuse of OTC codeine products are well documented in the literature (MacFadyen, Eadie et al 2001;Matheson, Bond et al 2002;Pates, A.J. et al 2002;Cooper 2011;Reed, Bond et al 2011;Cooper 2013a;Cooper 2013c).…”

Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies

“…paracetamol, aspirin or ibuprofen), requesting specific pack sizes and agitation when pharmacists intervene (Hamer et al, 2014). Pharmacy tactics currently include removal of codeine containing products displayed at point of sale, refusal of sale or restriction of quantity sold in the event of suspect requests, the on-site recording of incidences of suspected misuse, and medicines information provision by counter staff, direct pharmacist intervention by additional customer questioning, and customer referral to primary care professionals (Hamer et al, 2014;MacFadyen, Eadie, & McGowan, 2001;Nielson et al, 2010;Pates et al, 2002). Regulatory tactics to date have largely focused on guidelines for restricted supply (Cooper, 2011(Cooper, , 2013bHamer et al, 2014) and have met with resistance from the pharmaceutical industry (McAvoy et al, 2011).…”