The Pharmaceutical Journal Vol 267 No 7168 p457
6 October 2001

This article
Reprint
Photocopy

OTC medicines misuse and addiction: what can pharmacists do to help?

Addiction to over-the-counter medicines is an issue that has once again been raised by the national press. For those affected, the problem is a serious one. But just how widespread is such addiction and should pharmacists be doing more to tackle it? Harriet Adcock reports

Reports in some national newspapers would have us believe that there are tens of thousands of people affected by addiction to over-the-counter (OTC) medicines. And with more medicines being de-regulated from prescription control to pharmacy medicine status, concern over the increasing availability of medicines liable to misuse is likely to continue.

Dr Janie Sheridan of the National Addiction Centre, King’s College London, told The Journal that a lack of research into this issue means that it is hard to estimate the scale of the problem. She added that it was important to differentiate between misuse that is deliberate and that which is inadvertent.

People who purposefully misuse OTC medicines might do so either for their psychostimulant effects or to counter the effects of withdrawal from illicit drugs. Others might have become dependent through over-use of a particular product after an initial genuine need for symptomatic relief.

The authors of a Scottish study, published last week, looked at community pharmacists’ experience of non-prescription medicines misuse (Journal of the Royal Society for the Promotion Health 2001;121:185). Although the study did not address the issue of addiction caused by inadvertent use per se, it did attempt to quantify the level of OTC medicines misuse.

The authors, Dr Lynn MacFadyen and Douglas Eadie of the Centre for Social Marketing, University of Strathclyde, and Tony McGowan of the Health Promotion Department, Lanarkshire Health Board, report that OTC medicines misuse, particularly of certain preparations, is common.

It is recognised that misuse of some medicines can lead to addiction, so if misuse is common, could the problem of addiction be a significant one?

The Proprietary Association of Great Britain, which represents manufacturers of non-prescription medicines, does not think so. It says it is aware that a “very small minority of people” might have become addicted to OTC medicines through misuse, but concedes that more research is needed to determine the true extent of the problem. Sheila Kelly, executive director, PAGB, believes that the vast majority of people follow the advice that OTC medicines should not be used for more than a few days at a time. “People claiming to have a problem with addiction are ignoring that advice,” she said.

But if people are ignoring the advice that appears on non-prescription medicines then there is a clear need for pharmacists to intervene where misuse is apparent. The PAGB recognises this and has agreed to fund a study among community pharmacists designed to develop protocols for the identification and prevention of deliberate misuse of OTC medicines.

However, David Grieve, who runs a charity — Over-Count — that gives advice to people addicted to OTC medicines, warns that identifying people who misuse such products is difficult.

“Our clients may go to several chemists to buy one packet [of the misused OTC medicine] and will be careful not to return to that area for maybe a fortnight. For the pharmacist, this makes it difficult to identify the products that are being misused and also the people who are misusing them.”

The question of what pharmacists should do if they suspect that a person is addicted to an OTC medicine is a difficult one. Most drug services are not geared to help with this type of problem and general practitioners may not have experience of addiction to products that are not prescribed.

Kay Roberts, area pharmacy specialist, drug misuse, Greater Glasgow, said she suspected that the problem of customers becoming addicted to OTC medicines inadvertently was probably fairly rare. “However, it is a hidden problem and something that pharmacists need to be aware of,” she said.

She said that pharmacists could sometimes be over cautious when selling OTC medicines to methadone patients but if someone looked OK then suspicions about addiction might not be raised.

“Paying lip-service to the protocols for selling medicines is not enough.” She added that what pharmacists should be doing is raising staff awareness about products that had the potential to be misused, and the reasons why they might be misused.

Over-Count has long advocated the use of warning labels to alert customers to the risk of dependency that is inherent in some OTC medicines. However, Ms Roberts believes this would be counter-productive and could encourage misuse.

The Royal Pharmaceutical Society provides guidelines for pharmacists to help them balance their commercial and professional interests. The Code of Ethics states that pharmacists must ensure that they do not promote inappropriate or excessive consumption or use of medicines or their misuse, injudicious or unsafe use. In addition, it says: “Pharmacists and their staff must be aware of the abuse potential of certain OTC products and should not supply where there are reasonable grounds for suspecting misuse.”

Nigel Graham, head of practice, Royal Pharmaceutical Society, said: “If a pharmacist suspects misuse of over-the-counter medicine then it is important for them to intervene in the sale. A few simple questions should establish whether the supply is appropriate. Sometimes the misuse is not deliberate but based on ignorance of the correct use and indications for the medicine.

“It is important that pharmacists communicate with each other locally to identify trends of misuse and individual misusers. There may be a need to establish local policies on stocking or openly displaying medicines of known misuse.”

In their study of OTC medicines misuse in Scotland, Dr MacFadyen and her colleagues write that community pharmacists have a pivotal role to play in monitoring and controlling non-prescription medicine misuse. They identified a number of intervention strategies that pharmacists can use when dealing with customers suspected of misusing OTC medicines. Most pharmacists reported that they would intervene by advising a patient to seek advice from their general practitioner and by removing the product from the point of sale. However, the pharmacists involved in the study expressed a need for support in managing non-prescription medicines misuse and in organising early warning systems to share information locally.

Dr MacFadyen told The Journal that all of the pharmacists who had taken part in the study had some experience of OTC medicine misuse. “Pharmacists felt that it was an important issue, although not a disastrous one,” she said. Dr MacFadyen and her colleagues estimated that the average pharmacy encountered five or six customers each week who were suspected of misusing non-prescription medicines.

A report of Dr MacFadyen’s study will be published in 13 October 2001 issue of the Journal.

Back to Top

Harriet Adcock is on the staff of The Pharmaceutical Journal