The Pharmaceutical Journal
Vol 278 No 7451 p543
12 May 2007

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Doctors highlight cases of OTC medicines misuse

Large-scale research is needed to monitor and assess the extent of dependence on legal non-prescription drugs, a letter in the BMJ last week suggests. However, some research in this area has already been published in pharmacy journals.

Two doctors write that, in the past three months, they have come across three patients with addiction to Nurofen Plus (ibuprofen and codeine phosphate). All three, they write, had started using the product appropriately but had subsequently escalated their use as they became tolerant to codeine. They also highlight postings on the website of the charity Over-Count, which suggest that over 4,000 registered users are addicted to Solpadeine (paracetamol and codeine).

The doctors state that there is no official statistics on the extent of OTC drug dependence and suggest that research in this area is needed.

However, Catriona Matheson, senior research fellow, department of general practice and primary care, University of Aberdeen, told The Journal that her research team and several others have published papers on over-the-counter medicines misuse in pharmacy journals, which would not have been picked up via the doctors’ Medline search.

She added: “It was useful of the authors of the letter to highlight this problem to the medical profession but they should not assume pharmacists are not well aware of this.

“Managing OTC misuse is an integral part of a pharmacists’ everyday tasks and research has shown that they manage this in a stepwise manner. First, when product misuse becomes apparent they might ensure it is behind a counter, then kept out of sight and finally, as with codeine linctus, many stop stocking it altogether.” She added that some pharmacists also keep registers of people requesting products.

Dr Matheson highlighted the need for greater co-operation between pharmacy and general practice. “In some areas referral notes to GPs have been used to raise awareness of this issue for individual patients. However, if no feedback or response is given pharmacists are unsure if this is worthwhile.”

In response to the BMJ letter, Reckitt Benckiser, manufacturer of Nurofen Plus, pointed out that Nurofen Plus is only available in a restricted pack size and is labelled to state that patients should see their doctor or pharmacist if they need to take it for longer than three days.