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More can be done to counter the problem of inappropriate medicine
use |
Initiatives to support the correct use of over-the-counter
medicines could be improved through better understanding of the problem
of legal drug misuse or abuse, says Sheila Kelly, executive director of
the Proprietary Association of Great Britain (PAGB).
Pharmacy guidance
and training in the supply of OTC medicines play a vital role in the
fight against their inappropriate use. Sales protocols, such as WWHAM
(who for,
what symptoms, how long, action taken, other medicines) guidelines for
selling medicines and giving advice, patient information leaflets and
Royal Pharmaceutical Society guidance on substances of misuse1 are
all available
to help pharmacists monitor OTC sales and to ensure appropriate supply
of OTC medicines.
Pharmacies also have their own methods of ensuring
the appropriate supply of OTC medicines, including asking staff to refer
requests
for certain products to the pharmacist, not stocking certain products
and suggesting safer alternatives.2
Industry also takes its role in preventing misuse of OTC medicines seriously
and, to date, has been active in ensuring that product label and leaflet
information is clear and written in non-technical language that lay people
can understand. It voluntarily agreed to add addiction warnings to packs
of painkillers that contain codeine and dihydrocodeine, and it is in
the process of implementing new European patient information leaflet
legislation, which will be complete by July 2008.
The evidence shows that the combined efforts of pharmacy and industry
serve patients well. In the UK, in 2006, 930 million individual packs
of OTC
medicines were sold,3 and research shows
that most of these are used cautiously and responsibly; over 80 per cent
of people using an OTC medicine
for the
first time read the instructions carefully,4 and
only around 2 per cent of people say they would use the product more
often or for a longer time
than recommended.5
People are known to treat
OTC medicines with respect and on a par with prescription medicines.6 By
far the most common reason for stopping using a medicine was improvement
in the person’s condition.4
However, more can be done to counter the problem of inappropriate medicine
use, OTC medicine suppliers believe, which is why the current All-Party
Parliamentary Group on Drugs Misuse (APPGDM) inquiry into the misuse
of prescription-only and OTC medicines in the UK is to be welcomed.
According to the PAGB, the hope is that by more fully understanding the
problem of inappropriate OTC medicines use, counter strategies can be
improved.
To date, pharmacy strategies to prevent potential OTC medicine misuse
rely on the good judgement of alert, informed staff. There is no formal
procedure
for pharmacists to alert others of suspicions, which lends support to
the argument for standardised harm reduction strategies that can be implemented
nationally.
However, blanket, one-size-fits all strategies will not be appropriate
unless the extent of OTC abuse in the UK is fully understood.
The report of the International Narcotics Control Board for 2006 was
among the factors prompting the APPGDM to launch its inquiry. This points
out
that in the US, the level of misuse of prescription drugs, including
stimulants and OTC medicines is no less than the level of misuse of drugs,
such as
methylenedioxymethamphetamine, cocaine, methamphetamine and heroin7 but,
in the UK, more medicines (two thirds) are sold through pharmacies than
in the US.3
Figures from Over-Count, the Dumfries-based OTC drugs information and
support service have also contributed to the inquiry’s momentum
but these only estimate the size of the problem.
There is also little understanding of why products are being used inappropriately — no
research is available that establishes what proportion of those misusing
psychoactive OTCs are wilfully using them for recreational purposes and
what proportion are misusing them because of a dependency resulting from
use for a legitimate purpose.
There is also little understanding of who is abusing or misusing products,
and this affects industry’s ability to roll out effective programmes
and activities to prevent misuse and abuse. “The problem in providing
support is identifying strategies which will work for different people,” according
to the PAGB.
So far, the transition of the APPGDM inquiry from written to oral evidence
gathering has generated considerable publicity in the national media,
although most of this focuses on prescription medicines and has highlighted
only
a few ingredients found OTC medicines that are already known to be open
to abuse.
The allegations of inappropriate OTC medicine use that contributed to
the start of the inquiry are also yet to materialise into significant
amounts
of written evidence, and neither Over-Count nor Brian Iddon, MP and APPGDM
chairman, say they are “out to get OTCs”.
It is a matter of
record that the APPGDM was among those against a P to POM switch of pseudoephedrine
and David Grieve, founder of Over-Count, is also clear that he does not
personally wish to see codeine-based products taken off OTC sale. He
says: “People
want to buy products effective enough to relieve pain, and I don’t
want to take away people’s choice.”
By the time the oral sessions are finished it is the hope of MPs, the
OTC industry and OTC abuse and addiction support groups alike that the
final
outcome will be better, with sustainably funded NHS resources and support
for people who develop problems using medicines.
Dr Iddon says: “Anybody addicted to a substance, whatever that may
be, should be able to get advice and, if necessary, be referred for proper
treatment. If you have a problem with alcohol or Controlled Drugs then
help is available — why not for prescription and OTC medicines
as well?”
References
1. Royal Pharmaceutical Society of Great Britain. Substances of misuse.
2008 (PDF 100K)
(accessed 28 April
2008).
2. Pates R, McBride AJ, Li S, Ramadan R. Misuse of over-the-counter medicines:
a survey of community pharmacists in a south Wales health authority.
Pharmaceutical Journal 2002;268:179–82
(PDF 70K)
3. Proprietary Association of Great Britain. PAGB
Annual Review 2007
(accessed 28 April 2008).
4. Proprietary Association of Great Britain. Everyday Healthcare Study
1997. Available at www.pagb.co.uk (accessed 28 April 2008).
5. Wazaify M, Shields E, Hughes CM, McElnay JC. Societal perspectives
on over-the-counter medicines. Family Practice 2005;22:170–6.
6. Risks and benefits of medicines and medical devices —perceptions,
communication and regulation. Ipsos MORI research conducted for the Medicines
and Healthcare products Regulatory Agency research study for MHRA March
2006.
(PDF 380K)
(accessed 28 April 2008)
7. International Narcotics Control Board. Report
of the International Narcotics Control Board for 2006
(accessed
28 April 2008).
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The
Pharmaceutical Journal