A mixed-methods systematic review of the prevalence, reasons, associated harms and risk-reduction interventions of over-the-counter (OTC) medicines misuse, abuse and dependence in adults

Background Over-the-counter (OTC) medicines are typically safe. However, there is evidence that OTC medicines can sometimes cause harm as a result of their misuse, abuse and dependence. Aim of the review To review the literature on OTC medicines misuse, abuse and dependence in adults and identify the implicated medicines, contributing factors, associated harms and risk-mitigating interventions. Methods Following PRISMA guidelines, electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO Web of Science and Google Scholar were searched for peer-reviewed journal articles published in English between January 2011 and March 2019. Quantitative, qualitative and mixed-methods studies assessing aspects of misuse, abuse and dependence of OTC medicines in individuals aged 18 years or more were included. Studies that solely focused on adolescents only, doping in sports or abuse of OTC medicines in people who are substance abusers were excluded. The random effect meta-analysis model was used to pool the prevalence among the population-based studies. Results Of 2355 peer-reviewed studies initially identified, 53 were included in this review. According to the study design, the prevalence varied, but the overall pooled prevalence in the population-based studies was: 16.2% for misuse, 2.0% for abuse, and 7.2% for dependence. The common OTC medicines groups involved in the problematic use were analgesics (with or without codeine), sedative antihistamines, cough mixtures containing dextromethorphan. Physical, psychological, social and financial harms were associated with problematic use of OTC medicines in addition to hospitalisation and death. Interventions for the affected individuals were provided mainly through the community pharmacies, general practices and specialised addiction centres. Conclusion The problematic use of OTC medicines is quite prevalent in adults, necessitating raising public awareness about their safe use. In addition, innovative harm minimisation models need to be developed, evaluated and implemented across health care settings.

Management of common minor ailments in Qatar: Community pharmacists’ self-perceived competency and its predictors

Studies focused on comprehensive assessment of self-perceived competency of community pharmacists to manage minor ailments are scanty despite that self-perceived competency is a valid determinant of task performance. The objectives of the study were to assess community pharmacists’ self-perceived competency to manage fourteen common minor ailments in Qatar, and identify its significant predictors. A cross-sectional assessment of 307 community pharmacists was conducted with a pre-tested 20-item questionnaire. Self-perceived competency was assessed with nine elements on a scale of 1–10 (Maximum obtainable score: Each minor ailment = 90; each element = 140). Mann-Whitney U and bivariate logistic regression were used for data analyses. The response rate was 91.9% (282/307). The majority of the respondents were males (68.1%; 192/282), within the age range of 31–40 years (55.3%; 156/282). The minor ailments with the highest median competency score were constipation (76), and cold/catarrh (75) while travel sickness (69), and ringworm (69) had the lowest. The two condition-specific competency elements with the highest median score were recommendation of over-the-counter (OTC) medicines (115), and provision of instructions to guide its use (115). Ability to differentiate minor ailments from other medical conditions had the lowest median competency score (109). The significant predictors self-perceived competency were female gender (OR = 2.39, 95%CI: 1.34–4.25, p = 0.003), and working for chain pharmacies (OR = 2.54, 95%CI: 1.30–4.96, p = 0.006). Overall, Community pharmacists’ self-perceived competency was adequate for majority of the common minor ailments, and it was highest for constipation and cold/catarrh, and specifically for the recommendation of OTC medicines and provision of instructions to guide its use. However, diagnostic ability to differentiate minor ailments from other medical conditions with similar features had the lowest median competency score. Female gender and working in chain pharmacies were the significant predictors of self-perceived competency to manage minor ailments.

Future Pharmacists’ Opinions on the Facilitation of Self-Care with Over-the-Counter Products and Whether This Should Remain a Core Role

Background: The aim was to investigate pharmacy students’ views on the role of the pharmacist in facilitating self-care with over-the-counter (OTC) medicines, particularly in light of new roles, and establish personal practice. Methods: Final year pharmacy students at Queen’s University Belfast were invited to participate. Data were collected via a pre-piloted questionnaire, distributed at a compulsory class (only non-identifiable data were requested). Descriptive statistics were performed, and non-parametric tests were employed for inferential statistical analysis (responses by gender). Results: The response rate was 87.6% (78/89); 34.6% (27/78) males and 65.4% (51/78) females. Over a third [34.6% (27/78)] reported using OTC medicines about once a month. All appreciated the importance of an evidence-based approach to optimize patient care. Most [(96.2% (75/78)] deemed OTC consultations should remain a fundamental responsibility of pharmacists and 69.2% (54/78) thought OTC consultations have the potential to be as complex as independent pharmacist prescribing. Females felt more confident recommending OTC emergency contraception than males (p = 0.002 for levonorgestrel and p = 0.011 for ulipristal acetate). Many [61.5% (48/78)] considered more medicines should not be deregulated from prescription-only status. Conclusions: Data from this single institution suggests that enabling self-medication is an important part of practice but there were confidence issues around deregulations.

The Practice of OTC Dispensing by Community Pharmacist in Nepal

Over the counter (OTC) medications are the group of drugs that can be sold without the prescription of a registered medical practitioner to the consumers. Pharmacists are the most accessible health care professionals to the patient for the treatment of their minor illness. To provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counselling, community pharmacists need access to current and reliable information about medicines. A descriptive study was conducted on fifty pharmacists present in the community pharmacy of Kathmandu and Lalitpur districts. Predesigned validated questionnaire consisting of 16 questions were taken for the collection of data. Qualification of pharmacists, numbers of consumer asking for OTC medication in a week, most commonly dispensed OTC medicines by pharmacists, common symptoms told by consumers and average working hour of community pharmacists were recorded. The approval from the concerned authorities was taken. The study was a community based descriptive study done for 3 months. The data of the study was analyzed by using SPSS version 18. Out of 50 Pharmacists, 27 were males and 23 were females. Most of the study populations were qualified as assistant pharmacy. 82% of Community Pharmacy encountered more than ten consumers in a week. Analgesics and antipyretics, drugs for gastritis, antiprotozoals and antihistamines were the most commonly dispensed drugs by the pharmacies. The most common symptoms enquired by patients/consumers were fever (92%), common cold (90%) and headache (86%) as reported by pharmacists respectively. Average working hours of community pharmacists were 67 hours per week. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. There is increasing use of OTC medicines in Nepal. The study on community pharmacy practices regarding over the counter medicines can assist in evaluating pattern of use of OTC medicines by consumers thus help to reduce abuse and misuse of such medicines.

Facebook as a source of access to medicines. (Preprint)

BACKGROUND Over the last decade, we’ve observed an enormous social media development, which have recently become commercial services. OBJECTIVE The objective was to verify Facebook as a source of pharmaceuticals offers. We also intended to identify prescription (Rx) and over-the-counter (OTC) medicines if available on that platform. METHODS The study was conducted from January 2019 to July 2020. We investigated offers of pharmaceuticals posted on the Polish Facebook (individual posts and communities) between 2016 and 2019. Medicines were divided into Rx and OTC brands and in accordance with their possible therapeutic use. We verified whether the medicines were for sale, to exchange, or available for free. Posts and groups were investigated for example by entering the phrase “for free,” followed by a city in Poland. RESULTS Out of 409 offers, 380 (92.91%) concerned Rx brands and 29 OTC brands. 315 (77.02%) medications were available “for free”. In 47 (11.49%) cases, an “exchange” was expected, and 47 (11.49%) announcements were marked as “for sale”. Cardiovascular medicines (n=125) were the most popular. There were also antidiabetics (n=38) and antipsychotics (n=28). We also found clear candidates for misuse. These were opioids (n=7), benzodiazepines (n=2 )as well as clomifene (n=1) and letrozole (n=1). CONCLUSIONS Facebook is a significant source of uncontrolled access to medicines. The majority of offers concerned Rx brands, including opioids and benzodiazepines. Medicines offered on Facebook are mainly accessible for free, and the scope and the number of medicines offered on Facebook should make this issue a hazardous phenomenon.

Pharmacy Technology to Better Public Health

Healthcare access and delivery faces significant global and local challenges. This article aimed to explore the public's use of pharmacy services and aimed to obtain 200 completed surveys across eight districts of Bristol, UK, from non-registered pharmacy premises. Respondents reported as follows: 1) ability to order a repeat prescription (79.47%), 2) ability to collect a repeat prescription (72.63%), 3) ability to collect an acute prescription (66.84%), ability to purchase over the counter (OTC) medicines (59.79%), 4) followed by asking for specific advice on prescription medicines (48.42%), and 5) minor ailments (44.15%). Respondents had used the pharmacy at least once for collecting a repeat prescription for a routine medication (59.47%) or acute prescription (55.79%) and for buying OTC medicines (47.89%). Majority of respondents never approached a community pharmacist to specifically ask advice on medicines (51.32%). Participants had not ever approached a community pharmacist for minor ailment/health advice (71.58%).

Potential for Detection of Safety Signals for Over-the-Counter Medicines Using National ADR Spontaneous Reporting Data: The Example of OTC NSAID-Associated Gastrointestinal Bleeding

One post-marketing surveillance challenge for many regulatory authorities is access to information regarding the safety of over-the-counter (OTC) medicines. National spontaneous adverse drug reaction (ADR) report data represent a rich potential data source for the detection of safety signals associated with OTC medicines, yet little is known regarding the possibility of detecting safety signals for OTC medicines within these datasets. The aim of this study was to evaluate the potential for detecting safety signals for OTC medicines in National ADR spontaneous reporting data, using OTC non-steroidal anti-inflammatory drugs (NSAIDs) and gastrointestinal bleeding as an example. Data from the Australian Adverse Drug Reactions System (ADRS) dataset (1971–2008) and the Canadian Vigilance Adverse Reaction Online Database (VAROD) (1965–2013) were used to explore the feasibility of using spontaneous reporting data, exploring the association between gastrointestinal bleeding and the use of OTC NSAIDs. Safety signals were examined using disproportionality analyses and reporting odds ratios calculated. After adjusting for age, gender, medications known to increase the risk of bleeding, and medications used for the management of conditions associated with an increased risk of bleeding, a two-fold increase in the risk of gastrointestinal (GI) bleeding with OTC NSAID was observed within each dataset. This study demonstrates that spontaneous ADR reporting data can be used in pharmacovigilance to monitor the safety of OTC medicines.