ISSUES
: Drugs
Chapter 1: Drug issues
10
What is... over-the-counter medicine
misuse?
By Niamh Fingleton
O
ver-the-counter
(OTC)
medicines are medicines
which can be obtained and
supplied without a prescription. They
are also known as non-prescription
medicines. Examples of OTC
medicines include analgesics (e.g.
paracetamol, ibuprofen and certain
codeine-containing analgesics), cold
and flu products (e.g. Night Nurse),
sleep aids (e.g. Nytol and Sominex),
etc. Whilst OTC medicines are often
perceived by the public as being safer
than prescription medicines, they
have the potential to cause harm. All
OTC medicines have the potential to
be used incorrectly, whilst some have
the potential to cause dependence.
Cooper (2013a) identified three main
categories of harm in his literature
review of OTC medicine abuse:
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Direct harms related to the
pharmacological or psychological
effects of the drug, e.g.
dependence to codeine.
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Physiological harms related to
the adverse effects of another
active ingredient in a compound
formulation, e.g. adverse effects
of ibuprofen in compound
analgesics containing ibuprofen
and codeine.
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Harms
related
to
other
consequences
such
as
progression to abuse of other
substances, economic costs and
effects on personal and social life.
OTC medicines most frequently
associated with dependence are
those capable of causing physical
symptoms such tolerance and
withdrawal i.e. codeine-containing
analgesics and smoking cessation
products containing nicotine (Cooper
2013b, Nielsen, Cameron and Pahoki
2010, Hughes et al. 2004). However,
the psychological aspects of
dependence may occur with any.
The evidence regarding dependence
on OTC medicines is sparse. A
research team at the University of
Aberdeen recently conducted a postal
survey of the UK general population
(n=946) to determine
the
prevalence
of OTC medicine
dependence.
A
response
rate
of
43.4%
was
achieved.
The
lifetime prevalence
was 2%; 0.8% were
currently dependent
whilst 1.3% had
been dependent in
the past (Fingleton
et al. 2014). When
asked what they
were dependent on,
codeine-containing
analgesics were the most frequently
mentioned (n=4), e.g. Syndol and
Solpadeine. Other OTC medicines
mentioned were analgesics without
codeine, a sleep aid and a smoking
cessation product. Of the eight
individuals ever dependent on an
OTC medicine, five had never sought
help, two sought help from a GP and
one had sought help from family and
friends. A recent survey of community
pharmacies asked about products
they perceived to be misused.
Codeine-containing products were
most frequently suspected of misuse
(Matheson, Bond and Robertson
2014).
Previous
qualitative
research
conducted in the UK with people
dependent on OTC medicines found
there was considerable variation
in the perceived benefit of various
treatment and support options used
by participants; attempts at self-
treatment were often ineffective and
experiences with general practitioners
varied considerably (Cooper 2013b).
Specialist treatment services were
perceived as not being set-up to treat
OTC medicine dependence.
Further research is currently being
conducted by the research team
at the University of Aberdeen as
part of a PhD project funded by the
SSA. A qualitative study is currently
underway with people who have ever
been dependent on OTC medicines
to identify the barriers and enablers
to seeking treatment, and a survey
of specialist drug misuse treatment
providers will be conducted in the
near future to see how OTC medicine
dependence is managed in these
settings.
References
Cooper, R. (2013a)
Over-the-counter medicine
abuse - a review of the literature
, Journal of
Substance Use, 18(2), pp. 82-107.
Cooper, R.J. (2013b)
‘I can’t be an addict. I am.’
Over-the-counter medicine abuse: a qualitative
study
, BMJ Open, 3(6), pp. 1-9.
Fingleton, N., Matheson, C., Watson, M. and
Duncan, E. (2014)
Non-prescription medicine
misuse and dependence in the UK: a general
population survey
, Health Services Research
and Pharmacy Practice. Aberdeen, April 3-4.
Hughes, J.R., Pillitteri, J.L., Callas, P.W.,
Callahan, R. and Kenny, M. (2004)
Misuse of
and dependence on over-the-counter nicotine
gum in a volunteer sample
, Nicotine & Tobacco
Research, 6(1), pp. 79-84.
Matheson, C., Bond, C.and Robertson, H.
(2014) Community Pharmacy Services for Drug
misusers:
Measuring National Service Delivery
and the Development of professional Attitudes
and Practice over two decades. Report to Chief
Scientist Office, Scottish Government.
(Report
awaiting approval).
Nielsen, S., Cameron, J. and Pahoki, S. (2010)
Final report 2010:
Over the counter codeine
dependence
, Victoria: Turning Point Alcohol
and Drug Centre.
February 2015
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Information from the Society for
the Study of Addiction. www.
addiction-ssa.org.
© Society for the Study of Addiction