Guest guest Posted September 16, 2008 Report Share Posted September 16, 2008 Libreville, Gabon's capital, complained of pains caused by poor blood circulation in her swollen legs. She could hardly walk, she said, because of the cramps which started after she took slimming pills her sister had bought on a city street.She could be considered lucky. Others have suffered much more from drugs bought from informal vendors, according to Isabelle Mboumba, head nurse in the emergency wing of a public hospital in Libreville.The nurse said she had seen many people die from poisoning, develop severe stomach and kidney ailments or run mad after taking "dubious medicines" purchased on the streets or in markets without a doctor's prescription.In September, the Association of Gabonese Pharmacists ran a one-week awareness campaign on unlicensed drugs to alert the authorities and the public to the threat the medicines posed to public health. Two months later, Libreville's mayor, Andre Dieudonne Berre, banned their sale from the streets of his city.Since the ban, announced on 9 November, cigarette vendors and other street hawkers no longer openly peddle painkillers, tranquillizers, cough syrups, rheumatism medication and the host of other drugs they used to offer.However, the products are still being sold discreetly in markets in the Gabonese capital.Unlicensed medicinal drugs first started appearing on Libreville's streets about 20 years ago. The first tablets made in Nigeria appeared in corner shops, before they spread to Libreville's main markets, of Mont-Bouet and Nkembo, medical sources said.Most of the drugs now sold on the street are smuggled in from Benin, Cote d'Ivoire, Ghana, Nigeria and India. However, some legally imported ones have also found their way into the informal sector.http://www.mg.co.za/article/2004-12-19-street-drug-trade-flourishes-because-of-high-prices Best Regards Mohammad Bashaar From: Vijay <drvijaythawani@...>Subject: Re: OTC Drugs in India: Attn Allnetrum Date: Monday, September 15, 2008, 3:47 PM Hi,I am indeed proud that you guys are so good at networking that you started in absence of the moderator. Well the assigned moderator will take over, sooner or later. Till then we can continue. I will take this as an experiment if we can sail through without the moderator. Let us all give it a bold try.VijayGroupie> > From: Vijay drvijaythawani@ ...> Subject: Attn Yashashri : New discussion> netrumgroups (DOT) com> Date: Monday, September 15, 2008, 7:40 AM> > > > > > > Hi,> > The next topic on "Status of OTC medicines in India" was to be > moderated by Dr Yashashri Shetty from Bombay from today.> > Unfortunately she has not taken over NetRUM. This has never happened > with NetRUM in > 2years, in > 70 discussions , with > 20 moderators. > > Does any member have her telephone and will call her to remind?> > If we do not hear from her till eve, we will make some arrangement.> > Bear with us till then.> > Vijay> Groupie> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 Dear All, Thanks Dr Vijay for offering us to provide your valuable skills. Regarding OTC abuse and misuse although these terms are used interchangably but there is a thin line of demarcation in between them. A study on "societal perspectives on over the counter medicines" executed in 1000 consumers covering 10 sites in Northern Ireland covering both abuse and misuse aspects concluded remarkable awareness level in abuse potential of OTC medicines, thus highlighting pharmacist a probable actor to control the situation. Family Practice doi:10.1093/fampra/cmh723 Fam. Pract. 22:170-176, 2005. First published 14 Feb 2005; Mayyada Wazaify, Eileen Shields, Carmel M and C McElnay Societal perspectives on over-the-counter (OTC) medicines http://fampra.oxfordjournals.org/cgi/content/full/22/2/170 The full text of this article, along with updated information and services is available online at References http://fampra.oxfordjournals.org/cgi/content/full/22/2/170#BIBL This article cites 28 references, 6 of which can be accessed free at Reprints http://www.oxfordjournals.org/corporate_services/reprints.html Reprints of this article can be ordered at Email and RSS alerting http://fampra.oxfordjournals.org Sign up for email alerts, and subscribe to this journal’s RSS feeds at image downloads PowerPoint® Images from this journal can be downloaded with one click as a PowerPoint slide. Journal information http://fampra.oxfordjournals.org Additional information about Family Practice, including how to subscribe can be found at Published on behalf of http://www.wonca.org/ Oxford University Press Downloaded from http://fampra.oxfordjournals.org at Universiti Sains Malaysia on 18 September 2008 170 © The Author (2005). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@... doi:10.1093/fampra/cmh723 Family Practice Advance Access originally published online on 14 February 2005 Societal perspectives on over-the-counter (OTC) medicines Mayyada Wazaifya, Eileen Shieldsb, Carmel M b and C McElnayb Wazaify M, Shields E, CM and McElnay JC. Societal perspectives on over-the-counter (OTC) medicines. Family Practice 2005; 22: 170–176. Background. Over-the-counter (OTC) medicines are increasingly used for self-medication, but such products can be misused/abused. Objectives. The aim of this study was to investigate the general public’s opinion and perceptions of OTC medicines, including the misuse/abuse of such preparations. Methods. Data were collected using a survey administered to 1000 members of the public in 10 study sites in Northern Ireland, using a structured interview technique. The questionnaire was divided into four sections addressing: (a) attitudes towards community pharmacy and patients’ contact with pharmacies; ( attitudes towards the use of OTC medicines; © views on OTC medicines in terms of safety, potency and effectiveness; and (d) knowledge and opinion of abuse/misuse of OTC medicines. Data were coded and entered into a custom designed SPSS© database for statistical analysis. Results. The majority of participants (74.6%) visited a community pharmacy at least once per month. Almost one-third (32.2%) of participants reported buying OTC drugs at least once per month and the majority (86.4%) would always or often follow the directions on the product. The general public in Northern Ireland were highly aware of the abuse potential of some OTC drugs, with the majority naming painkillers as the products most liable for abuse. Almost one third of the participants reported having personally encountered cases of OTC abuse. Conclusions. This survey revealed that the general public had a high level of awareness of the abuse potential of OTC medicines. These findings indicate that pharmacists could be more proactive in the management of inappropriate OTC drug use. Keywords. Non-prescription medicines, over-the-counter drugs, public opinion, survey. pharmacists, increases access to medication and may contribute to reducing prescribed drug costs associated with publicly funded health programmes.3 However, increasing availability of non-prescription medicines may encourage patients to believe that there is a drug treatment for every ailment. Furthermore, the use of such products may delay/mask the diagnosis of serious illness,4 with increased risks of interactions and adverse reactions and of self-treatment being undertaken when medical aid should have been sought.5,6 There is also the potential for misuse and abuse of such products.7 The terms ‘misuse’ and ‘abuse’ are often used interchangeably, but they have precise meanings in this context. Misuse is defined as using an OTC product for a legitimate medical reason but in higher doses or for a longer period than recommended, e.g. taking more of a painkiller than recommended to treat headache. Abuse is the non-medical use of OTC drugs, e.g. to experience a ‘high’ or lose weight.7 There has been relatively little systematic research on the topic, partly due to the perception Received 30 June 2004; Accepted 27 September 2004. aDepartment of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan and bThe School of Pharmacy, The Queen’s University of Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK. Correspondence to Dr ; Email: C.@... Introduction In recent years there has been an increasing trend in selfmedication with non-prescription drugs [sometimes referred to as over-the-counter (OTC) medicines] available in pharmacies and in retail outlets. In parallel, more products have been deregulated for purchase without a prescription.1 The deregulation process has been championed by the pharmaceutical industry, the pharmacy profession and government health policy makers and is supported by the view that patients wish to have a greater role in their treatment choices.2 Self-medication also has advantages for healthcare systems as it facilitates better use of clinical skills of Societal perspectives on over-the-counter medicines 171 that misuse/abuse of OTC drugs is not as problematic as other types of drug abuse.8 Work in Australia9,10 and the UK on abuse and misuse focused mainly on the views of pharmacists7,11,12 and GPs13,14 and public opinion work on community pharmacy services have not investigated inappropriate use of OTC drugs.15,16 Therefore, this study sought to elicit the opinions of the public regarding OTC medicines generally and explore views around potential misuse and abuse. Methods This public opinion survey was administered using a structured interview technique. The target sample size was 1000. The questionnaire (available from the authors upon request) consisted of 34 questions (a mix of preformulated and free-text responses) and was piloted in a small sample of the general public (n = 20); these data were not included in the analysis. All interviews were conducted in shopping centres in Belfast or in provincial towns (10 study sites in total) which were representative of different geographical areas within Northern Ireland. The study took place between April and July 2002 (ten weeks), with one week being spent in each shopping centre. This ensured that interviewers visited each shopping centre on different weekdays (including weekends) thereby encountering a wide cross-section of the community. Members of the public who appeared to be over 16 years of age were randomly approached and asked to participate. Participants were informed that the questionnaire was about ‘non-prescription’ medicines and the researchers wore badges that identified them as researchers from Queen’s University Belfast. No reference was made to the School of Pharmacy during the interviews. The interviews (10–15 min duration) were conducted by two researchers (MW and ES) who had been trained with regard to interviewing skills and questionnaire administration. The questionnaire was divided into four sections: (a) attitudes towards community pharmacy and patient contact with pharmacies; ( attitudes towards the use of OTC medicines; © views on OTC medicines’ use in terms of safety, potency and effectiveness; and (d) an exploration of knowledge and opinion on the inappropriate use of OTC medicines. In these latter questions, the terms ‘abuse’ and ‘misuse’ were carefully explained to respondents (as defined in the Introduction). Demographic data for each respondent were collected to assist with data interpretation and analysis. The National Statistics Socio-Economic Classification (NS-SEC) was used to classify participants’ occupations.17 Responses were coded and entered into SPSS for Windows, version 11, for statistical analysis. Chi-square and Fisher exact tests were used to test for significant differences between groups (P 0.05). In a few cases, participants failed to answer every question, resulting in missing data. Missing data were not estimated or used in analyses. Results Demographics Of the 1000 members of the public interviewed, 417 were male (41.7%) and 583 were female (58.3%). The gender of the sample was shown to mirror closely that of the general population of Northern Ireland (48.7% males and 51.2% females).18 Almost half of all participants took regular prescription medicines (48.4%). More than half of the interviewees (55.4%) were exempt from prescription charges. The postcode districts were normally distributed throughout the sample. Patient contact with pharmacies Almost three-quarters of participants (74.6%) reported visiting the community pharmacy at least once per month. Females and those 60 years visited community pharmacies on a more regular basis then males or other age groups (P 0.001). Almost 700 (n = 679; 68.5%) reported always or often using the same pharmacy, with the main reason being to obtain a prescription medicine (54.4%). Only 11.3% of interviewees visited a pharmacy primarily to purchase non-prescription medicines. There was no difference in terms of gender with regard to non-prescription medicines’ purchase (P 0.05). Just over 60% (61.1%) reported that they would seek advice from a pharmacist rather than from a GP when the condition was not serious enough to visit the doctor. Just over one in every ten participants (11.3%) indicated that they would seek a pharmacist’s advice if they had no time to wait for a GP appointment. General attitudes towards the use of OTC medicines Almost one-third (32.2%) of participants reported buying non-prescription medicines as shown in Figure 1. Females (36.1%) and people 60 years of age (35.5%) bought OTC medicines on a more regular basis than males (26.5%, ÷2 = 10.457, df = 2, P 0.05) and people older than 60 years of age (20.5%, ÷2 = 19.724, df = 2, P 0.001). Most non-prescription medicine purchases were made from pharmacies (82.1%). Those who paid for their prescriptions bought OTC medicines on a more regular basis than those who were exempt (÷2 = 6.59, df = 1, P 0.05). The factor which most frequently influenced the choice of OTC medicines, was a recommendation by the pharmacist (27.3%). Figure 2 summarizes these findings. Table 1 indicates that more than 75% of the study sample (76.4%) reported that they would always stock painkillers at home, followed by vitamins and/or minerals (43.4%). medication. Less than 9% indicated that they would increase the dose while only 2.3% and 2.2% respectively would use the product more often or for a longer time than recommended. Males were more likely to increase the dose or use the product more often than recommended, while females were more likely to decrease the dose or stop using the OTC product if it did not work within the recommended period of time (÷2 = 18.07, df = 5, P 0.05). Respondents’ views on ten statements about OTC drugs in terms of safety, potency, effectiveness and liability for abuse or dependence are summarized in Table 2. Gender had little effect on responses to these statements apart from two cases; males were more likely than females to agree that ‘non-prescription medicines can sometimes mask serious health problems’ (÷2 = 11.26, df = 4, P 0.05) and that ‘some non-prescription medicines interfere with the natural healing process of the body’ (÷2 = 18.10, df = 4, P = 0.001). Younger people (53.7%) favoured further deregulation of prescription only medicines (POM) to OTC status compared to those over 60 (37.0%, ÷2 = 20.94, df = 4, P 0.001). Older people (60) were reluctant to use OTC medicines at the first sign of illness with 22.8% of them strongly disagreeing with this statement compared to 9.8% of the younger age group. Those older than 60 were more likely go to their GP than use OTC drugs compared to their younger counterparts. Knowledge and opinion on misuse and abuse of OTC medicines Following an explanation of the difference between the terms abuse and misuse, 84.8% (n = 848) of participants thought that non-prescription medicines could be abused. Almost 700 participants (n = 637) named at least one OTC product or category, 121 named two and 16 named 3 OTC products or categories (Table 3). The most frequent OTC medicine categories thought to be liable for abuse were painkillers (n = 501), sleep aids (n = 83) and cough mixtures (n = 81). Almost one in every three participants (33.1%; n = 242) identified specific products by name rather than category (e.g. cocodamol rather than painkillers). Interviewees were asked if they had encountered (based on personal experience, knowledge or observation) any cases of abuse or misuse of OTC medicines. Almost one third (n = 298) reported having personally encountered cases of OTC abuse (see Figure 3). Younger people had encountered significantly more cases (33.6% of those younger than 60, n = 261) of OTC abuse/ misuse than older people (16.5% of those older than 60, n = 37, ÷2 = 26.47, df = 1, P 0.001). There was a significant difference between reports made by males and females, with more females being aware of cases of laxative abuse to lose weight, while males described examples of mixing OTC medicines with alcohol (÷2 = 31.6, df = 7, P 0.001). Views on the safety, potency and effectiveness of OTC drugs From this sample, 74.5% reported that they always followed the directions on the OTC drug package, while 11.9% said they often followed the directions. Just under 7% of participants (6.6%) said they would sometimes follow these directions while 1.8% and 1.6% would rarely or never follow the directions respectively. Females and those 60 years old were more likely to follow the directions on the packet (÷2 = 10.38, df = 2, P 0.05, and ÷2 = 7.23, df = 2, P 0.05, respectively). When asked what action they would take if an OTC medicine did not work within the recommended period of time, 40.8% reported that they would stop and go to their GP. Almost a quarter (24.3%) said they would stop using the product and return to the pharmacy while 22.1% said they would decrease the dose or stop the 172 Family Practice—an international journal Weekly Monthly Less than monthly % of participants 80 60 40 20 0 Gender Female Male FIGURE 1 Frequency of purchase of OTC medicines by participants 0 5 10 15 20 25 30 Doctor Pharmacist Friend/Family Saw it advertised Used it before Other % of participants < or = 60 > 60 FIGURE 2 Factors which influenced the public’s choice of OTC medicines (subdivided by age: 60 years old or 60 years old) Societal perspectives on over-the-counter medicines 173 Those who thought there could be a problem of OTC medicines’ abuse (n = 848) were asked for their views on solutions. More than half (n = 501) either did not know how, or reported that something should be done but did not offer any suggestions. One in every eight respondents (12.5%, n = 106) said that nothing could be done or that it was difficult to control since people could move from pharmacy to pharmacy to obtain them. Eight per cent TABLE 1 Frequency of stocking common OTC medicines at home by participants OTC product Sample sizea Always % Sometimes % Seldom % Never % Painkillers 983 76.4 14.8 3.0 5.8 Vitamins and/or minerals 983 43.4 22.8 5.2 28.6 Indigestion/heart burn 983 33.6 16.0 9.0 41.4 Medicated skin care products 981 22.3 21.3 5.7 50.7 Cough remedies 983 21.4 36.3 14.7 27.6 Sore throat products 983 21.3 33.9 14.2 30.6 Hay fever products 983 16.2 8.9 5.6 69.3 Herbal remedies 981 12.9 20.7 7.5 58.9 Laxatives 983 11.4 9.9 9.0 69.7 Medicated eye care products 983 11.1 11.4 8.0 69.5 Medicated foot care products 983 10.3 15.1 10.4 64.2 Sleep aids 983 9.1 7.1 4.8 79.0 Antidiarrhoeals 982 8.2 11.5 11.1 69.2 Medicated ear care products 983 6.6 11.3 7.2 74.9 Haemorrhoids products 983 3.9 6.0 6.1 84.0 a Sample size is 983 because 17 people reported that they stored no OTC drugs at home. TABLE 2 Views of the public on the safety, potency and effectiveness of OTC drugs (n = 1000) Statement Strongly agree % Agree % Unsure % Disagree % Strongly disagree % More POM drugs should be deregulated 6.5 43.5 15.5 24.7 9.8 to OTC status I reach for OTC medicines at the first 1.8 25.9 5.9 53.7 12.7 sign of illness I use OTC medicines only if the illness is 4.1 53.1 9.2 25.7 7.9 quite severe Non-prescription medicines are totally 2.9 44.5 22.7 25.6 4.3 safe to use Non-prescription medicines can have 5.9 59.7 20.0 14.1 0.3 dangerous side-effects The effect of incorrect use of non-prescription 9.8 69.8 13.6 6.5 0.3 medicines can be as serious as that of prescription medicines Non-prescription medicines can sometimes 4.0 57.7 28.9 9.1 0.3 mask serious health problems Some non-prescription medicines interfere 4.1 50.5 31.9 13.3 0.2 with the natural healing process of the body With continual use, some non-prescription 9.2 74.0 12.0 4.7 0.1 medicines lose their effectiveness Some non-prescription medicines 14.7 65.2 10.8 9.0 0.3 may cause dependency or addiction if taken for a long period of time (n = 68) suggested reclassification of OTC medicines liable to abuse to POM status, while 7% (n = 59) suggested labelling of suspected products, together with education and raising public awareness. Some thought that the community pharmacist should have a greater role (n = 33) and should refuse any suspicious sale of these products. Nine people suggested that OTC sales should be recorded in pharmacies, with all OTC purchase information being stored on a ‘smart card’. Discussion Overall, this study revealed that three-quarter of participants in this survey were regular users of community pharmacy services for self-medication purposes and almost one-third reported having personally encountered OTC drug abuse. The percentage of participants who reported that they visited a pharmacy at least once per month represented a slight increase in frequency of pharmacy visits from that previously reported,15,16 thus emphasizing the accessibility and importance of community pharmacy within the UK’s National Health Service.19 There was also a rise in the number of people buying OTC medicines regularly (32.2%) from that previously reported15,16,20 which may reflect the public’s growing confidence in self-care.6,21 More than a quarter of those receiving regular prescriptions reported buying OTC medicines at least monthly. This may have implications in respect of safety. Interactions between prescribed medication and OTC products are well documented.22 A large nationally representative survey in the US revealed high levels of concurrent prescription and non-prescription drug use in respondents, leading to concerns about unintended interactions;23 this confirmed similar findings reported by Finnish researchers who utilized data from a populationbased interview survey on health care.24 Doctors and pharmacists must be aware of polypharmacy and any non-prescribed remedies that the patient may be taking.25 The main factor found to influence the public’s choice of OTC medicines was pharmacist recommendation. This is reassuring especially with increasing availability of potent medications without prescription and the increased potential for interactions.16,27 Almost 20% of respondents reported that their GP was likely to recommend an OTC product which represented an almost two-fold increase over a similar survey in 1992. This may reflect a more favourable attitude on the part of GPs to patient self-care.13,20 Sihvo et al.28 reported that Finnish GPs were moderately positive towards the availability of selected drugs on an over-the-counter basis, but were less supportive of products that had been recently deregulated. Research commissioned by the Proprietary Association of Great Britain (PAGB) in 1997 has revealed GP support for self-medication is growing, with 83% of the GPs stating that they would feel comfortable about referring patients to pharmacists.29 Just over 80.0% of participants reported always or often reading the instructions on the OTC drug package before they used the product, which is less than that reported previously during the Everyday Healthcare Study (96.0%).30 This decrease could be due to an 174 Family Practice—an international journal TABLE 3 OTC products reported by the public as liable for abusea OTC drug n OTC drug n OTC drug N Paracetamol 106 Benylin® 13 Pro-plus® 4 Paracodol® 37 Anadin® 8 Nytol® 3 Co-codamol 30 Kaolin & Morphine 7 Panadol® 2 Aspirin 27 Ibuprofen 6 Calpol® 1 Codeine 15 Vicks®-inhaler 6 Nurofen plus® 1 Solpadeine® 13 Night nurse® 5 Sudafed® 1 a The numbers in the table add up to 285 because some participants mentioned more than one product. 0% 5% 10% 15% 20% 25% 30% Addicted to an OTC Take too many for no reason Taking it for a "rush" Overdose on OTC Mixing OTC with alcohol To lose weight Other FIGURE 3 Cases of inappropriate OTC drug use reported by interviewees (n = 298) Societal perspectives on over-the-counter medicines 175 increase in people’s confidence over time in relation to self-treatment. It could also be due to people’s belief that only safe medicines are permitted to be sold without prescription and that OTC medicines do not usually have serious side-effects.6 Although detailed information may be found in a package insert of the OTC product, the package label is usually the primary source of this information.1 In the present study, only 3.4% of the participants said they would rarely or never read the information on the OTC drug package. This proportion is small; however, when including those who reported reading the instructions ‘sometimes’, one in every ten people (10%) would be at risk of misusing OTC medicines. In a previous study, reading the enclosed instructions was confined to using a product that had not been used before, if a side-effect was experienced or if the medication was for a child.6 The main reason for not reading it was having read it on a previous occasion. Some criticism has been reported regarding the poor design of leaflets e.g. small font size, non-specific information, long lists of side-effects and confusing dosing instructions for children.4 In 1999, The Food and Drug Administration (FDA) issued a regulation regarding new standardized easy-to-understand labels for OTC products that all such products in the USA will be required to adopt by 2005.31 Moreover, a number of respondents were at risk of misusing OTC medicines. Males were found to be at higher risk of misuse than females as they were more likely than females to increase the dose or use the OTC product more often than recommended. This research revealed that almost 85.0% were aware of the abuse potential of OTC medicines, with painkillers, sleeping aids, cough mixtures and laxatives being the main categories reported. This supports the findings from a community pharmacy survey in Northern Ireland in which pharmacists identified opioid-containing products, antihistamines and laxatives as being prone to abuse.7 However, there were some differences as pharmacists had identified kaolin and morphine as being associated with abuse and misuse,7 while the public specifically identified paracetamol. This may be due to differences in the personal experience and perspective of pharmacists and the general public. Although the terms misuse and abuse were explained to respondents, some confusion may have occurred in the meaning of the two terms. We acknowledge that this is a drawback of this study. However, health care professionals have also demonstrated confusion between the two terms.7 Furthermore, some of the cases cited by the respondents (see below) in this present study indicated that they clearly understood and had encountered cases of OTC abuse and these reflected what had been previously reported in the literature. Almost one-third of participants reported encountering cases of inappropriate OTC drug use that they had classified as abuse. Some participants reported cases of mixing OTC products with alcohol. Wills (1997) described the use of soluble aspirin tablets along with fizzy cola drinks or beer in order to produce a ‘high’,32 despite the lack of pharmacological evidence. The use of laxatives to lose weight especially by young women with eating disorders has been often cited.33 One participant in this study reported witnessing separation of codeine from OTC analgesics using coffee filters in an attempt to avoid toxicity of other ingredients of the product of abuse. This method has been reported previously documented.26,27 Such cases clearly represent abuse. Record-keeping could be a method of restricting access to some OTC drugs. In this case, individuals would have to register with a certain community pharmacy and all purchases of restricted OTC drugs would be recorded. Using this method, pharmacists could control the quantities of OTC drugs that people could purchase and prevent ‘hopping’ from one pharmacy to another. This could be supported by technology in the form of smart cards in which all patients’ data related to OTC purchase could be stored confidentially and only pharmacists would have access to such information.36 However, and Rees37 have found that a minority of the community pharmacists in the UK use patient medication record (PMR) systems to store information relating to OTC sales. This approach may require further investigation. The challenge in controlling the problem of OTC misuse and abuse is to achieve the necessary high level of consumer safety for the few at risk, while not restricting access to OTC products for those who continue to use them safely. It is recommended that by monitoring usage of certain OTC products, in addition to data recording and education, safe and effective use of such medicines can be promoted. Acknowledgements The authors would like to thank the management authorities of each of the ten shopping centres for their co-operation during this study. Declaration Funding: the study was funded under a PhD studentship provided by the University of Jordan to Mayyada Wazaify. Ethical approval: at the time of this study, ethical approval was not required for this study. Conflicts of interest: none. References 1 Bond C. POM To P—Implications for Practice Pharmacists. Prim Care Pharm 2001; 2: 5–7. 2 Bradley C, Blenkinsopp A. The future for self-medication. Br Med J 1996; 312: 835–837. 3 CM, McElnay JC, Fleming GF. Benefits and risks of self medication. Drug Safety 2001; 24: 1027–1037. 4 C. Monitoring self-medication. Expert Opin Drug Saf 2003; 2: 1–5. 5 Bradley CP, Bond C. Increasing the number of drugs available over the counter: arguments for and against. Br J Gen Pract 1996; 46: 121–122. 6 L, Whittlesea C, Luscombe D. Patients’ knowledge and perceptions of the side-effects of OTC medication. J Clin Pharm Ther 2002; 27: 243–248. 7 GF, McElnay JC, CM, McKenna P. Abuse/misuse of non-prescription drugs. 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