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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>

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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

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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; (B) 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; (B) 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. Pharm World Sci 1999; 21: 251–255.

8 Akram G. Over-the-counter medication: an emerging and neglected

drug abuse? J Substance Use 2000; 5: 136–142.

9 Ye M, Benrimoj SJ, KA. Inappropriate use of

nonprescription drugs for primary dysmenorrhoea. Aust J

Pharm 1999; 80: 1286.

10 De-Almeida-Neto AC, Benrimoj SJ, Gomel M, Fois R.

Inappropriate self-medication practices: pharmacy-based

intervention. J Soc Admin Pharm 1996; 13: 131–138.

11 Paxton R, Chapple P. Misuse of over-the-counter medicines: a

survey in one English County. Pharm J 1996; 256: 313–315.

12 MacFadyen L, Eadie D, McGowan T. Community pharmacists’

experience of over-the-counter medicine misuse in Scotland.

J R Soc Prom Health 2001; 121: 185–192.

13 Erwin J, Britten N, R. General practitioners’ views on over the

counter sales by community pharmacists. Br Med J 1996; 312:

617–618.

14 GF, Bell HM, McElnay JC. General practitioners’

awareness of the appropriate and inappropriate use of overthe-

counter products. Pharm J 1999; 263: R29.

15 McElnay JC, Nicholl AJ, Grainger-Rousseau TJ. The role of the

community pharmacist-a survey of public opinion in Northern

Ireland. Int J Pharm Pract 1993; 2: 95–100.

16 Bell H, McElnay J, C. Societal perspectives on the

role of the community pharmacist and community-based

pharmaceutical services. J Soc Adm Pharm 2000; 17: 119–128.

17 The National Statistics Socio-economic Classification (NS-SEC).

Available from URL: http://www.hewett.norfolk.sch.uk/

curric/soc/class/NS.htm (Accessed on 4 Nov 2003).

18 Northern Ireland statistics and Research Agency (NISRA). Key

Statistics 2001. Available from URL: http://www.nisra.gov.uk/

statistics/keystatistics.html (Accessed on 30 Sep 2001).

19 Hassell K, Noyce PR, A, J, Wilkinson J. A pathway to

the GP: the pharmaceutical ‘consultation’ as a first port of call

in primary health care. Fam Pract 1997; 14: 251–255.

20 Bradley CP, Riaz A, Tobias RS, Kenkre JE, Dassu DY. Patient

attitudes to over-the-counter drugs and possible professional

responses to self-medication. Fam Pract 1998; 15: 44–50.

21 Bissell P, Ward PR, Noyce PR. Mapping the contours of risk:

consumer perceptions of non-prescription medicines. J Soc

Adm Pharm 2000; 17: 136–142.

22 Proprietary Association of Great Britain. OTC directory for the

pharmacy 2002/2003: Treatments for common ailments.

London: Proprietary Association of Great Britain; 2002.

23 Kaufman DW, JP, Rosenberg L, TE, AA.

Recent patterns of medication use in the ambulatory adult

population of the United States: the Slone survey. J Am Med

Assoc 2002; 287: 337–344.

24 Sihvo S, Klaukka T, Martikainen J, Hemminki E. Frequency of

daily over-the-counter drug use and potential clinically

significant over-the-counter prescription drug interactions in

the Finnish adult population. Eur J Clin Pharmacol 2000;

56: 495–499.

25 Honig PK, Cantilena LR. Polypharmacy. Clin Pharmacokinet 1994;

26: 85–90.

26 Al-Samman M, JA, Zuckerman MJ, Dudrey EF,

MoldesO. Hepatic iron overload associated with self-medication.

South Med J 1995; 88: 654–656.

27 Honig PK, Gillespie BK. Drug interactions between prescribed and

over-the-counter medication. Drug Saf 1995; 13: 296–303.

28 Sihvo S, Hemminki E, Ahonen R. Physicians’ attitudes toward

reclassifying drugs as over-the-counter. Med Care 1999; 37:

518–525.

29 British Market Research Bureau (BMRB). Everyday healthcare

study: a consumer study of self-medication in Great Britain.

London: Proprietary Association of Great Britain; 1997.

30 British Market Research Bureau (BMRB). Everyday healthcare

study: a consumer study of self-medication in Great Britain.

London: Proprietary Association of Great Britain; 1987.

31 Nightingale SL. New easy-to-understand labels for OTC drugs.

J Am Med Assoc 1999; 281: 113.

32 Wills S. Over-the-Counter products. In Wills S (ed.). Drugs of

Abuse. London: The Pharmaceutical Press; 1997: 131–143.

33 Vanin JR, Saylor KE. Laxative abuse: a hazardous habit for weight

control. Coll Health 1989; 37: 227–230.

34 Jensen S, Hansen AC. Abuse of codeine separated from overthe-

counter drugs containing acetylsalicylic acid and codeine.

Int J Leg Med 1993; 105: 279–281.

35 Nathwani BD. Abuse potential of Nurofen plus. Pharm J 1998; 261:

489.

36 Sanz F, Silveira C, C, Alonso A, Loza M, Cordero L et al.

Information Technology in community pharmacies for

supporting responsible self-medication. Am J Health Syst

Pharm 2000; 57: 1601–1603.

37 PJ, Rees JE. Comparison of the use of PMRs in community

pharmacy in 1991 and 1995: (1) PMR use and recording of

product details. Pharm J 1996; 256: 161–166.

176 Family Practice—an international journal

Shazia Jamshed

USM

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