Publish date: Feb 2015
Over-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:
- Direct harms related to the pharmacological or psychological effects of the drug, e.g. dependence to codeine.
- 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.
- 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.
Niamh Fingleton, University of Aberdeen
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.
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.