Over the counter drugs can be highly addictive
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39199.472326.3A (Published 03 May 2007) Cite this as: BMJ 2007;334:917All rapid responses
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Ford and Good's have highlighted the problem of OTC drug misuse and
dependence which is greatly welcomed. Managing this problem has always
been an integral part of community pharmacy practice. From Codeine
linctus to Nytol to newer codeine combinations, there are always products
available over the counter that require careful monitoring. Pharmacists
control OTC drug misuse in a stepwise manner starting with more specifi
questioning to keeping the product behind the counter or out of view to no
longer stocking it.
There has in fact been a fair bit of research in this field. The
author's limited medline search will not have found this because they did
not look at the relevant pharmacy literature. I suggest anyone wanting to
explore this topic further should contact appropriate experienced pharmacy
practice researchers in this field and the Royal Pharmaceutical Society of
Great Britain would be a useful staring point for those not familiar with
this area.
Competing interests:
None declared
Competing interests: No competing interests
We share the concern Drs Good and Ford’s raise about addiction and
usage of over-the-counter (OTC) drugs. While Good and Ford point towards
an alarming phenomenon, addiction to OTC drugs represents only a small
part of a larger problem. Despite being one of the most regulated drugs in
the US, for example, OTC pain relievers have long been associated with
serious side-effects, ranging from gastrointestinal problems, acute liver
failure and even death.1 Yet, many Americans perceive and treat OTC pain
relievers as harmless products them (we are aware of no similar UK base
study), which lead the FDA to voice concern and to issue new and stricter
labeling guidelines in order to battle consumers’ misuse of OTCs.
As the FDA recognized, how individuals perceive the risks associated
with OTC pain relievers, could translate into different consumption
behaviors. Indeed, in a recent study,2 we studied American and German
students’ knowledge and perceptions involved in the decision to buy and
consume OTC Pain relievers. Our findings suggest that American not only
consume more OTC pain relievers, but that they posses less knowledge about
the risks associated with these drugs. One possible reason for our results
rests with the fact that in Germany OTC Pain relievers are sold only in
pharmacies after talking to a pharmacist. Thus, one way to increase
consumers’ awareness of the dangers associated with OTC pain relievers
could be to change their status to match that of simvastatin—they would
still be sold over the counter, yet with a pharmacists’ supervision. Other
recommendations,3 such as providing better training for pharmacy stuff
restriction of quantity sold per costumer, should also be considered.
1. Hanoch Y, Gummerum M, Katsikopoulos KV. American and German
Students’ Knowledge, Perceptions, and Behaviors with Respect to Over-the-
Counter Pain Relievers. Health Psychology In press.
2. Lee, W M. Acetaminophen and the U.S. acute liver failure study group:
Lowering the risks of hepatic failure. Hepatology 2004; 40(1): 6-9.
3. McBride AJ, Pates R, Ramadan R, McGowan C. Delphi survey of experts’
opinions on strategies used by community pharmacists to reduce over-the-
counter drug misuse. Addiction 2003; 98: 487-497.
Competing interests:
None declared
Competing interests: No competing interests
Drs Ford and Good's article is both timely and helpful.
I am aware from current enquiries that problems with otc drugs are
increasing, however I suggest that there is a considerable difference
between what is referred to as both dependency and addiction in this
article.
Dependency on any drug, prescribed, or otherwise is inevitable since
many of those on prescribed drugs for conditions such as blood pressure,
heart problems, etc; are dependent on their medication for maintaining a
reasonable way of life; whether or not increased, stronger, or more
frequent doses are required to maintain the status quo does not
necessarily mean that the patient has become addicted since neither
quantity or frequency of use forms part of the criteria for addiction.
The sum of addiction is when the pursuit and consumption of the
drug(s) of choice has become a priority in a persons life, rather than a
dependency for the relief of pain, or an efforless altered state of
consciousness. There are of course other factors that need to be present
for the condition of addiction to be be met.
None of the foregoing is intended to be either an exercise in
semantics, or a criticism of the authors. It does however highlight the
riduculous use of the word dependency to describe the far more serious
condition of addiction, and at the same time detract from the seriousness
of the latter.
The use of the word dependency,despite being hoplessly and clincially
inaccurate to describe addiction, was substituted for the sake of
political correctness in the belief that it was less pejorative. Alas! it
has only served to spread confusion and to shield addicts from the reality
of their condition, thus delaying their entering into recovery.
Competing interests:
None declared
Competing interests: No competing interests
Open letter to Dr Chris Ford & Dr Beth Good
Open letter to Dr Chris Ford & Dr Beth Good
re: BMJ Letter
I read with interest your letter that appeared in the British Medical
Journal.
Codeinefree.me.uk wholeheartedly agree that more research needs to be
done into the area of Over The Counter Addictions. We also believe that
awareness of the problem needs to be highlighted. This awareness needs to
extend to the medical and pharmaceutical professions as well as to the
consumers of OTC products. We do however have reservations as to how this
research could be carried out as, due to the nature of this addiction, it
is often referred to as "The Silent Addiction" with sufferers feeling
isolated not knowing where to go for assistance.
We are more than willing to assist with research into this addiction.
Mark Edwards
Administrator
www.codeinefree.me.uk
Competing interests:
None declared
Competing interests: No competing interests