In a British Medical Association (BMA) report launched today (14 June 2005) doctors are calling for education programmes for health professionals and patients about available over-the-counter (OTC) medicines.
Over-the-counter medication, is being launched by the BMA’s Board of Science and is aimed at health professionals and policy makers.
The self-management of medical conditions and long-term self-treatment to prevent ill health is likely to be more extensive in the future. It is essential, therefore, says the report that patients and doctors understand both the benefits and risks of OTC medicines. OTC medication enables people to take responsibility for their own health and reduces their need to see doctors about minor conditions.
Increased switching from prescription only medicines (POM) to pharmacy medicines (P) has meant that the public can self treat more conditions than ever before but highlights the key role of pharmacists as well as the need for education.
Risks as well as benefits can be associated with OTC medicines and the new BMA report says the public needs to be made aware of this. There can be potentially dangerous consequences from combining OTC medicines and some prescription only drugs. The herbal drug, St John’s Wort has adverse effects on some commonly prescribed medicines, for example, blood thinning drugs like warfarin, the contraceptive Pill, and some anti-depressants. Pharmacists can advise on this.
Eight out of 10 people use OTC drugs for a headache and the report says that this is the most common ailment for which people treat themselves rather than consult a doctor1. This is generally a sensible use of resources, but there can be problems associated with the over-use of painkillers. For example, some people who use these pain killers long term for daily headaches, can become dependent on them. Although such cases are not common, patients and health professionals need to work together to identify them and provide support.
Dr Vivienne Nathanson, the BMA’s Head of Science and Ethics, made the following comment:
“It is extremely important that the public realise that just because medicines are available over-the-counter does not mean that they are risk-free. Educational programmes and improved labelling will help people understand how to make the best use of over-the-counters medicines and take control of their illness.”
“It is also important for doctors, especially GPs, to know if their patients are regularly taking any over-the-counter drugs. Doctors and pharmacists need to be aware that there are a minority of people who are at risk of misusing and becoming addicted to some OTC medicines. Improved record keeping will help to identify this group.”
There has been limited research on addiction to OTC medicines but there is some evidence that a problem does exist. Research in Scotland found that over two thirds of community pharmacists reported having suspicions of the misuse of OTC medicines, particularly in urban areas. The four main areas were: antihistamines, opiates, mild stimulants and laxatives.
Key recommendations from the report are as follows:
- As more potent medicines move from pharmacy to general sales research is needed to assess the effects on public health.
- Healthcare providers need to know about available OTC medicines and their licensed indications and doses. Education programmes during basic training and as part of continued professional development are needed.
- Educational courses on self-management of common illnesses for children and adults should be considered.
- Education about self-care could support parents from the birth of their first child, to develop knowledge and confidence about when to seek advice.
- A general leaflet, available from pharmacies, could describe trends in OTC availability, point out advantages and drawbacks and encourage patient reporting of adverse reactions.
- Formal user testing of both patient information leaflets and package labelling should be a requirement for any medicine switches from prescription only to pharmacy sales, or from pharmacy to general sales.
- Healthcare providers and medicine users need to discuss the extent to which formal record keeping for OTC medicines should be implemented. There is a balance to be struck between patient autonomy and safety.
- Including OTC treatment in the NHS core electronic patient record could make an important contribution to improving patient safety.