A report of a study investigating over the counter medicine (OTC) abuse published by the Pharmacy Practice Research Trust provides evidence that there is a group of individuals experiencing a range of problems often with codeine-based medicines purchased from pharmacies, and for whom help and support varied.
Respectable addiction - a qualitative study of over the counter medicine abuse in the UK was undertaken by Dr Richard Cooper, Lecturer in Public Health, School of Health and Related Research, University of Sheffield. The study, funded by the Pharmacy Practice Research Trust through its Research Awards programme, aimed to describe and understand current issues relating to OTC medicine addiction through investigating the experiences of individuals affected by medicine abuse in the UK, pharmacists and medicines counter assistants (MCAs) and key stakeholders.
Individuals in the qualitative study all described the use of an opiate - usually codeine - containing medicine with some other medicines being implicated and most had begun using OTC medicines for genuine medical reasons. Three types of abuse were identified based on quantity of medicine taken, ranging from never exceeding the maximum recommended dose, to taking significantly higher doses than recommended. All described withdrawal symptoms and using the medicine for different reasons than clinical indicated and all had attempted to stop. Sources of help or advice ranged from internet support groups, to medical treatment, but none sought pharmacy advice and an over-riding concern was of the need to hide their addiction. However, the author found that individuals blamed themselves more than pharmacists, regulation, manufacturers or doctors for their OTC medicine addiction. Individuals were termed 'respectable addicts' based on their own recognition of, and use of the word addiction, and their desire to present themselves as being normal and very different from their perception of illicit drug misusers.
Stakeholder perceptions and experience identified codeine as a key problem, but supported the continued availability of OTC medicines of potential abuse, to enable the public to manage their own symptoms, as long as risks were known. Concerns were also raised in relation to the current lack of treatment and support options and the availability of medicines via the internet represented an increasing safety concern.
Pharmacists and MCAs referred to abuse rather than addiction and used frequency of purchases to define who might be abusing a medicine, reflecting a monitoring and surveillance approach. Whilst pharmacists identified a wider range of medicines being abused, they were often not aware of how and where to refer the individuals. Lack of relevant medical information relating to customers and their use of different pharmacies were identified as concerns.
Dr Cooper identified a number of tensions that emerged from the study:
- Protecting individuals from the potential harms of medicines whilst ensuring they remain accessible to the public
- Recognising that OTC medicines are often considered less harmful than prescription medicines but are still capable of causing addiction
- Providing addiction services to a 'hidden' and secretive group of individuals who perceive themselves to be respectable and professional and different from others
He concludes: "Raising awareness of OTC medication addiction and improving treatment and support options are key to managing these and other issues discussed in the study."
Beth Allen, PPRT Director commented: "OTC medicines abuse and addiction is a much under researched subject. This study represents an important contribution to the evidence base of an issue of great importance and concern to the pharmacy profession."