An investigation into the problematic use of OTC medicines among pharmacy customers in Saudi Arabia: a mixed-methods study

Algarni, Mohammad ORCID: 0000-0002-5767-4036 (2023). An investigation into the problematic use of OTC medicines among pharmacy customers in Saudi Arabia: a mixed-methods study. University of Birmingham. Ph.D.

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Abstract

Background

Over the counter (OTC) medicines may be misused, abused, and could develop dependency. Pharmacists are often first point of contact for consumers seeking OTC medicines. They are well-positioned to identify and manage problematic use associated with OTC medicines.

Aim

This thesis aims to determine the prevalence of OTC medicines misuse, abuse, and dependence among pharmacy customers, identify reasons and contributing factors, and examine community pharmacists' practice in identifying and managing OTC medicines misuse and abuse in Saudi Arabia.

Method

A pragmatic, mixed-methods sequential exploratory study was conducted. First, a cross-sectional survey was conducted among pharmacy customers aged 18 and older to establish the prevalence of misuse, abuse, and dependence on OTC medicines. Then, semi-structured interviews were conducted with a convenient sample of chain pharmacy-based pharmacists in AL-Baha region, Saudi Arabia. The interviews aimed to explore the views and experiences of community pharmacists towards OTC medicines misuse and abuse, particularly to identify OTC medicines commonly misused and abused, reasons and contributing factors, pharmacists' roles in identification and management, and barriers to pharmacists' interventions. In addition, to report potential strategies to reduce the risks of OTC medicine misuse and abuse and improve pharmacists’ current practice to ensure the safe and effective use of OTC medicines. After that, a web-based survey was developed based on these findings to examine community pharmacists' perspectives on a national level.

Results

A response rate of 42.4% (306/723) was achieved for the pharmacy customers' survey. The lifetime prevalence was 26.2% for OTC medicines misuse, 8.3% for abuse and 8.9% for dependence. Individuals’ age, employment, and smoking status significantly predict misuse and abuse. The existence of a long-standing illness demanding constant use of OTC medicines was a predictor for dependence. Non-codeine-containing analgesics, sedative antihistamine products, codeine-containing analgesics, and dextromethorphan-based cough remedies were the most commonly implicated in the misuse, abuse and dependence. The interviews with the community pharmacists generated five main themes, including commonly misused and abused OTC medicines, reasons and contributing factors to misuse and abuse, interventions to address misuse and abuse, barriers to pharmacists’ interventions, and potential strategies to reduce OTC medicines misuse and abuse and improve pharmacist practice. In the pharmacists’ national survey, a response rate of 15.6% (502/3215) was achieved. The number of misuse and/or abuse cases encountered by pharmacists ranged from 5 to 100 per week. Pharmacists' gender, years of work experience, and pharmacy location significantly affected the number of encountered cases. The most commonly perceived reasons for misuse and abuse were using OTC medicines as alternatives to abused prescription-only medicines (80%, n=397) and treating long-lasting medical conditions (73.3%, n=368). Pharmacists frequently identified misuse and abuse by questioning customers using the pharmacy mnemonics (61%, n=306). The everyday actions taken by pharmacists to address misuse and abuse were advising customers on the appropriate use of medication (78%), offering safe alternative products (65%) and alerting fellow pharmacists about misuse and abuse incidents (62%). Pharmacists identified detecting misuse and abuse in new customers (74.5%), obtaining medicines from another pharmacy (65.7%), customers' ability to circumvent (65.7%), and online purchase of OTC medicines (65.5%) as common barriers limiting their interventions in misuse and abuse. Reclassifying medicines with abuse potential was the top suggested strategy by pharmacists (77%) to minimise OTC medicine misuse and abuse.

Conclusion

Awareness about the potential of OTC medications for misuse, abuse, and dependence should be enhanced among medication users and healthcare professionals. Pharmacists' counselling should be actively provided to consumers requiring OTC medicines, particularly those at greater risk of misuse and abuse. To reduce the risks of OTC medicine misuse and abuse, a multifaceted strategy that includes upskilling community pharmacists, reviewing OTC medicine sales legislation, and increasing public awareness is required.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):