(OTC)

Drug
Misuse

TAHSEEN SHAMSHAD
ROLL NO.26
HEALTH SERVICES ACADEMY
What are the over
the counter drugs?
Over-the-counter (OTC) drugs are
non prescription drugs sold in ;
 convenience stores,
 grocery stores and
 health shops.
They range from pain relievers,
cough and cold remedies to
sleeping aids, weight reducing
aids, and vitamin supplements.
 a v a ila b ilty o f O T C m e d ic in e s

O T C d ru g s to re ,
s u p e r m a rk e ts e tc
5% 0%

O T C p h a r m a c pi er es s c r i p t i o n
39% 46%

O T C p r e s c rib e d
10%
OTC drugs ,
emerging threat of
drug misuse
The biggest threat now comes from the
mounting misuse of pharmaceutical
agents like
■ Buprenorphine
■ diazepam,
■ antihistamines, and
■ cough syrups containing codeine, and its
synthetic derivatives like
dextromethorphan.
Commonly abused
OTC drugs
OTC medicines commonly used by teenagers
are:
◆ Caffeine stimulants.
◆ Antihistamines containing dyphenhydramine
◆ Decongestants containing pseudoephedrine
◆ Weight loss supplements containing ephedra
◆ Sleep aids containing doxylamine.
◆ Motion sickness treatments with dimenhydrinates.
◆ Cough syrups containing codeine derivatives like
dextromethorphan.
Cough syrups, the
major source of OTC
drug abuse in teen
agers
■ Teens are drawn to an ingredient
containing in half of the cold and
cough remedies called
dextromethorphan
■ At excessive dose can produce
high or psychoactive effects.
What is
dextromethorph
an
■ DXM is a synthetically produced
substance that is chemically related to
codeine,
■ DXM is an ingredient in more than 140
over-the-counter cough and cold
remedies
■ since 1950s gradually replaced codeine
as the most widely used cough
suppressant in the United States.
■ available in capsule, liquid, liquid gelatin
capsule, lozenge, and tablet forms.
Legislation
enforcement
■ DXM could be added to the Controlled
Substances Act if warranted.
■ In 2003 legislation was introduced in
Texas and North Dakota to prohibit the
sale of DXM to minors. The proposed
legislation did not pass in either state.
■ A similar bill introduced in California in
2008 was also defeated.
 Calls Involving Abuse or Misuse of
DXM to Poison Control Centers

Year Teenagers All Other Age Groups

2000 1,623 900

2001 2,276 1,107

2002 2,881 1,139

2003 3,271 1,111

Cough medications with DXM
may contain other active
ingredients.
Source: American Association of Poison Control Centers.
Abuse of DXT in
USA
■ Most typically abused OTC-drug
■ Abuse of DXM by American
teenagers 2005: 2,4 million
teenagers
■ 1 in 10 American teens has
abused OTC medications
■ Estimated purchasing costs of
DXM by teenagers:
$84 million dollars / year
Predisposing
factors
Factors perceived by respondents as predisposing to drug usage
among students
PREDISPOSING FACTOR FREQUENCY (%)

FRIENDS USING DRUGS 166 (90)

TOBACCO SMOKING 139 (76)

FAMILY USING DRUGS 136 (74)

CERTAIN SOCIAL GATHERINGS 128 (70)

LIVING AWAY FROM HOME 114 (62)

MALE GENDER 98 (53)

LOW SELF-ESTEEM 93 (51)

INADEQUATE RECREATIONAL FACILITIES 91 (50)

Shafiq et al. Substance Abuse Treatment, Prevention, and Policy 2006 1:31
doi:10.1186/1747-597X-1-31
Social
determinant of
drug abuse
 Stress
 Parent child relation ship
 Gender, race and class
 the social, economic and cultural
characteristics of a society
 societal systems and institutions
 Social alienation and social support
 social cohesion and social exclusion
Figure 5.2 Past Year Initiates for
Specific Illicit Drugs among
Persons Aged 12 or Older: 2008
Global
magnitude
■ In 2006, about 3.1 million persons aged 12 to 25
(5.3 percent) had ever used an over-the-counter (OTC)
cough and cold medication to get high (i.e., "misused"
the drug), and nearly 1 million (1.7 percent) had done
so in the past year
■ Among youths aged 12 to 17, females were more likely
than males to have misused OTC cough and cold
medications in the past year, but among young adults
aged 18 to 25, males were more likely than females to
have misused these medications
■ Among persons aged 12 to 25 who had misused an
OTC cough and cold medication in the past year,
30.5 percent misused a NyQuil® product, 18.1 percent
misused a Coricidin® product, and 17.8 percent
misused a Robitussin® product.[4]
Magnitude in
pakistan
■ National data on self-medication
as well as OTC drug abuse are not
available in Pakistan, but local
studies reveal that this may vary
between 6.3% and 51.3%
depending on the setting
 Emergency department
visits involving
dextromethorphan
■ an estimated 12,584 emergency department visits (0.7% of all
drug related emergency department visits) involved
pharmaceuticals containing dextromethorphan.
■ for those aged 12 to 20 was 7.1 visits per 100,000 population
compared with 2.6 visits or fewer per 100,000 for other age groups.
■ patients aged 12 to 20 accounted for almost half (48%) of all the
emergency department visits resulting from nonmedical use of
dextromethorphan.
■ visits resulting from any type of use of dextromethorphan among
those aged 12 to 20 was 10.3 per 100,000 population compared
with 4.3 visits per 100,000 for the population overall.
■ Alcohol was implicated in about a third (36%) of the DAWN
emergency department visits involving nonmedical use of
dextromethorphan for those aged 18 to 20 and in 13% of visits for
those aged 12 to 17.

SAMHSA's Drug Abuse Warning Network (DAWN) for 2004,

Administrative and
regulatory bodies
■ Pharmacy act 1967
■ Pharmacy act 1976
■ National drug policy
■ Control of narcotic drug substance
Rational drug use
by national drug
policy
◆ Drug information bulletin published on regular
basis.
◆ Ethical Criteria for Medical Drug Promotion to
allow sales promotion only through the health
institutions though a well defined system
◆ National Formulary shall be published in a
new context so as to serve as reliable
prescribing to all doctors and pharmacists of
the country and as an effective teaching aid.
◆ Establishment of computerized drug
information and poison centre to undertake
postmarketing surveillance studies of newly
registered drugs.
Weaknesses of
national drug
policy.
■ prescription based dispensing has
never been implemented and
enforced by law in the country
■ There is no legislation for those,
who dispense with out prescription
■ There is no ADR monitoring and
reporting system/centers in action
Aim
Reduction in abuse of OTC drugs in Pakistan.

Objectives
■ To increase awareness of adverse drug
reaction in 100% parents and families in
Pakistran.
■ To improve dispensing practices of OTC
drugs in 90% of pharmacies within three
years in Pakistan.
Interventions/preve
ntion strategies
■ 1-development and strengthening of drug control
organizations at district level
■ 2-to ensure computerized drug sales information
system at retail and hospital pharmacies with record of
patients, their prescription as well as over the counter
drugs .this system provide accurate information on
current trends of drugs prone to induce addiction.
■ 4- to establish ADR monitoring centers and ensure the
proper reporting system of any over the counter drug
abuse case at district level and promote their existence
though mass media campaigns
■ 5- Promoting Health education to, technical sale staff
at pharmacies, parents and teachers through
seminars, workshops and media. And promoting the
importance of communication between parents and
children through group discussion using school level
events, electronic media and community based events.
BARRIERS AND CHALLENGES
TO PREVENT DRUG ABUSE

■ Easy access OTC drugs.

■ The societal attitude toward OTc drugs
■ OTC drug problems seem to be related to
current (medical) standards and prevailing
practices.
■ insufficient policies, regulations and legislation
pertaining to none prescription drugs.
■ Lack of parental knowledge, involvement and
action regarding OTC drug abuse.
■ Inadequate legislation or lobbying regarding OTC
drug abuse
■ Poor/inadequate media participation .
A Future challenges:
improvement of existing
systems
■ Are existing systems exhausted?

◆ Likely improvement of spontaneous reporting by medical

doctors can enable more early signal detection

■ Can patients and pharmacists reporting improve patients safety?

◆ Initiatives of creating data bases of patient reports

◆ Pharmacists based reporting

■ Regulatory guidance in which cases new/alternative methods

have to be imposed
A Future challenges:
improvement of information,
education and communication
■ Improvement of information

 In many parts of the World information is either not

readily available or of poor quality
✦ In some countries still only OTC drugs have PIL although
both POM and OTC are delivered without prescription
■ Education

 Can education of consumers/patients improve drug

safety?
■ Communication

 Health professionals
 Patients
 Media
Prioritized Areas
1. Creating awareness among
parents and schoolteachers
2. creating awareness in children
about common OTC drugs used
at home and their good and bad
effects
3. improving knowledge of non
technical sales persons about
OTC drugs and safe dispensing
practices
MONITORING
■ Monitoring of the sessions conducted by Health
Officials, in Schools.
■ assurance of syllabus about basic knowledge of
drugs by school boards
■ Quality of material presented in schools,
checking quality of the material.
■ Monitoring the implementation of knowledge of
non technical sale staff
EVALUATION
■ No. of cases of OTC abuse detected at
pharmacies
■ proportion of teen agers having basic knowledge
of drugs
■ No. of training sessions conducted
■ No. of sessions for parents and school teachers