Drug addiction and dependence is a widely recognized problem throughout the world. Use of over-the-counter (OTC) drugs is rarely addressed, but can still present a major public health concern. This is particularly true of the use of drugs that have addictive properties.
OTC drugs fall into a variety of categories. The ones that have the highest likelihood of posing a dependency or abuse problem are those that must be acquired directly from a pharmacist. Although these medications do not require a prescription, they have properties that can lead to addiction. The research on rates of dependency, addiction, and abuse on these types of OTC medications is scarce.
Because the potential for abuse is very high and these drugs are legal, affordable, and easily accessible, it is imperative that prevalence be determined so that any trends for abuse can be addressed. To this end, Anne Roussin of the Team Pharmacoepidemiology at the University of Toulouse III in France recently conducted a survey involving 2,263 French pharmacies. Roussin gathered questionnaires from 295 customers who purchased either paracetamol (a control), paracetamol with codeine or H1 sedative antihistamines. The customers were asked about their frequency of use, the type of medication they took, and the reasons they took them. They were also asked if they thought they were dependent upon the medications.
With respect to codeine, 17.8% of participants reported dependence and 6.8% reported misuse. In all, nearly 20% of the participants reported using codeine OTC medication every day in the previous six months. The prevalence was even higher for H1 sedative antihistamine (doxylamine) users, with 37.1% of all respondents reporting using during the prior month. Despite the label recommendations for short-term use only for insomnia, over 72% of those who used doxylamine reported daily use.
Roussin discovered that headache was the most common reason for codeine use. But prolonged use and abuse of codeine can lead to medication headaches. She also noted that the majority of those who used doxylamine regularly did so for insomnia; and even though a third said they desired to control their use, they were unable to do so on their own.
Roussin believes these findings show that OTC medication users may misuse as a way to cope with stress and normal life events. “In addition, they also should help improve clinical management of patients dependent on these drugs,” added Roussin, as many participants in this study reported an inability to stop without help.
Roussin, A., Bouyssi, A., Pouché, L., Pourcel, L., Lapeyre-Mestre, M. (2013). Misuse and dependence on non-prescription codeine analgesics or sedative H1 antihistamines by adults: A cross-sectional investigation in France. PLoS ONE 8(10): e76499. doi:10.1371/journal.pone.0076499
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