In dealing with cases of suspected abuse and misuse of over-the-counter products, pharmacists are directed by their Code of Ethics to prevent the supply of unnecessary and excessive quantities of products liable to abuse/misuse and where necessary, to refuse the sale ^1,2. Pharmacists in response to a postal survey³ reported a number of methods for dealing with suspected OTC abuse/misuse.

Overall, these methods were limited and did not offer a solution in the longer term. The overall aim of this present project was to develop and pilot a harm-minimisation model for the identification and treatment of OTC drug abuse/misuse by the community pharmacist, in conjunction with other health care professionals and to pilot the scheme in two community pharmacies.

The model focused on the abuse/misuse of opioids, laxatives and antihistamines. During the developmental stages, a number of professionals were consulted including a community addiction nurse, GPs, a psychiatrist in charge of the Community Addiction Team (CAT) and a psychologist specialising in communication skills. The model can be broadly divided into three sections namely: identification and recruitment of clients, treatment and referrals and outcome measurement.

The participating pharmacists were provided with a study manual and attended a training day. The communication skills' section of the manual and training in this area wee provided by the psychologist.

Client identification was via a process of record-keeping which was implemented together with an information campaign aimed to promote safe use of OTC medicines. Once identified the pharmacists attempted to recruit clients. Treatment depended on whether the problem was one of misuse or abuse and on the product in question. Pharmacists had a number of options, including treating the client according to an agreed protocol, referral to the GP or to the CAT. Data collection forms were developed and these, together with SF-36 and patient satisfaction questionnaires, formed the basis of outcome measurement.

In total, 18 clients were identified as abusing/misusing OTC products over a four week period. The subject of inappropriate OTC use was raised with a total of 14 clients. Some success was noted in that 7 clients agreed to stop using the product and/or to try safer alternatives. As expected, in some instances, sales had to be refused as the client was unwilling to accept the pharmacist's intervention.

If sales were refused in an intervention pharmacy, other pharmacists in the locality were informed by telephone. This "networking" enabled pharmacists to adopt a uniform approach in cases of abuse/misuse. As anticipated, difficulties did arise and unfortunately, no client was formally enrolled into the outcome measurement phase of the project. Identified barriers included lack of confidence on the part of the pharmacists, lack of time and lack of GP support.

This study represents the first reported structured attempt by community pharmacists in the UK to address the abuse/misuse of OTC medication. Work is now ongoing to modify this model to allow further data collection, intervention and outcome measurement to take place.

References

1. Pharmaceutical Society of Northern Ireland. Ethics and Practice: A Guide for Pharmacists in Northern Ireland. 1997 edition. Belfast: Pharmaceutical Society of Northern Ireland; 1997:34-36
2. Royal Pharmaceutical Society of Great Britain. Medicines, Ethics and Practice. A Guide for Pharmacists. Number 23. London: Royal Pharmaceutical Society of Great Britain; 2000:72 � 74.
3. Hughes GF, McElnay JC, Hughes CM & McKenna P. Abuse/misuse of non-prescription drugs. Pharmacy World and Science. 1999; 21 (6): 251 � 255