Non-prescription medicine misuse, abuse and dependence in the UK:

a general population surveyNiamh Fingleton

Dr Catriona Matheson, Dr Margaret Watson, Dr Eilidh Duncan

Non-prescription medicines (NPMs)

• Obtained and supplied without a prescription

• Used to treat a wide range of symptoms

• Potential for misuse, abuse and dependence

Non-prescription medicinesCaffeine tablets Laxatives

Codeine-containing painkillers Medicated skin care products

Cold/flu remedies Painkillers without codeine

Cough remedies Sleep aids (non-herbal)

Decongestants Smoking cessation products

Diarrhoea treatment Sore throat products

Haemorrhoid products Travel sickness products

Hay fever products Vitamins/dietary supplements

Herbal remedies Weight management products

Indigestion products

Definitions

Misuse• “The use of a medicine for medical purposes

but in an incorrect manner.” (Hughes et al. 1999)

Abuse• “The use of a medicine for non-medical

purposes e.g. to experience mind-altering effects.” (Hughes et al. 1999)

General population survey

Aim: Determine the prevalence of self-reported misuse, abuse and dependence in the UK

Method• Cross-sectional, postal survey of 1000• Pre-notification and two reminders• Questionnaire informed by literature and two

existing questionnaires (Watson et al. 2008; Wazaify et al. 2005)

General population survey

Secondary aim: Assess the effect of behaviour change techniques on response rate

Behaviour change technique“A replicable component of an intervention designed to alter or redirect causal processes that regulate behaviour.” (Michie et al. 2013)

Behaviour change techniques

Sample(n=1000)

Cue/prompt (n=334)

Self-reward (n=333)

Control (n=333)

Behaviour change techniques

Cue/prompt“Please now place the questionnaire in a prominent place, i.e. somewhere where seeing it will remind you to complete it.”Self-reward“If you finish completing the questionnaire, why not reward yourself with a cup of tea? We have provided a teabag for you.”

Response (n=974)Overall 41.3%

(n=402)

Cue/prompt38.3% (n=125)

Self-reward 43.8%

(n=142)

Standard 41.7%

(n=135)

Demographics

Sex: 50.6% female

Age (mean): 60 years

Employment: 46% working, 43% retired

General health: 71% ‘good’ or ’very good’

Demographics

Alcohol: 75% drink alcohol

Units per week (median): men=9, women=5.5

Smoking: 49% non-smokers; 39% ex-smokers

Ever used drugs: 8% said ‘yes’

Overall sample (n=402)

Past month % (n)

Ever % (n)

Higher dose than recommended 2.6 (10) 11.9 (46)

More often than recommended 2.8 (11) 10.6 (41)

Longer time than recommended 2.3 (9) 10.6 (41)

Reason not recommended 0.8 (3) 5.4 (21)

Misuse and abuse

Misuse (n=75)

Higher dose(13)

More often(7)

Longer time(18)

(14) (3)

(4)

(16)

‘Some NPMs may cause dependence or addiction’

Strongly disagree

Disagree Neither Agree Strongly agree

0%

10%

20%

30%

40%

50%

4% 6%

18%

27%

45%

Dependence: Do you personally know someone?

No (88%)

Yes (12%)

Ever been dependent yourself?

Overall sample (n=389)

Past month Ever% (n) % (n)

Yes 0.8 (3) 2.1 (8)

Acknowledgements

Can you help?Do you work with people in the UK who are:• currently dependent on NPMs or• currently receiving treatment for NPM

dependence?n.fingleton@abdn.ac.uk

References• Hughes, G. F., McElnay, J. C., Hughes, C. M., & McKenna, P. (1999). Abuse/misuse of

non prescription drugs. ‐ Pharmacy World and Science, 21(6), 251-255.• Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W.,

Eccles, M.P., Cane, J. & Wood, C.E. 2013, "The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions", Annals of Behavioral Medicine, , pp. 1-15.

• Watson, M.C., Johnston, M., Bond, C.M., Entwistle, V.A. & Lee, A.J. 2008, Improving customers communication during consultations for non-prescription medicines in community pharmacies, Chief Scientist Office (Reference number: CZH/4/376), Edinburgh.

• Wazaify, M., Shields, E., Hughes, C.M. & McElnay, J.C. 2005, "Societal perspectives on over-the-counter (OTC) medicines", Family practice, vol. 22, no. 2, pp. 170-176.