Exploring Over the Counter and Prescription Only Medication misuse amongst adults accessing specialist treatment services: A survey during COVID-19
Authors: Gittins R E , Maidment I 
Published: April 2022

Abstract

Introduction
An improved understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse by people who access substance misuse services (SMS) is essential so that appropriate treatment interventions can be provided. There is growing awareness and concerns about this issue, especially during COVID-19; however, there is a paucity of published data (1, 2).

Aim
To use a questionnaire to explore the misuse of OTC/POM by adults accessing SMS, including the types of medication involved, demographic characteristics, the use of other substances and changes during COVID-19.

Methods
Following successful piloting, an anonymous (online/paper) self-administered survey was completed by English-speaking adults (18 years or over) currently accessing SMS with a purposive sampling approach. This was undertaken in community SMS across England, provided by one of the UK’s largest third sector organisations. Quantitative analysis was undertaken using SPSS and thematic analysis for qualitative data.

Results
In 2021, 80 questionnaires were completed, and the 56 that met the inclusion criteria were analysed. All were caucasian (94.6% British), aged between 18 and 61 years and the majority identified as male (58.9%). Forty respondents (71.4%) were in receipt of prescribed interventions for their use of substances, with an adherence rate of 92.5% despite increased liberalisation of dispensing arrangements and additional challenges during COVID-19. In the preceding month 44.6% used alcohol (52% daily), 73.2% used tobacco/vaped and 58.9% used illicit substances concomitantly. Twenty-one (37.5%) reported misusing more than one OTC/POM, route of administration was predominantly oral and ease of their availability was conveyed. Relationships between categories were tested using chi-square/Fisher’s exact test and statistically significant relationships (p &lt;0.05) were identified between the misuse of codeine and the prescribing of oral opioid substitute treatment, and changes during COVID-19 to OTC/POM and illicit misuse. Generally respondents were very complimentary about SMS, outlining the positive impact of accessing pharmacological and psychosocial interventions. However, the need for more training/education and psychologically informed approaches by GPs and pharmacies was highlighted: there was a theme of primary care restrictions on access to medicines leading to escalating OTC/POM misuse and increased use of unregulated illicit sources.

Conclusion
Conducting research during a pandemic is exceptionally challenging. OTC/POM misuse is occurring amongst people accessing SMS and polypharmacy is concerning. A renewed approach to liberalisation, withdrawal management and training for primary care professionals must be considered. Improvements at a systems-level and changes to commissioning/national pathways may assist this and further research is required to explore the themes identified.

References
(1) Gittins R, Missen L, Maidment I. Misuse of medication in adult substance misuse services: a systematic review protocol. BMJ Open 2021;11:e047283. doi: 10.1136/bmjopen-2020-047283
(2) Gittins R, Cole S. Buprenorphine for the management of kratom dependency during covid-19: A case report. Drug Science, Policy and Law. January 2021. doi:10.1177/20503245211021193