By Pat Hagan

LONDON (Reuters Health) – Pharmacists in the UK need more guidance and better training to deal with people who misuse over-the-counter (OTC) medicines, according to the results of a new survey.

Researchers from the University of Strathclyde who polled nearly 90 pharmacists in Scotland said although misuse of commonly available drugs is not on a large scale, it is widespread.

The results, published in the Journal of The Royal Society for the Promotion of Health, show pharmacists have an average of five patients a week they suspect of misusing drugs bought OTC.

The most commonly abused drugs included sleeping preparations, laxatives, analgesics and cough linctuses. The survey showed most pharmacists rely on their experience of patients' behaviour, knowledge of what medicines are most likely to be misused and quantities purchased to indicate possible abusers.

"Some pharmacists felt very frustrated that they were trying to deal with it but another pharmacist down the road might not be doing anything about it," lead researcher Lynn MacFadyen told Reuters Health.

"There are no easy solutions to this problem, but it would be good if it was built in to pharmacists' training," she said.

The university–with funding from Lanarkshire Health Board–undertook the survey because of the shift in recent years to move more drugs from prescription-only to OTC status.

As a result, it has been estimated that around one in four of all adult ailments and one third of all children's ailments are now treated with OTC medicines.

However, this trend has heightened concerns about the potential for misuse by patients, particularly involving drugs with a sedative or stimulant effect.

Researchers sent a questionnaire to all local pharmacies in an area of west central Scotland and received 86 replies. They also interviewed 24 respondents as part of the poll.

The results showed 58% had encountered misuse "occasionally" while just under one third had experienced problems "frequently."

Pharmacists in urban areas were more likely to report misuse than those in rural districts. When asked to estimate how many times in a "typical week" they suspected patients of misuse, 45% said at least once or twice a week, while just over 20% reported three to four suspicious patients a week. A few reported 20 to 30 incidents a week.

The vast majority of respondents said they would intervene if they suspected drug misuse–usually by advising the patient to seek their GP's advice before being allowed to have the drug. Other tactics included hiding the product from view, refusing to sell it to the patient or confronting them directly about their problem.

Reporting their findings in the latest issue of the journal, the researchers write: "This study has demonstrated the need for greater consistency in the management of OTC misuse and the need for the development of nationally recognised guidelines for pharmacists."

"There was interest expressed in developing an 'early warning system,' whereby other local pharmacists could be warned of a suspected case of misuse," they write.

The Royal Pharmaceutical Society of Great Britain, which oversees pharmacy issues, says pharmacists must "exercise professional judgement to prevent the supply of unnecessary and excessive quantities of medicines."

J Royal Soc Promot Health 2001;121:185-192.