Health-Related Policy Analysis

To: Todd Kiminsky

From: Andrew Simon, PA-S

Date: 7/18/2022

Re: Abuse of over-the-counter medicines: a pharmacist’s perspective

 

Statement of issue: OTC (over-the-counter) medications are an essential component of any health care system. The popularity of OTC meds may increase the abuse potential of OTC meds. Pharmacists are the first-line contact for patients and they are there to ensure safe and effective use. However, a pharmacist has traditionally been underutilized in this role. This leaves the door for OTC abuse open. Abusing OTC drugs can lead to health problems including memory loss, kidney failure, heart problems, and death.

 

  • Abuse of widely available, over-the-counter drugs and supplements such as laxatives and diet pills for weight control by youths is well documented in the epidemiological literature.
  • The FDA has the authority to designate a drug as OTC or prescription but more frequently, OTC drug manufacturers can legally market drugs without pre-approval as long as they comply with the previously established OTC drug monograph.
  • The Federal Trade Commission is responsible for regulating the advertising of OTC drug products. Advertisements for OTC drugs must be truthful and non-deceptive. Manufacturers must have a “reasonable basis’ ‘ for any claim they make.

 

Policy Options

Requiring certain OTC drugs, specifically more laxatives and diet pills should be Behind the Counter (BTC). BTC medications are defined as “ a third category of drugs without a prescription, however, the patient must consult with the pharmacist. Other medications that are making (or have made) the transition to the behind-the-counter category are statins, insulin, plan B, painkillers with small amounts of codeine, and aspirin.

 

  • Advantages – Decrease access to OTC meds which leads to a decrease in usage. The presence of a pharmacist is essential to purchasing a BTC medication. Medications should only be provided upon a pharmacist’s recommendation. Certain tests can be done to dispense BTC medications such as those with hypertension, gastrointestinal reflux, asthma, and diabetes,
  • Disadvantages – Increases wait times for those who need OTC medications and are not abusing them. May also increase wait times for those picking up prescription medications. May increase the demand for personnel in the pharmacy.

 

The Federal Trade Commission incorporates stricter rules when advertising OTC medications. Currently, advertisements for OTC drugs show bias toward the medication they are selling and do not disclose full information about the drug. This would allow the patient to have more transparency with the company and knowledge of their medical health.

 

  • Advantages- Full disclosure allows patients to learn more about their medication. Furthermore, if there is uncertainty about ingredients, the patient should inquire with the pharmacist. The pharmacist is more likely to be educated on certain OTC meds due to more inquires
  • Disadvantages – Certain medication ingredients may deter patients from purchasing that medication even though said ingredients are not harmful. May lose advertising time in commercials due to extensively listing side effects.

 

Age Requirement and Picture of Identification to purchase OTC medication – Adolescents represent one of the fastest growing segments of the general population abusing prescription and OTC drugs as represented by national surveys. Currently, there are no age requirements to purchase OTC medications in New York. This would significantly decrease the accessibility to OTC meds, in hopes of decreasing the trend in teenagers. Also, scanning identification would keep track of those buying OTC medications. Using the dosage and instructions on the box, the patient would have to wait a certain amount of time until they can purchase another.

  • Advantages – significantly decrease access to OTC medication to those under 18. Can increase awareness of those currently abusing OTC drugs. This can lead to referral to doctors from the pharmacist for patients seeking OTC drug abuse help.

 

  • Disadvantages – Adolescents who need OTC drugs for confirmed medical conditions will have a longer wait time. For example, menarche usually takes place between the ages of 10-16, and usually occurs every month. Those experiencing premenstrual symptoms will not have access to those medications unless bought by parents/guardians. Can also lead to those over 18 being a gateway for adolescents to buy OTC meds illegally.

 

Policy Recommendation

 

Require more OTC medications, to be sold Behind the Counter (BTC). BTC medications are defined as “a third category of drugs available without a prescription; placed BTC, they are available only after consultation with a pharmacist. BTC medications are widely adopted in many countries including the UK, Ireland, Canada, New Zealand, France, and Australia. This Policy seems most efficient considering some medications have already made this transition. This also promotes more interaction with the pharmacist to detect possible OTC abuse and promotes the under-utilized dialogue between the pharmacist and a patient.

 

 

 

 

 

 

 

 

 

 

References

 

Fain, K. M., & Alexander, G. C. (2014). Mind the gap: understanding the effects of pharmaceutical direct-to-consumer advertising. Medical care, 52(4), 291–293. https://doi.org/10.1097/MLR.0000000000000126

 

Gonzales, R., Brecht, M. L., Mooney, L., & Rawson, R. A. (2011). Prescription and over-the-counter drug treatment admissions to the California public treatment system. Journal of substance abuse treatment, 40(3), 224–229. https://doi.org/10.1016/j.jsat.2010.11.003

 

Lacroix AE, Gondal H, Shumway KR, et al. Physiology, Menarche. [Updated 2022 Mar 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470216/

 

NIDA. 2017, December 17. Over-the-Counter Medicines DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/over-counter-medicines on 2022, July 23

 

Sansgiry, S. S., Bhansali, A. H., Bapat, S. S., & Xu, Q. (2016). Abuse of over-the-counter medicines: a pharmacist’s perspective. Integrated pharmacy research & practice, 6, 1–6. https://doi.org/10.2147/IPRP.S103494