An Exploration of the Misuse of Over the Counter and Prescription Only Medication in Substance Misuse Treatment Services

Abstract

Background: There are growing concerns about the misuse of over the counter (OTC) and prescription only medication (POM), due to the associated negative socioeconomic and health implications. To improve care delivery, more needs to be known about how this affects people who are accessing specialist substance misuse services (SMS). Aims and Objectives: The overall aim was to explore the misuse of OTC and POM by adults that were accessing community SMS. To achieve this, the objectives were to complete three linked phases: 1. Systematic review of the published literature (PROSPERO: CRD42020135216); 2. Questionnaires completed by adults accessing English community SMS, to identify the OTC/POM types involved and associated characteristics; 3. Semi-structured interviews with adults accessing SMS, SMS staff and affected friends/family, to explore their associated experiences. Methods and Key Findings: The systematic review identified thirteen relevant studies and highlighted the paucity of published literature. Oral sedating medication (especially opioids and benzodiazepines) predominated the findings from the fifty-six questionnaires, and demographic characteristics were typical of people who usually access English SMS (middle-aged White men). To enable a more in-depth understanding of the experiences of OTC/POM misuse in SMS, thematic analyses of 24 interviews with adults accessing SMS, 20 SMS staff and 8 affected friends/family were undertaken. This research was conducted during COVID-19, in community adult SMS, operated by a national treatment provider. OTC/POM misuse was associated with a wide range of adverse socioeconomic, physical, and psychological effects. Polypharmacy and concomitant use of other substances was commonplace. Unmanaged withdrawal symptoms caused concern and contributed to perpetuating misuse: sudden cessation in supplies created risks. Conclusion: OTC/POM misuse should be routinely enquired about during healthcare reviews and tailored harm reduction, pharmacological and psychosocial interventions offered (including support for friends/family). Future research should investigate perceived barriers to SMS engagement and identify if demographic characteristics and treatment needs differ by OTC/POM type.