Drug Misuse Dr Tehseen

(OTC) Misuse

Drug

TAHSEEN SHAMSHAD ROLL NO.26 HEALTH SERVICES ACADEMY

What are the over the counter drugs? Over-the-counter (OTC) drugs are non prescription drugs sold in ;  convenience  

stores, grocery stores and health shops.

They range from pain relievers, cough and cold remedies to sleeping aids, weight reducing aids, and vitamin supplements.

a v a ila b ilty o f O T C m e d ic in e s

O T C d ru g s to re , s u p e r m a rk e ts e tc 0% 5% O T C p h a r m a c pi er es s c r i p t i o n 46% 39% O T C p r e s c rib e d 10%

OTC drugs , emerging threat of drug misuse The biggest threat now comes from the mounting misuse of pharmaceutical agents like ■ ■ ■ ■

Buprenorphine diazepam, antihistamines, and cough syrups containing codeine, and its synthetic derivatives like dextromethorphan.

Commonly abused OTC drugs OTC medicines commonly used by teenagers are: ◆ ◆ ◆ ◆ ◆ ◆ ◆

Caffeine stimulants. Antihistamines containing dyphenhydramine Decongestants containing pseudoephedrine Weight loss supplements containing ephedra Sleep aids containing doxylamine. Motion sickness treatments with dimenhydrinates. Cough syrups containing codeine derivatives like dextromethorphan.

Cough syrups, the major source of OTC drug abuse in teen agers ■

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Teens are drawn to an ingredient containing in half of the cold and cough remedies called dextromethorphan At excessive dose can produce high or psychoactive effects.

What is dextromethorph an ■

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DXM is a synthetically produced substance that is chemically related to codeine, DXM is an ingredient in more than 140 over-the-counter cough and cold remedies since 1950s gradually replaced codeine as the most widely used cough suppressant in the United States. available in capsule, liquid, liquid gelatin capsule, lozenge, and tablet forms.

Legislation enforcement ■

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DXM could be added to the Controlled Substances Act if warranted. In 2003 legislation was introduced in Texas and North Dakota to prohibit the sale of DXM to minors. The proposed legislation did not pass in either state. A similar bill introduced in California in 2008 was also defeated.

Calls Involving Abuse or Misuse of DXM to Poison Control Centers Year

Teenagers

All Other Age Groups

2000

1,623

900

2001

2,276

1,107

2002

2,881

1,139

2003

3,271

1,111

Cough medications with DXM may contain other active ingredients. Source: American Association of Poison Control Centers.

Abuse of DXT in USA ■ ■

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Most typically abused OTC-drug Abuse of DXM by American teenagers 2005: 2,4 million teenagers 1 in 10 American teens has abused OTC medications Estimated purchasing costs of DXM by teenagers: $84 million dollars / year

Predisposing factors Factors perceived by respondents as predisposing to drug usage among students PREDISPOSING FACTOR

FREQUENCY (%)

FRIENDS USING DRUGS

166 (90)

TOBACCO SMOKING

139 (76)

FAMILY USING DRUGS

136 (74)

CERTAIN SOCIAL GATHERINGS

128 (70)

LIVING AWAY FROM HOME

114 (62)

MALE GENDER

98 (53)

LOW SELF-ESTEEM

93 (51)

INADEQUATE RECREATIONAL FACILITIES

91 (50)

Shafiq et al. Substance Abuse Treatment, Prevention, and Policy 2006 1:31 doi:10.1186/1747-597X-1-31

Social determinant of drug abuse   

Stress Parent child relation ship Gender, race and class  the social, economic and cultural characteristics of a society  societal systems and institutions  Social alienation and social support  social cohesion and social exclusion

Figure 5.2 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2008

Global magnitude ■

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In 2006, about 3.1 million persons aged 12 to 25 (5.3 percent) had ever used an over-the-counter (OTC) cough and cold medication to get high (i.e., "misused" the drug), and nearly 1 million (1.7 percent) had done so in the past year Among youths aged 12 to 17, females were more likely than males to have misused OTC cough and cold medications in the past year, but among young adults aged 18 to 25, males were more likely than females to have misused these medications Among persons aged 12 to 25 who had misused an OTC cough and cold medication in the past year, 30.5 percent misused a NyQuil® product, 18.1 percent misused a Coricidin® product, and 17.8 percent misused a Robitussin® product.[4]

Magnitude in pakistan ■

National data on self-medication as well as OTC drug abuse are not available in Pakistan, but local studies reveal that this may vary between 6.3% and 51.3% depending on the setting

Emergency department visits involving dextromethorphan ■

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an estimated 12,584 emergency department visits (0.7% of all drug related emergency department visits) involved pharmaceuticals containing dextromethorphan. for those aged 12 to 20 was 7.1 visits per 100,000 population compared with 2.6 visits or fewer per 100,000 for other age groups. patients aged 12 to 20 accounted for almost half (48%) of all the emergency department visits resulting from nonmedical use of dextromethorphan. visits resulting from any type of use of dextromethorphan among those aged 12 to 20 was 10.3 per 100,000 population compared with 4.3 visits per 100,000 for the population overall. Alcohol was implicated in about a third (36%) of the DAWN emergency department visits involving nonmedical use of dextromethorphan for those aged 18 to 20 and in 13% of visits for those aged 12 to 17.

SAMHSA's Drug Abuse Warning Network (DAWN) for 2004,

Administrative and regulatory bodies ■ ■ ■ ■

Pharmacy act 1967 Pharmacy act 1976 National drug policy Control of narcotic drug substance

Rational drug use by national drug policy ◆ ◆

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Drug information bulletin published on regular basis. Ethical Criteria for Medical Drug Promotion to allow sales promotion only through the health institutions though a well defined system National Formulary shall be published in a new context so as to serve as reliable prescribing to all doctors and pharmacists of the country and as an effective teaching aid. Establishment of computerized drug information and poison centre to undertake postmarketing surveillance studies of newly registered drugs.

Weaknesses of national drug policy. ■

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prescription based dispensing has never been implemented and enforced by law in the country There is no legislation for those, who dispense with out prescription There is no ADR monitoring and reporting system/centers in action

Aim Reduction in abuse of OTC drugs in Pakistan. Objectives ■ To increase awareness of adverse drug reaction in 100% parents and families in Pakistran. ■ To improve dispensing practices of OTC drugs in 90% of pharmacies within three years in Pakistan.

Interventions/preve ntion strategies ■

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1-development and strengthening of drug control organizations at district level 2-to ensure computerized drug sales information system at retail and hospital pharmacies with record of patients, their prescription as well as over the counter drugs .this system provide accurate information on current trends of drugs prone to induce addiction. 4- to establish ADR monitoring centers and ensure the proper reporting system of any over the counter drug abuse case at district level and promote their existence though mass media campaigns 5- Promoting Health education to, technical sale staff at pharmacies, parents and teachers through seminars, workshops and media. And promoting the importance of communication between parents and children through group discussion using school level events, electronic media and community based events.

BARRIERS AND CHALLENGES TO PREVENT DRUG ABUSE ■ ■ ■

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Easy access OTC drugs. The societal attitude toward OTc drugs OTC drug problems seem to be related to current (medical) standards and prevailing practices. insufficient policies, regulations and legislation pertaining to none prescription drugs. Lack of parental knowledge, involvement and action regarding OTC drug abuse. Inadequate legislation or lobbying regarding OTC drug abuse Poor/inadequate media participation .

A Future challenges: improvement of existing systems ■

Are existing systems exhausted? ◆

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Can patients and pharmacists reporting improve patients safety? ◆ ◆

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Likely improvement of spontaneous reporting by medical doctors can enable more early signal detection

Initiatives of creating data bases of patient reports Pharmacists based reporting

Regulatory guidance in which cases new/alternative methods have to be imposed

A Future challenges: improvement of information, education and communication ■

Improvement of information 

In many parts of the World information is either not readily available or of poor quality ✦

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Education 

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In some countries still only OTC drugs have PIL although both POM and OTC are delivered without prescription

Can education of consumers/patients improve drug safety?

Communication   

Health professionals Patients Media

Prioritized Areas 1.

2.

3.

Creating awareness among parents and schoolteachers creating awareness in children about common OTC drugs used at home and their good and bad effects improving knowledge of non technical sales persons about OTC drugs and safe dispensing practices

MONITORING ■ Monitoring of the sessions conducted by Health Officials, in Schools. ■ assurance of syllabus about basic knowledge of drugs by school boards ■ Quality of material presented in schools, checking quality of the material. ■ Monitoring the implementation of knowledge of non technical sale staff EVALUATION ■ No. of cases of OTC abuse detected at pharmacies ■ proportion of teen agers having basic knowledge of drugs ■ No. of training sessions conducted ■ No. of sessions for parents and school teachers