Development of a community pharmacy-based model to identify and treat OTC drug abuse/misuse: a pilot study.
OBJECTIVE
The aim of this study was to develop and pilot a harm-minimisation model for the identification and treatment of over-the-counter (OTC) drug abuse/misuse by community pharmacists.


METHODS
Extensive consultation was conducted during the development of the model. This included an exploratory conference involving an interdisciplinary group of delegates and detailed individual consultation with a range of healthcare practitioners. Consultation with a psychologist specialising in communication skills allowed development of the communication aspects of the model. A comprehensive manual detailing the model was prepared.


RESULTS
The model is designed to be used by community pharmacists in conjunction with other healthcare professionals. It focuses on the abuse/misuse of opioids, laxatives and antihistamines and can be broadly divided into three phases, namely: patient identification and recruitment, treatment/referrals and data collection/outcome measurement. Client identification is via record-keeping which is implemented alongside an information campaign promoting safe use of OTC medicines. Once identified, the pharmacist aims to recruit clients using the developed communication strategies. Treatment depends on whether the problem is misuse or abuse and on the product. Several treatment paths are available including treatment according to an agreed protocol and referring to the GP or community addiction team (CAT). Two pharmacists were recruited and trained to pilot the model. Of the clients, 18 were identified as abusing/misusing OTC products over a one-month period. The subject of inappropriate OTC use was raised with 14 of these clients. Some success was noted in that clients agreed to stop using the product and/or to try safer alternatives. As expected, some sales had to be refused, as the client was unwilling to accept the pharmacist's intervention.


CONCLUSIONS
This study represents the first reported structured attempt by community pharmacists in the UK to address the abuse/misuse of OTC medication. Work is now ongoing to modify this model in light of the pilot study findings.
Fleming
Glenda F
GF
Research and Development Office, Belfast BT2 8BS, Northern Ireland.
McElnay
James C
JC
Hughes
Carmel M
CM
D000465:Algorithms; D003157:Community Pharmacy Services; D006801:Humans; D008960:Models, Psychological; D004366:Nonprescription Drugs / Q000009:adverse effects; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
D004366:Nonprescription Drugs