New Scale Measures, Helps Address Stigma Toward OTC Drug Misuse

Using the drug stigma scale (DSS), pharmacists possess the tools to measure and address stigma toward patients’ use of OTC medications in pharmacy settings, according to a study in Neuropsychopharmacology Reports.¹

“Besides having adequate knowledge of how to interact with individuals who use drugs, less stigmatized attitudes of medical professionals, including pharmacists, toward these individuals play a crucial role in their successful encounters,” said the study authors. “Stigmatized attitudes of health care professionals cause hesitation among individuals who use drugs regarding help-seeking, resulting in unsuccessful interactions and further exacerbating drug use.”

For many individuals struggling with dependence, the pharmacist is the only health care professional they encounter. However, the current study suggests that internal prejudices among pharmacists may be a significant barrier to effective intervention.¹

By validating the DSS for the first time among community pharmacists, researchers highlighted how stigmatized attitudes, such as the belief that drug use is a sign of personal failure or that users are untrustworthy, hinder the pharmacist’s critical role as a gatekeeper for public safety among OTC products.

READ MORE: OTC Medications Expose Toddlers to Potentially Risky Parabens

The research conducted in Japan found that stigma is a complex phenomenon influenced by several demographic and personal factors. Notably, women pharmacists and those who have had direct or familial experience with OTC drug misuse demonstrated significantly lower levels of stigma, according to the study.¹

Furthermore, pharmacists who felt more confident in their knowledge and their ability to act as gatekeepers—a concept known as gatekeeper self-efficacy—were less likely to hold discriminatory views. These findings suggest that empathy and personal connection are often more effective at reducing bias than traditional knowledge-based education alone.

The Power in Removing Stigmas Around Drug Use

The necessity of removing this stigma is underscored by the way the public perceives and uses these medications globally. In Saudi Arabia, for instance, a cross-sectional study revealed that while nearly 80% of the public is aware of potential drug interactions, risky behaviors remain rampant, according to a study published in Healthcare.²

Approximately 66% of respondents admitted to sharing medications, and 15.5% reported exceeding recommended dosages. Despite these risks, 64.6% of the public still looks to health care professionals as their primary source of information, placing a heavy responsibility on the pharmacist to provide nonjudgmental guidance.

This responsibility is further complicated by a general public impression that OTC drugs are inherently safer than prescription options. A study from Pharmacy (Basel) indicates that consumers often view OTC use as a mundane activity and assume regulatory safeguards guarantee absolute safety.³

Although safety ratings for common agents such as headache medicines are generally positive, they are rarely rated at the top of the scale, suggesting a subtle, underlying public awareness that these drugs must be used with care. When pharmacists harbor stigma, they miss the opportunity to bridge the gap between this perceived safety and the actual risks of long-term use.

The human cost of failing to intervene is also staggering. Qualitative interviews from the United Kingdom illustrate that OTC misuse “ruins lives,” creating a “horrible situation” for entire families, as authors state in a study published in Drug Science, Policy and Law.⁴

Friends and relatives often face severe financial strain, theft, and psychological burdens while trying to support a loved one. These families report that when health care professionals respond with empathy and clear boundaries rather than judgment, the sense of hopelessness is significantly reduced.

Looking Ahead to Address Stigma

To move forward, the CDC advocates for a “person-first” approach, reminding clinicians that a substance use disorder is a treatable chronic disease rather than a defining character trait. Pharmacists are encouraged to use destigmatizing language—replacing terms like “addict” or “user” with “person with a substance use disorder.” This will help foster an environment where patients feel safe seeking help.⁵

In the long run, removing stigma requires pharmacists to look beyond the pharmacy counter and engage with the lived experiences of their communities, ensuring that every patient encounter is defined by compassion rather than prejudice.¹

“This study found that the DSS can be applied to pharmacists to measure stigma toward individuals who use OTC drugs for unintentional purposes,” concluded the authors of the current study. “This study suggests that this scale can be applied in various contexts to examine the situation and determine an effective way to overcome stigma toward individuals who use drugs in pharmacy settings, which is a crucial point of interaction for meeting individuals who use OTC drugs for unintentional purposes.”

READ MORE: OTC Resource Center

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REFERENCES

1. Katayama M, Shimane T, Shirakawa N, et al. Psychometric properties of the drug stigma scale among community pharmacists concerning individuals who use over-the-counter drugs. Neuropsychopharmacol Rep. 2026 Mar;46(1):e70101. doi: 10.1002/npr2.70101.

2. Alharthi MS, Alsulami FT, Fathelrahman AI, et al. Attitudes and behaviors of the public toward over the counter (OTC) medications in the western region of Saudi Arabia: a cross-sectional study. Healthcare. 2025;13(5):472. https://doi.org/10.3390/healthcare13050472

3. Taylor JG, Ayosanmi S, Sansgiry SS. Consumer impressions of the safety and effectiveness of OTC medicines. Pharmacy (Basel). 2023 Mar 10;11(2):51. doi: 10.3390/pharmacy11020051.

4. Gittins R, Vaziri R, Maidment I. “It’s a horrible situation for everyone”: the impact of over the counter and prescription medication misuse on friends and family. DSP. 2023;9. https://doi.org/10.1177/20503245231215407

5. Stigma: beyond the numbers. CDC. January 31, 2025. Accessed March 19, 2026. https://www.cdc.gov/stop-overdose/stigma-reduction/stigma-beyond-the-numbers.html