Pharmacist Interventions Help Prevent OTC Drug Abuse, Misuse, and Dependence

Proactive interventions by pharmacists can help prevent OTC drug abuse, according to authors of a survey published in Exploratory Research in Clinical and Social Pharmacy. The authors detailed that drug abuse goes beyond pharmaceuticals that are designated for abuse, including caffeine, diphenhydramine, dextromethorphan, and acetaminophen.¹

“OTC drugs that are abused but do not contain the designated ingredients tend to have low survey item achievement rates,” the study authors said. “This suggests that legal regulations may affect the handling of medicines that may be subject to abuse.”

In the study, investigators focused on OTC drugs and set survey items that included warnings at the time of the drug sale. They targeted 25 drugs in 17 random drugstores in Chiba City, Japan, where a researcher bought 1 product at a time from each store from August 7, 2024, to May 13, 2025. Investigators analyzed both designated and nondesignated products in the analysis.¹

In the 25 products, 13 contained medications that were designated ingredients, and 12 were sometimes abused but did not include designated ingredients. In Japan, the ministry designates products that are subjected to abuse as ephedrine, codeine, dihydrocodeine, bromovaleryl urea, pseudoephedrine, and methylephedrine. The products that did not contain designated ingredients included diphenhydramine, caffeine, dextromethorphan, and acetaminophen.¹

Study Results

Approximately 44% of medications (11/25) were accompanied by an explanation from a qualified person, followed by POP warning displays at 36% (9/25) and a display near the cash register at 32% (8/25), according to the investigators. For the 13 medications containing designated ingredients, 77% had an explanation by a qualified person, 69% had POP warning displays, 15% had a display of empty boxes, and 8% had verbal verification of age.¹

Specifically for drugs that had potential for abuse but did not contain designated ingredients, display of an empty box and display near the register (with 2 positives for each) were the most common warning measures. All other warning measures either received 1 or zero positives.¹

The achievement rate of explanation by a qualified person was 88% for dihydrocodeine compared with the display of a warning POP and a check of the sales quantity of 75%. Methylephedrine had an achievement rate of 89% for explanation by a qualified person, 56% for the check of sales quantity of intended use, 67% for the display of warning POP and checking if the purchaser has the same product, and 11% for the display of empty boxes and age verification.¹

The Role of the Pharmacist

In a review published in the Journal of Pharmaceutical Policy and Practice, there was a significant prevalence of misuse, abuse, and dependence of OTC medication at 16.2%, 2%, and 7.2%, respectively, in a pooled analysis of 53 population-based studies. The most common OTC medication groups included analgesics, either with or without codeine, sedative antihistamines, and cough medications containing dextromethorphan.²

They also found that the interventions to reduce OTC medication abuse, misuse, and dependence varied across countries, but community pharmacists reported various actions that they can take. The pharmacists reported that actions such as physician referral, shifting to a more convenient medicine, monitoring and registering sales, denying sales, providing restrictive pack size, and storing products out of sight were the most beneficial to mitigate these issues.

“Community pharmacists are the only healthcare professionals who interact with customers in self-medication and provision of OTC medicines,” the investigators said. “Their involvement in consultation concerning OTC medicines use revealed problematic use in 1 of 5 encounters.”

READ MORE: OTC Resource Center

Are you ready to elevate your pharmacy practice? Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips straight to your inbox.

REFERENCES

1. Nagashima K, Nasu H, Sekine Y. Field survey on warnings to prevent drug abuse when selling over-the-counter drugs at drugstores. Explor Res Clin Soc Pharm. 2025;21:100690. Published 2025 Dec 3. doi:10.1016/j.rcsop.2025.100690

2. Algarni M, Hadi MA, Yahyouche A, Mahmood S, Jalal Z. A mixed-methods systematic review of the prevalence, reasons, associated harms and risk-reduction interventions of over-the-counter (OTC) medicines misuse, abuse and dependence in adults. J Pharm Policy Pract. 2021;14(1):76. Published 2021 Sep 13. doi:10.1186/s40545-021-00350-7