Gittins Rosalind, Missen Louise, Maidment Ian
Clinical Department, Humankind, Durham, UK.
Aston Pharmacy School, Aston University, Birmingham, UK.
Subst Abuse. 2022 Jul 11;16:11782218221111833. doi: 10.1177/11782218221111833. eCollection 2022.
Concerns about the misuse of over the counter (OTC) and prescription only medication (POM) are due to their impact upon physical/mental wellbeing, drug interactions and drug-related deaths. Improving an understanding of the pattern of use by people accessing specialist substance misuse services (SMSs) should enable improvements to treatment provision.
To review the literature on the misuse of OTC/POM among adults accessing SMS, including the pattern of use, types of medication and associated characteristics.
This review is reported in line with PRISMA. The protocol has been registered on PROSPERO (CRD42020135216) and separately published. A search of Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases and grey literature was undertaken. Only English language publications outlining OTC/POM misuse by adults in receipt of psychological/pharmacological interventions for substance misuse were included. Two reviewers conducted the title, abstract and full-text reviews using predetermined selection criteria and a piloted data extraction form to ensure a consistent approach. A third reviewer resolved disagreements and the Mixed Methods Appraisal Tool assessed for bias. Ethical approval was not required.
Thirteen studies with notable heterogeneity were included in the narrative synthesis after non-UK-based and ineligible publications were excluded, from the 143 potentially relevant papers. To reduce bias all studies were included in the analysis and GRADE-CERQual was applied. 'High confidence' was identified for all review findings, despite moderate methodological limitations. Antihistamine, benzodiazepine and opioid misuse was mentioned most frequently. Usage patterns and supply sources varied. Adverse consequences and polypharmacy are concerning. Withdrawal symptoms perpetuated misuse, often alongside illicit substance use, comorbid psychiatric/pain disorders and street drug shortages.
OTC/POM misuse is common amongst adults accessing SMS. A renewed approach to withdrawal management is required. The limited number of studies may impact on generalisability but allowed for a more detailed review. Restricting to UK studies improved relevance due to drug market variations and availability of medicines in different countries. Further UK-based research on OTC/POM misuse in SMS is needed to build upon the current paucity in the published literature.
对非处方（OTC）药和处方药（POM）滥用的担忧源于它们对身心健康、药物相互作用及药物相关死亡的影响。增进对使用专业药物滥用服务（SMS）人群用药模式的了解，应能改进治疗服务。
回顾关于使用SMS的成年人滥用OTC/POM的文献，包括用药模式、药物类型及相关特征。
本综述按照系统评价和Meta分析的首选报告项目（PRISMA）进行报告。方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42020135216）注册并单独发表。对Cochrane、OVID Medline、Pubmed、Scopus和科学引文索引数据库以及灰色文献进行了检索。仅纳入了概述接受药物滥用心理/药物干预的成年人滥用OTC/POM情况的英文出版物。两名审阅者使用预先确定的选择标准和试点数据提取表进行题目、摘要和全文审阅，以确保方法一致。第三名审阅者解决分歧，并使用混合方法评估工具评估偏倚。无需伦理批准。
在排除非英国的和不符合条件的出版物后，从143篇潜在相关论文中纳入了13项具有显著异质性的研究进行叙述性综合分析。为减少偏倚，所有研究均纳入分析并应用了GRADE-CERQual。尽管方法存在一定局限性，但所有综述结果均被确定为“高可信度”。抗组胺药、苯二氮䓬类药物和阿片类药物的滥用被提及得最为频繁。用药模式和供应来源各不相同。不良后果和多药联用令人担忧。戒断症状使滥用持续存在，通常与非法药物使用、共病精神/疼痛障碍和街头毒品短缺同时出现。
OTC/POM滥用在使用SMS的成年人中很常见。需要一种新的戒断管理方法。研究数量有限可能会影响研究结果的普遍性，但允许进行更详细的综述。由于不同国家药品市场的差异和药品供应情况，仅限于英国的研究提高了相关性。鉴于目前已发表文献的匮乏，需要在英国进一步开展关于SMS中OTC/POM滥用情况的研究。
