American Journal of Clinical Medicine Research, 2018, Vol. 6, No. 2, 35-40
Available online at http://pubs.sciepub.com/ajcmr/6/2/3
©Science and Education Publishing
DOI:10.12691/ajcmr-6-2-3
Social Knowledge and Attitude
toward Over-the-Counter Drug Use
Malak Khalifeh
1,2,*
, Nicholas Moore
1
, Pascale Salameh
2
1
INSERM U 657 - Pharmaco-épidémiologie et évaluation de l'impact des produits de santé sur les populations,
University Bordeaux Segalen, Bordeaux, France
2
Clinical & Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
*Corresponding author: malak.k9@hotmail.com
Abstract Introduction: With the increasing range of potent medicines available for sale 'over-the-counter' (OTC)
in community pharmacies and the absence of data in Lebanon related to OTC abuse, this study sought to find
opinions of the public regarding OTC medicines generally and explore views around potential misuse and abuse.
Method: A cross sectional study was conducted in a community-based pharmacy setting in Lebanon. A structured
random interview was used to patients visiting community pharmacy seeking for OTC drugs. Baseline
characteristics and reason for self-medication were collected. The questionnaire consists of sections about sources
and reasons of self-medication, attitudes towards community pharmacy and patient contact with pharmacies,
attitudes towards the use of OTC medicines; views on OTC medicines’ use in terms of safety, potency and
effectiveness. Result: Overall this study revealed the knowledge and attitude of general public toward OTC use in
Lebanon. Self-presentation on previous experience of the same medication or through pharmacist advice. Almost
half requested OTC medications more than twice per year. This show the important role of pharmacist in guiding the
patients on the correct OTC use. Around 60% agreed that some non-prescription medicines may cause dependency
or addiction if taken for a long period of time. Conclusion: The findings of this research should form the basis for
future interventional plans to maximize benefits and minimize risks of self-medication practice. Educational
programs to population, pharmacists and health care providers should be implemented to limit the potential
misuse/abuse of these medicines.
Keywords: self-medication, OTC, Lebanon, public views, knowledge, attitude
Cite This Article: Malak Khalifeh, Nicholas Moore, and Pascale Salameh, “Social Knowledge and Attitude
toward Over-the-Counter Drug Use.” American Journal of Clinical Medicine Research, vol. 6, no. 2 (2018):
35-40. doi: 10.12691/ajcmr-6-2-3.
1. Introduction
One of the quiet revolution occurring in our pharmaceutical
industry is the transformation of prescription medications
to over the counter medications ((OTC) referred to
non-prescription medications or self-medications). Although
OTC drugs are believed to be safe and effective, indeed
they are not. They mask the underlying disease and may
cause several adverse effects [1], with increased risks of
interactions and adverse reactions and of self-treatment
being undertaken when medical aid should have been
sought. [2,3] There is also the potential for misuse and
abuse of such products [4].
The misuse of codeine products is an emerging public
health challenge in many countries around the world, in
part because such products are present in a range of OTC
medicines regularly dispensed without prescription to the
public[5]. The greatest proportion of evidence on codeine
misuse and dependence is from the United States (US)
where codeine based products are not available over the
counter, with smaller proportions (but not directly
comparable) of studies on OTC codeine use and misuse
conducted in the United Kingdom (UK) and Australia.
A recent review on the changing patterns of codeine
based product use was conducted by Reed et al., (2011)
and reported on levels of public awareness of misuse
potential, and pharmacists’ continued concerns for misuse.
[6] Reed et al., (2011) observed the need for further
investigation, as OTC codeine based drugs become
available, either as sold by and under supervision of a
pharmacist or sold off the shelf from any outlet. [6] A
clearer understanding of the general public’s awareness on
the potential risks of codeine use, misuse and dependence,
and impact of pharmacy controls of codeine is needed
[6,7]. Although effects are milder than heroin, abuse
potential remains of concern, with physical dependence
occurring with regular use over a short period of time. [8]
According to the EMCDDA Annual Report in 2010, the
misuse of prescribed and OTC medication, and the sale of
counterfeit medicines sold for therapeutic and non-
therapeutic use is now under consideration within the
European Pharmaco-vigilance system, which operates
under the responsibility of the European Medicines
Agency, and collaborates with the EMCDDA on drug
misuse issues. The report underscores the need for timely
responses from pharmaceutical and drug control regulatory