Over-the-counter drug abuse and misuse in Palestine

Abstract
Self-care and self-medication practices are essential components of Palestinian health care
systems. The use of over-the-counter (OTC) medications is a part of the self-medication
process. The popularity of OTC medication use among patients may increase the abuse
potential of OTC medications. Many surveys in many countries have shown that a large
percentage of OTC consumers misuse/abuse these medications. The term abuse refers to
the use of medications for non-medical reasons, while the expression misuse refers to the
use of a drug for medical purposes. Examples of OTC medications that are misused or
abused encompass a huge range of medication. Like amphetamines, ephedrine,
caffeine, that are stimulants used mainly to delay the onset of mental and physical fatigue.
Antitussives and expectorants that contain alcohol, codeine and dextromethorphan. Opioids
with psychoactive action present in cold and cough medications. Laxatives to promote
weight loss, anabolic steroids used to increase the muscle mass and even sildenafil may
be overly used in particular via addicts to counteract the sexual miserable results of opioids.

Introduction
The unique socioeconomic background in Palestine, which is marked by political and
economic tensions, has generated conditions that have aided the spread of drug abuse.
Palestinians are subjected to political unrest, house demolitions, arrests, movement bans,
and land encroachment. Palestinians use drug abuse as a coping strategy to cope with the
harsh and sometimes humiliating conditions they face.[1]

Changes in Palestinian family structure (e.g., from extended to nuclear families) have
resulted in a deterioration of relational and financial support structures within families,
whereas modern societal standards (e.g., from traditional cultural norms to liberal
individualistic western lifestyles) have developed conditions conducive to increased drug
abuse. The lack of a standard Palestinian authority and police system, as well as the internal
Palestinian conflict and poor legal enforcement of legislation, have all led to the rise in
Palestinian drug abuse.[1]

Given the persistent public concerns of drug abuse in Palestinian population it is somewhat
disappointing that few health-care practitioners are educated and trained in this field.
Pharmacists are the most important and accessible members of a health-care team.[1]

During the purchase of over-the-counter drugs, pharmacists are the first point of contact.
They are expected to track the use of over-the-counter medications in a particular
population. Pharmacists, for example, should be more cautious in the case of older patients
who take multiple drugs. Patients that come in with requests for repeated refills, including
OTC prescriptions, must also be tracked. By using their clinical expertise, providing oral and
written medication information, and building confidence among patients, pharmacists may
be more proactive in handling OTC medication abuse.[1]

While the potential for OTC medication misuse and abuse is obvious, no tools for
determining the scope of the issue have been established. The possibility that abusers will
frequent several pharmacies in an effort to acquire supplies while avoiding surveillance
complicates quantification. Furthermore, no study into this issue has been undertaken in
Palestine.[2] Some studies were conducted to collect information specifically from local
pharmacists about their understanding of the level of OTC substance misuse, the
medications concerned, and the sort of consumers that they accuse of abusing medicines for
quantification purposes the study produced a questionnaire to be answered anonymously by
volunteer pharmacists. [2] The questionnaire was sent to all community pharmacists in
Palestine's Nablus district. [2]

Suspected drug classes and characteristics of abusers/misusers.

According to the questionnaire, when questioned about the most widely abused/misused
drug types, 80.34% of respondents said antitussives were the most commonly
abused/misused type. [2] The bulk (52.6 %) of alleged antitussive clients were between the
ages of 20 and 40, and were mainly males, though some respondents reported seeing
female abusers. [2] Codeine (opioids)-containing antitussives were the most widely abused.
Antihistamines is another type of medication that 41.2% of responding pharmacists claimed
were abused/misused, with 23.7% of clients were between the ages of 20 and 40, and
mainly males. When asking about potential laxative abuse/misuse, 67% of respondents said
there was abuse/misuse of laxatives found in their pharmacies, with 33% of
abusers/misusers being between the ages of 20 and 40, and mainly females. [2] Patients
who abused laxatives were either trying to regulate their weight (females) or had a tendency
to defecate on a daily basis. Combination drugs products including more than one active
ingredient, like analgesics and decongestants or antihistamines in cold and flu formulations)
were listed as a potential drug of abuse/misuse by 49.5% of respondents. [2] Simple
analgesics, like nonsteroidal anti-inflammatory medications, paracetamol, and paracetamol-
containing medications, were also listed as a potential class of abuse/misuse by 70.1% of
respondents. Table 1 lists additional categories of potential abuse/misuse. [2] 

Table 1 - Distribution of clients according to age group, gender and abused/misused drugs.
[2]

Product group and client’s characteristics Relationships

Antitussives, Age, Gender
Antihistamines, Age, Gender
Laxatives, Age, Gender
Combination products, Age, Gender
20-40 years age group is more likely to be
suspected than all other age groups.
Males are more likely to be suspected than
females.
Only 9.3% respondents mentioned that
abuse/misuse is gender insensitive.
20-40 years age group is more likely to be
suspected than all other age groups.
Males are more likely to be suspected than
females.
20-40 years age group is more likely to be
suspected than all other age groups.
40-60 years age group is more likely to be
suspected than under 20 years of age.
Females are more likely to be suspected
than males.
20-40 years age group is more likely to be
suspected than all other age groups.
< 20 and 40-60 years age group are equally

Decongestants, Age, Gender
Simple analgesics, Age, Gender
Sedatives hypnotics and tranquilizers, Age,
Gender
suspected.
Males are more likely to be suspected than
females.
20-40 years age group is more likely to be
suspected than all other age groups.
Males are more likely to be suspected than
females.
20-40 years age group is more likely to be
suspected than all other age groups.
Males are more likely to be suspected than
females.
20-40 years age group is more likely to be
suspected than all other age groups.
Males are more likely to be suspected than
females.

References
[1] Q. X. Sujit S Sansgiry, Archita H Bhansali, Shweta S Bapat, “Abuse of
over-the-counter medicines : a pharmacist ’ s perspective,” pp. 1–
6, 2017.
[2] W. M. Sweileh, R. T. Arafat, L. S. Al-Khyat, D. M. Al-Masri, and N. A.
Jaradat, “A pilot study to investigate over-the-counter drug abuse
and misuse in Palestine,” Saudi Med. J., vol. 25, no. 12, pp. 2029–
2032, 2004.