Over-the-counter drug abuse and misuse in Palestine

Abstract
The vast majority of non-prescription medications marketed over-the-counter (OTC) in
regional pharmacies are believed to be used properly by patients. However, a small
percentage of patients can misuse or abuse these medications. Many surveys in many
countries, for example, 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
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.[1] 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. [1] The questionnaire was sent to all community pharmacists in
Palestine's Nablus district. [1]

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. [1] 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. [1] 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. [1] 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. [1] 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. [1] 

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

Product group and client’s characteristics Relationships

Antitussives, Age, Gender
Antihistamines, Age, Gender
Laxatives, Age, Gender
Combination products, Age, Gender
Decongestants, Age, Gender
Simple analgesics, Age, Gender
Sedatives hypnotics and tranquilizers, 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
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] 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.