Abuse of Dextromethorphan, Naphazoline, and Carbamazepine in Community Pharmacies and Health Centers
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Keywords
Dextromethorphan, naphazoline, carbamazepine, abuse, OTC drugs, pharmacists and physicians
Abstract
Purpose: This study aims to collect data on the prevalence of abuse of dextromethorphan, naphazoline, and Carbamazepine from pharmacies and comprehensive health centers in Al-Karak, Jordan. Moreover, it seeks to understand the medical staff awareness and knowledge of this issue. Method: This cross-sectional study was conducted between July 2023 and October 2023 and two questionnaire forms were constructed. The first one was handed to pharmacists in twenty community pharmacies in Al-Karak. The second one was distributed to physicians who work in five comprehensive health centers in the same area. Results and conclusion: This study showed that cold and cough medications containing dextromethorphan and ophthalmic solutions containing naphazoline are the most widely abused OTC drugs (55% and 45%, respectively). Most pharmacists (95%) agreed that dextromethorphan can cause euphoria and hallucination at high doses, and 80% recognized that naphazoline can cause similar effects. All physicians (100%) stated that OTC drugs can be abused, and all participants reported that dextromethorphan and naphazoline can cause euphoria and hallucinations if overused. Most participants from both pharmacies and health centers had faced suspected cases of OTC drug abuse. Almost 95% of pharmacists suspected the abuse of dextromethorphan and naphazoline, and 60% noted that suspicious customers were both regular and strangers. Among health center participants, 80% prescribed these drugs daily, while 20% prescribed them 2 to 6 days per week. The main reasons for abuse were identified as these drugs were non-prescribed and easily accessible. Regarding carbamazepine abuse, which is a prescribed drug, 55% of pharmacists stated that carbamazepine has a potential for abuse, and the demand for it had increased recently. Moreover, 65% reported that people often requested multiple packs at once. Among physicians, 80% stated that carbamazepine has a potential for abuse and 40% observed that specific individuals requested carbamazepine more frequently than others did and displayed signs and symptoms of carbamazepine abuse
References
2. Nomura K, Kitagawa Y, Yuda Y, Takano-Ohmuro H. Medicine reclassification processes and regulations for proper use of over-the-counter self-care medicines in Japan. Risk Manag Healthc Policy. 2016;9:173-183.
3. Cohen BR, Mahoney KM, Baro E, et al. FDA initiative for drug facts label for over-the-counter naloxone. N Engl J Med. 2020;382(22):2129-2136.
4. Schifano F, Chiappini S, Miuli A, et al. Focus on over-the-counter drugs’ misuse: a systematic review on antihistamines, cough medicines, and decongestants. Front Psychiatry. 2021;12:657397.
5. 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 medicines misuse, abuse and dependence in adults. J Pharm Policy Pract. 2021;14(1):1-16.
6. Volkow ND. Prescription drug abuse. National Institute on Drug Abuse. 2010;22.
7. Al-Khalaileh W, Abu-Farha R, Wazaify M, Van Hout MC. Ophthalmic drug abuse: An observational study from community pharmacies. Res Social Adm Pharm. 2019;15(8):943-948.
8. Cooper RJ. Over-the-counter medicine abuse–a review of the literature. J Subst Use. 2013;18(2):82-107.
9. Partnership for a Drug-Free America. The partnership attitude tracking study. New York: Partnership for a Drug-Free America; 2005.
10. Abbott FV, Fraser MI. Use and abuse of over-the-counter analgesic agents. J Psychiatry Neurosci. 1998;23(1):13.
11. Albsoul-Younes A, Tahaineh L, Moumani B. Parents’ knowledge, perception, and practices of over-the-counter medicines used for their children. Jordan J Pharm Sci. 2011;4(3):181-189.
12. Ravichandran A, Basavareddy A. Perception of pharmacists regarding over-the-counter medication: A survey. Indian J Pharmacol. 2016;48(6):729.
13. Wazaify M, Shields E, Hughes CM, McElnay JC. Societal perspectives on over-the-counter (OTC) medicines. Fam Pract. 2005;22(2):170-176.
14. Bond C, Hannaford P. Issues related to monitoring the safety of over-the-counter (OTC) medicines. Drug Saf. 2003;26:1065-1074.
15. Hughes CM, McElnay JC, Fleming GF. Benefits and risks of self medication. Drug Saf. 2001;24:1027-1037.
16. National Institute on Drug Abuse. Over-the-Counter Medicines DrugFacts. 2017.
17. Albsoul-Younes A, Wazaify M, Yousef AM, Tahaineh L. Abuse and misuse of prescription and nonprescription drugs sold in community pharmacies in Jordan. Subst Use Misuse. 2010;45(9):1319-1329.
18. Zaremba M, Serafin P, Kleczkowska P. Antipsychotic drugs efficacy in dextromethorphan-induced psychosis. Biomedicines. 2023;11(1):123.
19. Spangler DC, Loyd CM, Skor EE. Dextromethorphan: a case study on addressing abuse of a safe and effective drug. Subst Abuse Treat Prev Policy. 2016;11(1):1-7.
20. Logan BK. Combined dextromethorphan and chlorpheniramine intoxication in impaired drivers. J Forensic Sci. 2009;54(5):1176-1180.
21. Logan BK, Goldfogel G, Hamilton R, Kuhlman J. Five deaths resulting from abuse of dextromethorphan sold over the internet. J Anal Toxicol. 2009;33(2):99-103.
22. Logan BK, Yeakel JK, Goldfogel G, Frost MP, Sandstrom G, Wickham DJ. Dextromethorphan abuse leading to assault, suicide, or homicide. J Forensic Sci. 2012;57(5):1388-1394.
23. Al-Khalaileh W, Wazaify M, Van Hout MC. The misuse and abuse of ophthalmic preparations: a scoping review of clinical case presentations and extant literature. Int J Ment Health Addict. 2018;16:1055-1084.
24. Wazaify M, Alali MB, Yousef MA, Qammaz S. Ophthalmic drops abuse in community pharmacy setting: A cross-sectional study from Jordan. J Subst Use. 2017;22(6):656-660.
25. Wazaify M, Abood E, Tahaineh L, Albsoul-Younes A. Jordanian community pharmacists’ experience regarding prescription and nonprescription drug abuse and misuse in Jordan–An update. J Subst Use. 2017;22(5):463-468.
26. Wazaify M, Scott J. Prescription/non-prescription medicine misuse and regulation–time for a modern, fit for purpose approach. J Pharm Pract Community Med. 2017;3(4):197-199.
27. Post RM, Ketter TA, Uhde T, Ballenger JC. Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: principles and practice. CNS Drugs. 2007;21:47-71.
28. Sansgiry SS, Bhansali AH, Bapat SS, Xu Q. Abuse of over-the-counter medicines: a pharmacist’s perspective. Integr Pharm Res Pract. 2016;5:1-6.
29. Alhrerat KA, Zakaraya Z, Dayyih WA, Hailat M, Hamad M, Alabbadi I. Decriminalization of narcotics in Jordanian legislation: Theory and practice. Jordan J Pharm Sci. 2023;16(3):541-549.
30. Al-Banna SR, Moh’d Khair Al-Zarrad F. The effect of play therapy on the reduction of post traumatic stress disorder in abused children. EC Psychol Psychiatry. 2018;7:701-714.
31. Levine DA. ‘Pharming’: the abuse of prescription and over-the-counter drugs in teens. Curr Opin Pediatr. 2007;19(3):270-274.
32. Silverstein FS, Parrish MA, Johnston MV. Adverse behavioral reactions in children treated with carbamazepine (Tegretol). J Pediatr. 1982;101(5):785-787.
33. Stuppaeck CH, Whitworth AB, Fleischhacker WW. Abuse potential of carbamazepine. J Nerv Ment Dis. 1993;181(8):519-520.
34. Crawford P, Fisher B. Recreational overdosage of carbamazepine in Paisley drug abusers. Scott Med J. 1997;42(2):44-45.
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