Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market
Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs.
Objective: To examine the adult general public’s views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market.
Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old.
Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals’ recommendation. Differences in how OTCs are perceived were however found with regards to respondents’ country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash.
Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals’ recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.
2. Konsumentverket. Pharmacy market during the process of re-regulation. Report Swedish Consumer Agency 2011:9 (in Swedish). http://www.konsumentverket.se/Global/Konsumentverket.se/Best%c3%a4lla%20och%20ladda%20ner/rapporter/2011/2011_9_omregleringen_av_apoteksmarknaden.pdf (accessed 15 March 2016).
3. Hawton K, Bergen H, Simkin S, Arensman E, Corcoran P, Cooper J, Waters K, Gunnell D, Kapur N. Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study. BMC Public Health. 2011;11:460. doi: 10.1186/1471-2458-11-460
4. Holmström IK, Bastholm-Rahmner P, Bernsten C, Röing M, Björkman I. Swedish teenagers and over-the-counter analgesics - responsible, casual or careless use. Res Social Adm Pharm. 2014;10(2):408-418. doi: 10.1016/j.sapharm.2013.06.004
5. Hurwitz J, Sands S, Davis E, Nielsen J, Warholak T. Patient knowledge and use of acetaminophen in over-the-counter medications. J Am Pharm Assoc (2003). 2014;54(1):19-26. doi: 10.1331/JAPhA.2014.13077
6. Indermitte J, Reber D, Beutler M, Bruppacher R, Hersberger KE. Prevalence and patient awareness of selected potential drug interactions with self-medication. J Clin Pharm Ther. 2007;32(2):149-159.
7. Roumie CL, Griffin MR. Over-the-counter analgesics in older adults: a call for improved labelling and consumer education. Drugs Aging. 2004;21(8):485-498.
8. Wazaify M, Kennedy S, Hughes CM, McElnay JC. Prevalence of over-the-counter drug-related overdoses at Accident and Emergency departments in Northern Ireland--a retrospective evaluation. Clin Pharm Ther. 2005;30(1):39-44.
9. Westerlund LT, Marklund BR, Handl WH, Thunberg ME, Allebeck P. Nonprescription drug-related problems and pharmacy interventions. Ann Pharmacother. 2001 Nov;35(11):1343-1349.
10. Westerlund T, Andersson IL, Marklund B. The quality of self-care counselling by pharmacy practitioners, supported by IT-based clinical guidelines. Pharm World Sci. 2007 Apr;29(2):67-72.
11. Westerlund T, Gelin U, Pettersson E, Skärlund F, Wågström K, Ringbom C. A retrospective analysis of drug-related problems documented in a national database. Int J Clin Pharm. 2013;35(2):202-209. doi: 10.1007/s11096-012-9724-1
12. Westerlund T, Grenholm, A., Magnusson, M., Nemeth-Lundberg, E., Petterson-Droguet, E., Surkovic, S., Fäldt, A. Customer selection, knowledge and use of OTC analgesics and NSAIDs. FIP Pharmacy World Congress. Basle; 2008. http://fip.org/abstracts?page=abstracts&action=item&item=2194 (accessed 29 April 2015).
13. Blaiss MS, Dicpinigaitis PV, Eccles R, Wingertzahn MA. Consumer attitudes on cough and cold: US (ACHOO) survey results. Curr Med Res Opin. 2015;31(8):1527-1538. doi: 10.1185/03007995.2014.1002558
14. SCB. Registret över totalbefolkningen (RTB) (in Swedish). http://www.scb.se/sv_/Vara-tjanster/SCBs-data-for-forskning/SCBs-datalager/Registret-over-totalbefolkningen-RTB/ (accessed 29 April 2015).
15. SCB. Longitudinell integrationsdatabas för sjukförsäkrings- och arbetsmarknadsstudier (LISA) (in Swedish). http://www.scb.se/lisa/ (accessed 29 April 2015).
16. SCB. Meddelande i samordningsfrågor (MIS) 1999:1 (in Swedish). http://www.scb.se/sv_/Dokumentation/Publikationer-om-statistiska-metoder/ (accessed 29 April 2015).
17. Lundström S, Särndal CE. Estimation in the Presence of Nonresponse and Frame Imperfections. Statistics Sweden 2001.
18. Statistical Analysis System (SAS). Cary, NC, USA; 2015.
19. Håkonsen H, Sundell KA, Martinsson J, Hedenrud T. Consumer preferences for over-the-counter drug retailers in the reregulated Swedish pharmacy market. Health Policy. 2016;120(3):327-333. doi: 10.1016/j.healthpol.2016.01.016
20. Cuzzolin L, Benoni G. Safety of non-prescription medicines: knowledge and attitudes of Italian pharmacy customers. Pharm World Sci. 2010;32(1):97-102. doi: 10.1007/s11096-009-9348-2
21. Calamusa A, Di Marzio A, Cristofani R, Arrighetti P, Santaniello V, Alfani S, Carducci A. Factors that influence Italian consumers' understanding of over-the-counter medicines and risk perception. Patient Educ Couns. 2012;87(3):395-401. doi: 10.1016/j.pec.2011.10.003
22. Wilcox CM, Cryer B, Triadafilopoulos G. Patterns of use and public perception of over-the-counter pain relievers: Focus on nonsteroidal antiinflammatory drugs. J Rheumatol. 2005;32(11):2218-2224.
23. Schmiedl S, Rottenkolber M, Hasford J, Rottenkolber D, Farker K, Drewelow B, Hippius M, Saljé K, Thürmann P. Self-medication with over-the-counter and prescribed drugs causing adverse-drug-reaction-related hospital admissions: results of a prospective, long-term multi-centre study. Drug Saf. 2014;37(4):225-235. doi: 10.1007/s40264-014-0141-3
24. Simoens S, Lobeau M, Verbeke K, van Aerschot A. Patient experiences of over-the-counter medicine purchases in Flemish community pharmacies. Pharm World Sci. 2009;31(4):450-457. doi: 10.1007/s11096-009-9293-0
25. Brabers AE, Van Dijk L, Bouvy ML, De Jong JD. Where to buy OTC medications? A cross-sectional survey investigating consumers' confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers. BMJ Open. 2013;3(9):e003455. doi: 10.1136/bmjopen-2013-003455
26. Wazaify M, Shields E, Hughes CM, McElnay JC. Societal perspectives on over-the-counter (OTC) medicines. Fam Pract. 2005;22(2):170-176
27. Villako P, Volmer D, Raal A. Factors influencing purchase of and counselling about prescription and OTC medicines at community pharmacies in Tallinn, Estonia. Acta Pol Pharm. 2012;69(2):335-340.
28. Paut Kusturica M, Tomas A, Sabo A. Disposal of unused drugs: Knowledge and behavior among people around the world. Rev Environ Contam Toxicol. 2017;240:71-104.