Abstract
BackgroundDependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally. However, relatively little is known about those affected, particularly in relation to their management at drug dependence treatment centres. This study aimed to explore the views and experiences of health care professionals (HCPs) working in formal drug treatment services in relation to supporting clients with prescription and OTC drug dependence.MethodsAn exploratory, qualitative design was used involving semi-structured telephone interviews. 15 staff were recruited using purposive sampling to represent a variety of different professional roles, funding (NHS, charity and local government) and geographical locations across England. Transcribed interviews were analysed using Braun and Clarke’s six stage thematic analysis.ResultsCurrent services were considered to be inappropriate for the treatment of OTC and prescription drug dependence, which was perceived to be a significantly under-recognised issue affecting a range of individuals but particularly those taking opioid analgesics. Negativity around current treatment services involved concerns that these were more suited for illicit drug users and this was exacerbated by a lack of specific resources, funding and commissioning. There was a perceived variation in service provision in different areas and a further concern about the lack of formal treatment guidelines and care pathways. Participants felt there to be stigma for affected clients in both the diagnosis of OTC or prescription drug dependence and also attendance at drug treatment centres which adversely impacted service engagement. Suggested service improvements included commissioning new specific services in general practices and pain management clinics, developing national guidelines and care pathways to ensure equal access to treatment and increasing awareness amongst the public and HCPs.ConclusionsThis study reveals considerable negativity and concern about current treatment services for prescription and OTC drug dependence in England from the perspective of those working in such services. Policy and practice improvement are suggested to improve outcomes for this neglected group in relation to increasing funding, guidelines and awareness.
Highlights
Dependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally
A related concern is the lack of evidence to inform specific clinical guidelines for licit opioid dependent treatment [7, 8]; the most recent United Kingdom (UK) guidelines for drug misuse and dependence, published in 2017 remain centred around illicit drug treatment [9] and it has been noted that: “overall, the evidence base to determine practice is weak [and] patients solely dependent on prescription or OTC opioids may respond differently than heroin dependent patients [...]” [9] pp 205–206
Representation from a wide geographical area was undertaken as literature suggests there is regional variation in the UK of opioid prescribing, and based on variation identified in National Drug Treatment Monitoring System (NDTMS) data obtained via a freedom of information request from Public Health England [3, 20]
Summary
Dependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally. This study aimed to explore the views and experiences of health care professionals (HCPs) working in formal drug treatment services in relation to supporting clients with prescription and OTC drug dependence. The problematic use of licit drugs, including those available over-the-counter (OTC) from pharmacies, on prescription and over the Internet represent an increasingly important public health problem in England and many other countries. Despite attempts to prevent harm through legislation to license and restrict supplies, and provide training in appropriate prescribing, there were 9231 presentations at formal drug treatment services in 2016/2017 in England related to dependence to OTC or prescription drugs with males, and individuals aged between 35 and 54 years old being more likely to present [3]. A related concern is the lack of evidence to inform specific clinical guidelines for licit opioid dependent treatment [7, 8]; the most recent UK guidelines for drug misuse and dependence, published in 2017 remain centred around illicit drug treatment [9] and it has been noted that:
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
