Nonprescription Use Research Articles

Antioxidant use in Friedreich ataxia

Many antioxidants have been suggested as potential treatments for Friedreich ataxia, but have not been tested in clinical trials. We found that a majority of patients in our cohort already use such antioxidants, including idebenone, which is not available at a pharmaceutical grade in the United States. Younger age, cardiomyopathy and shorter GAA repeat length were independent predictors of idebenone use, but no factors predicted use of other antioxidants. This confirms that non-prescription antioxidant use represents a major confounder to formal trials of existing and novel agents for Friedreich ataxia.

Perceived antigay discrimination and physical health outcomes.

Theories of minority stress posit that experiences of discrimination are stressful events with the potential to cause mental and physical illness. Although some empirical studies have demonstrated a positive linear association between perceived discrimination and a variety of health outcomes, 2 studies of African Americans have revealed that those of lower occupational status who report no discrimination have higher tonic blood pressure compared with those who report modest amounts of discrimination. The authors of the present study sought to determine if this provocative pattern of findings could be replicated using a different population and different health outcomes. Gay and bisexual men (n = 361) were recruited through outreach to venues and community events and through advertising in local publications. They responded to survey questions using a self-administered paper questionnaire, the Internet, or a telephone. Men self-reported their frequency of nonprescription medication use, number of physician visits, and number of sick days from work during the past year. Perceived discrimination interacted with participant education, yielding an association between discrimination and health outcomes that was curvilinear (U-shaped) among men with lower education and an association that was positive among men with relatively higher education. This unusual pattern of results in gay and bisexual men replicates the findings from previous research with African American men and suggests that failing to recognize or acknowledge discrimination can have negative health consequences for some individuals from marginalized groups.

Patient care interventions by pharmacy students in the intensive care unit

The effect on patient outcomes of including pharmacists as members of a multidisciplinary team in a hospital setting is well established.1,–4 Pharmacists and pharmacy students have demonstrated positive effects on patient care outcomes, including preventing adverse drug reactions (ADRs) and medication errors, improving patient satisfaction and quality of life, and improving economic outcomes.1,–8 We undertook a project to determine the number of interventions by pharmacy students and the acceptance of recommendations during their acute critical care rotation at the Ralph H. Johnson Veterans Affairs (VA) Medical Center in Charleston, South Carolina. This project was originally implemented as part of the students’ evaluations and then turned into a monthly quality assurance presentation to pharmacy staff and administrators. The institutional review board approved the presentation of this project. Pharmacy students rounded with a team of physicians in the medical intensive care unit (ICU) during their four-week clinical clerkship. All activities performed by the students were part of routine patient care activities. All patients followed by the students were assessed for venous thromboembolism (VTE) and stress ulcer prophylaxis. Patients were assigned to the students by the preceptor on the basis of the patient’s diagnosis, acuity, number of potential medication issues identified, and student interest. Each medication in the patient profile was reviewed for its appropriate indication and dosage. Laboratory data were reviewed for all patients, and appropriate monitoring parameters were recommended for each prescribed medication. In addition, all able and willing patients were interviewed regarding nonprescription, herbal, alternative, and non-VA-prescribed and self-prescribed medication use. Students also monitored warfarin effect, performed pharmaco-kinetic calculations, and participated in the reporting of medication errors and ADRs. Some interventions were identified with the help of the preceptor. The preceptor was not able to attend rounds but was available to answer questions. All recommendations were reviewed with the preceptor before they were discussed with team members. Each intervention was documented in the patient chart, reviewed, and cosigned by the preceptor. Recommendations were also discussed orally with team members when feasible. The fundamental scope of practice and activities performed were based on published guidelines.9,–11 Data were collected from four separate pharmacy students from July 1, 2004, to October 30, 2004.

Nonsteroidal Antiinflammatory Drug Use and Breast Cancer Risk: Subgroup Findings

Nonsteroidal antiinflammatory drugs (NSAIDs) may play a role in breast cancer prevention; however, breast cancer subtypes and lifestyle/host factors may influence their impact. During 1996-1998 in Canada, the authors examined the association between regular NSAID use (defined as daily use for at least 2 months) and breast cancer risk by estrogen receptor (ER) and progesterone receptor (PR) status, cigarette smoking exposure, and history of arthritis. Breast cancer cases (n = 3,125, including 1,600 ER+PR+ and 591 ER-PR-) and an age-matched, random sample of controls (n = 3,062) completed a general risk factor questionnaire, including detailed questions on prescription and nonprescription NSAID use. NSAID use was associated with reduced risk of breast cancer (odds ratio = 0.76, 95% confidence interval: 0.66, 0.88). The association was not significantly different for ER+PR+ (odds ratio = 0.71, 95% confidence interval: 0.60, 0.84) and ER-PR- cancers (odds ratio = 0.80, 95% confidence interval: 0.62, 1.03) (p(heterogeneity) = 0.66). The magnitude of the NSAID inverse association was similar for women with and without arthritis and across smoking strata (risk estimates ranged from 0.74 to 0.84). Breast cancer risk tended to decrease with increasing duration of NSAID use and was generally lowest for >or=7 years of use, and both acetylsalicylic acid and non-acetylsalicylic acid use were associated with reduced risks.

A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century

Background Several studies have examined the use of psychoactive substances among selected groups in Nigeria. Here, we extend the description to include the features of substance dependence. Method A stratified multi-stage random sampling of households was used to select respondents in 21 of Nigeria's 36 states (representing 57% of the national population). In-person interviews with 6752 adults were conducted using the World Health Organization Composite International Diagnostic Interview, Version 3. Lifetime history and recent (past year) use, as well as features of dependence on, alcohol, tobacco, cannabis, sedatives, stimulants, and other drugs were assessed. Results Alcohol was the most commonly used substance, with 56% (95% confidence interval, CI = 54, 58%) ever users and 14% (95% CI = 13, 15%) recent (past year) users. Roughly 3% were recent smokers (3%, 95% CI = 2.6, 4.2%). Next most common were sedatives, 4% (95% CI = 2.3, 4.5%), and cannabis smokers, 0.4% (95% CI = 0.1, 0.6%). Males were more likely than females to be users of every drug group investigated, with male preponderance being particularly marked for cannabis. Prevalence of both alcohol and tobacco use was highest among middle aged adults. Moslems were much less likely to use alcohol than persons of other faiths, but no such association was found for tobacco, non-prescription drug use, or illegal drug use. Features of abuse and dependence were more common at the population level for alcohol; but among users, these features were just as likely to be experienced by alcohol users as they were by other drug users. Conclusion Alcohol is the most commonly used psychoactive drug in Nigeria. Features associated with drug dependence and abuse are less prevalent but may require attention by public health authorities.

Non-prescription antibiotic use in Hungary

To estimate the extent, prevalence, and trends in non-prescription antibiotic use in Hungary between 2000 and 2004 at national and regional levels. To identify determinants of nonprescription antibiotic use. Data on non-prescription sales of systemic antibiotics (Anatomical Therapeutic Chemical (ATC) class J01) were analyzed over a five-year period. The 2004 version of the World Health Organisation ATC/defined daily dose (DDD) methodology was used to quantify antibiotic consumption. Non-prescription antibiotic sales were expressed as number of DDD per 1,000 inhabitants per day and as a percentage (%) of total antibiotic use. Further measurement units were introduced for better understanding of consumption and to seek an association between price, prescription antibiotic use, and non-prescription antibiotic use. During the study period nationwide non-prescription sales of antibiotics increased threefold and reached nearly 2% prevalence in 2004. Substantial interregional differences were detected in both the level and the share of non-prescription antibiotics sales. Ten drugs were responsible for 90% of non-prescription antibiotic sales in 2004 (doxycyline, co-amoxiclav, co-trimoxazole, penamecillin, ampicillin, amoxicillin, clindamycin, clarithromycin, norfloxacin, and cefuroxime); of these, doxycycline was the number one nonprescription antibiotic in all five years. A relationship was found between price and non-prescription antibiotic use (R = -0.732, P = 0.016). Despite the prescription-only status of antibiotics in Hungary, non-prescription sales occur. A further increase in non-prescription sales of antibiotics could be prevented by strict law enforcement, price augmentation, and intervention focusing on pharmacist and the general public. More detailed studies are needed to identify other sources and causes of self-medication.

Medication use and the risk of breast cancer

To investigate whether the use of commonly-prescribed medications, primarily antihypertensives and antidepressants, is associated with an increased risk of breast cancer. Participants from a population-based case-control study were re-contacted 5-8 years after the original study regarding prescription and non-prescription medication use during the 10 years prior to diagnosis. Controls (n = 647) were frequency-matched to the cases (n = 600) by 5-year age groups. Medication use information was obtained during a telephone interview, and participants were sent the questionnaire in advance to facilitate recall. Odds ratios and 95% confidence intervals were estimated using conditional logistic regression. A slightly increased risk of breast cancer was associated with use of calcium channel blockers (CCBs), but there was no trend with increasing duration or recency of use. Breast cancer risk was not associated with use of antidepressants, beta blockers, corticosteroids, or non-steroidal anti-inflammatory drugs. Results were similar when analyses were restricted to cases with localized disease. These results support previous findings that CCBs may be associated with modest increases in breast cancer risk, but not findings that non-steroidal anti-inflammatory use reduces risk.

Diverting Drugs: Teens and Misuse of Psychoactive Prescription Drugs

Several surveys have highlighted increases in the nonprescribed use of prescription drugs among adolescents. In the current study, researchers

Ambulatory Care: Efficacy and Safety of Oral Phenylephrine: Systematic Review and Meta-Analysis

Oral phenylephrine is used as a decongestant, yet there has been no previously published systematic review supporting its efficacy and safety. To assess the efficacy and safety of oral phenylephrine as a nonprescription decongestant. MEDLINE, the Cochrane Central Registry of Controlled Trials, EMBASE, International Pharmaceutical Abstracts, and the Federal Register were searched for English and non-English-language studies published through January 2007 that measured the effects of oral phenylephrine on nasal airway resistance (NAR) in patients with nasal congestion. The retrieved studies were supplemented with information from our personal files and by hand searches of the references in any of the studies. Additionally, a Web of Science Search was conducted using the Cited Reference function for all published clinical trials identified. Studies included in the analysis were randomized, placebo-controlled trials; studies of combination products were excluded. Two investigators independently extracted data on NAR, self-reported decongestant effects, and cardiovascular effects (ie, heart rate, blood pressure) from each of the included studies. Meta-analyses were performed for NAR and cardiovascular effects using a random effects model. Subjective decongestant effects were summarized. Based on 8 unpublished studies that included 138 patients, phenylephrine 10 mg did not affect NAR more than placebo; the mean maximal difference in relative change from baseline between phenylephrine and placebo was 10.1% (95% CI -3.8% to 23.9%). Eight unpublished studies on phenylephrine 25 mg showed a significant reduction of maximal NAR compared with placebo of 27.6% (95% CI 17.5% to 37.7%). There was significant heterogeneity among the studies included in this analysis, which was partially attributable to different laboratories and methods used. Patient-reported decongestion was not consistently better for any phenylephrine dose compared with placebo, and NAR was a more sensitive measurement of efficacy. Phenylephrine showed no consistent effect on heart rate or blood pressure for doses of 25 mg or less. There is insufficient evidence that oral phenylephrine is effective for nonprescription use as a decongestant. The Food and Drug Administration should require additional studies to show the safety and efficacy of phenylephrine.

Use of Nonprescription Dietary Supplements for Weight Loss Is Common among Americans

Objective Dietary supplements are not recommended as part of a weight-loss program due to concerns about efficacy and safety. This study sought to assess prevalence and duration of nonprescription weight-loss supplement use, associated weight-control behaviors, discussion of use with a health care professional, and specific ingredient use. Participants and Design Adults aged ≥18 years (n=9,403) completed a cross-sectional population-based telephone survey of health behaviors from September 2002 through December 2002. Statistical Analyses Performed Both χ 2 and t tests were conducted for categorical and mean comparisons and multiple variable logistic regression was used to determine significant predictors. Results An estimated 15.2% of adults (women 20.6%, men 9.7%) had ever used a weight-loss supplement and 8.7% had past year use (women 11.3%, men 6.0%); highest use was among women aged 18 to 34 years (16.7%). In regression models, use was equally prevalent among race/ethnic groups and education levels. One in 10 (10.2%) of users reported ≥12 month use, with less frequent long-term use in women (7.7%) than men (15.0%), P=0.01. Almost one third (30.2%) of users discussed use during the past year; 73.8% used a supplement containing a stimulant including ephedra, caffeine, and/or bitter orange. Conclusions Use of supplements for losing weight seems to be common among many segments of the US adult population. Many adults are long-term users and most do not discuss this practice with their physician. Most of the weight-loss supplements taken contain stimulants. Qualified professionals should inquire about use of supplements for weight loss to facilitate discussion about the lack of efficacy data, possible adverse effects, as well as to dispel misinformation that may interfere with sound weight-management practices.

Diet quality among a community sample of Latinas reporting drug and alcohol use; The Latino Women’s Study

Background: Substance use is known to negatively impact health through direct toxicity of drugs on metabolism, substance using lifestyle and poor dietary intake. Hispanic women (Latinas) have not been the focus of substance use research because their rates of use tend to be lower compared to Latinos. Yet, Latinas enter substance use treatment with more severe medical conditions than their male counterparts. Objective: To determine whether diet quality of Latinas who use substances is different from those who do not. Method: 320 Latinas were recruited from Miami, FL. After signed informed consent, a 24 hour dietary recall, the Drug Use Frequency Questionnaire and the Health and Daily Living Form were administered. We calculated the Healthy Eating Index (HEI), a measure of diet quality based on conformance to Federal dietary guidelines. Substance users (n=153) were defined as those reporting illicit drug use, non-prescribed use of sedatives, and/or >5 alcoholic beverages on one occasion at least once a month in the past year. Results: ANOVA indicated substance using Latinas had lower mean HEI scores than non using (n=167) (60.4±12 vs. 64.5±12 p=.002). Similarly, substance users had lower HEI component scores with respect to fruit consumption (5.0±4 vs. 3.2±3.7 p<.05) and variety of diet (8.9±2.3 vs. 8.2±2.8 p=.03). Conclusions: Diet quality among substance using Latinas is compromised and needs improvement. This group should receive nutrition counseling to meet dietary guidelines. Funded by NIDA grant #1F31 DA020205-01A1

Ibuprofen: A Journey from Prescription to Over-the-Counter Use

Ibuprofen was the first non-aspirin non-steroidal antiinflammatory drug (NSAID) to be approved for over-the-counter (OTC) use and is widely considered to be the best tolerated drug of its class. Low-dose, OTC ibuprofen has been used for pain relief for over 30 years without any obvious major health issues. However, there is no clear differentiation between the OTC and prescription doses of ibuprofen, and their respective effects. Adverse reactions to ibuprofen appear to be dose and duration dependent, and this may be the reason for the observed tolerability of the drug at OTC doses. OTC ibuprofen is at least as effective as aspirin and more effective than paracetamol. The tolerability concerns associated with higher dose NSAIDs currently do not apply to low-dose, short-term use of ibuprofen for common pain. Ibuprofen is associated with the least risk of GI complications compared with other NSAIDs and is considered relatively benign in overdose. This review will aim to distinguish the safety of OTC or non-prescription use of ibuprofen from its prescription use.

Maintenance Treatment of Opioid Dependence and Patterns of Non-Prescribed Drug Use: Results of a 4-Year Trial

Maintenance Treatment of Opioid Dependence and Patterns of Non-Prescribed Drug Use: Results of a 4-Year Trial

Prevalence and determinants of dietary supplement and non‐prescription medicine use by men and women over 53 years old in Taiwan. Results from a population‐based cross‐sectional survey

Objectives: This study investigated the prevalence and determinants of the use of dietary supplements and non‐prescription medicines by older adults in Taiwan. Methods: Data are from the 1999 Survey of Health and Living Status of the Elderly in Taiwan. The survey involved a national random sample of 2360 men and 2080 women, 53 years or older. Results: Overall, 32.4% of elderly men and 42.7% of elderly women used at least one kind of dietary supplement during the past 12 months. Approximately 16% of elderly men and 19% of elderly women used multivitamin and mineral supplements, 10.5 and 22% used calcium, and 10 and 14% used vitamin E, respectively. Conclusions: The rates of supplement use are generally lower than those observed in the USA but comparable to that in other industrialised countries. Elderly who are females or who are more highly educated or physically more active are more frequent supplement users.

Nonprescription Drug Therapy: Issues and Opportunities

Nonprescription drug therapy is tightly woven into the fabric of American health care. Market forces are expected to contribute to significant expansion of nonprescription drug use. Consumers place high value on nonprescription drug therapy; however, self-medicating patients frequently need assistance from a learned intermediary to assure optimal integration of nonprescription drug therapy into the total care regimen. Pharmacist-assisted self-care holds vast potential to serve the public interest, but this expanded practice role will require higher levels of professional practice commitment by American pharmacy. That commitment must be supported by practice-relevant, competency-based, patient-centered college and school of pharmacy curricula and continuing education that assures perpetual intellectual proficiency in nonprescription drug pharmacotherapy. That knowledge and competency must be integrated holistically into the total mix of patient comorbidity and polypharmacy. The pharmacist-assisted self-care business and professional practice model must be further facilitated by state and national pharmacy organizations, chain and independent community pharmacy, pharmacy wholesalers, and others. Consumers await expanded and differentiated pharmacy-based, pharmacist-provided medication therapy management services focused on the safe, appropriate, and effective selection, use, and monitoring of nonprescription drugs therapy.

Interactive Effects of the Serotonin Transporter 5-HTTLPR Polymorphism and Stressful Life Events on College Student Drinking and Drug Use

A common functional polymorphism, 5-HTTLPR, in the serotonin transporter gene has been associated with heavy drinking in college students. We examined this polymorphism as it interacted with negative life events to predict drinking and drug use in college students. Daily reports of drinking and drug use obtained using a daily web-based survey were combined with self-reports of past-year negative life events and 5-HTTLPR genotypes in a regression analysis of alcohol and nonprescribed drug use in a sample of 295 college students. Genotype and negative life events significantly interacted in relation to drinking and drug use outcomes. Individuals homozygous for the short (s) allele who experienced multiple negative life events in the prior year reported more frequent drinking and heavy drinking, stronger intentions to drink, and greater nonprescribed drug use. In individuals homozygous for the long (l) allele, drinking and drug use were unaffected by past-year negative life events. Heterozygous subjects showed drinking outcomes that were intermediate to the two homozygous groups. The 5-HTTLPR s-allele is associated with increased drinking and drug use among college students who have experienced multiple negative life events. The s-allele carriers may be at risk for a variety of adverse behavioral outcomes in response to stress.

Medicine Use by Finnish Female Conscripts during Voluntary Military Service

The goal was to assess the prevalence of prescribed and nonprescribed medicine use, use predictors, and origin of medicines for Finnish female conscripts during their voluntary military service. An anonymous mail survey was conducted in April 1999 among all Finnish female conscripts on duty. Of the respondents (N = 177; response rate, 68%), 61% had used at least one medicine in the 2 weeks preceding the study, 44% prescribed and 31% nonprescribed medicines. Most of the prescribed medicines were provided by Finnish Defence Forces health care, whereas most of the nonprescribed medicines were of civilian origin. The consumption of prescribed and nonprescribed medicines was differently related to respondents' background variables. Common overall medicine use and use of over-the-counter analgesics and stimulants and their association with potentially negative health behaviors may contribute to inappropriate medicine use. Finnish female conscripts commonly use prescribed and nonprescribed medicines. The importance of sufficient medication information for female conscripts is emphasized.

Nalbuphine (Nubain): Non-Prescribed Use, Injecting, and Risk Behaviors for Blood-Borne Viruses

Nalbuphine hydrochloride is a synthetic opiate with agonist-antagonist properties that has been prescribed for pain relief in several countries in North and Central America, Europe, and elsewhere. Marketed for several years under the tradename Nubain®, the drug was believed to have low potential for dependence. Research into nalbuphine misuse is limited but studies have documented misuse among some bodybuilders, weightlifters, and users of anabolic steroids. This study examines patterns of nalbuphine misuse and injecting behaviors that pose risk for blood-borne viruses among ten respondents residing largely in one community in Ireland. Contrary to other research findings, most individuals had no history of weightlifting and no experience with the use of anabolic steroids. Most of the respondents had injected nalbuphine several times per day, and reported frequent injection of stimulants. Tampered bottle caps had been observed by respondents who also reported that needles and syringes were scarce. At least some of the nalbuphine in the region has been found to be “counterfeit.” Implications of the findings are discussed.

Agreement between medical record documentation and patient-reported use of nonsteroidal antiinflammatory drugs

Nonsteroidal antiinflammatory drugs (NSAIDs), one of the most frequently prescribed medication classes in adult outpatient medicine,1 have the potential to cause substantial toxicity.2 The gastrointestinal,3,–5 cardiovascular,6,–8 and renal9,–12 complications associated with NSAID use have received considerable attention. It has been estimated that NSAID-induced gastrointestinal complications result in the death of over 16,000 patients each year.3 Patients frequently fail to report concomitant use of nonprescription and prescription NSAIDs to their physicians. Serious adverse reactions may occur when nonprescription NSAIDs are used alone or in combination with other medications.3,–13 Two national surveys found that 38% of respondents took prescription and nonprescription NSAIDs.13 Of those respondents, 60% of those taking nonprescription NSAIDs were unaware of the drugs’ risks and 30% believed that there was less risk associated with taking nonprescription NSAIDs. Methods to better ascertain patient nonprescription and prescription NSAID use may assist in the development of educational interventions and reduction of adverse reactions.13

The rise of Viagra among British illicit drug users: 5-year survey data

Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms.